In the absence of an opioid overdose-specific appropriation, NCIPC proactively dedicated $6 million through our injury prevention activity line, which we use for cross cutting and emerging topics. Boost for State Prevention (Prevention Boost) was an initiative where CDC’s Injury Center equipped five of the hardest hit states – Kentucky, Oklahoma, Tennessee, Utah, and West Virginia – with resources and scientific assistance to prevent prescription drug overdoses. This work focused in three key areas: (1) maximizing the use of prescription drug monitoring programs (PDMPs); (2) improving public insurance mechanisms to protect patients; and (3) evaluating policies to identify prevention that works.

CDC’s Injury Center was appropriated $20 million to address the opioid crisis. Through a competitive application process, we selected 16 states to receive funds through the Prevention for States program. Participating states began executing and evaluating prevention strategies to improve safe prescribing practices and prevent prescription drug overuse, misuse, abuse, and overdose.

Congress appropriated $75.6 million to CDC for opioid overdose activities. CDC allocated $70 million of appropriated funds to opioid overdose prevention activities under two programs. CDC’s Overdose Prevention for States (PfS) program added 13 states in 2016, funding 29 state health departments. CDC launched the Data-Driven Prevention Initiative (DDPI), supporting 13 states and Washington, DC. DDPI was meant to support states with less capacity and/or a lower burden to help them build their capabilities to engage in a more robust response. The main difference between the PfS and DDPI programs was level of capacity of the states and funding.

These programs equipped states with tools to respond to the opioid overdose crisis. Activities included enhancing prescription drug monitoring programs (PDMP) and leveraging them as public health tools, improving health system and insurer practices for safer opioid prescribing, and evaluating policies that may impact the opioid crisis (e.g., naloxone distribution, Good Samaritan laws).

Of the $75.6 million appropriated by Congress in 2016, CDC dedicated $5.6 million to launch a surveillance program for opioid overdoses, Enhanced State Opioid Overdose Surveillance (ESOOS). ESOOS funded 12 states to continue to address the rising rate of overdoses attributable to opioids, including a specific focus on heroin and synthetic opioids such as illicitly manufactured fentanyl.

CDC received $125.4 million in appropriated funding to address the overdose crisis through prevention and surveillance programming, an increase from $75.6 million. The increase allowed CDC to scale its ESOOS surveillance program from 12 to 32 states and Washington, DC, and gave supplemental funding to support medical examiners and coroners for toxicology testing. Over $88 million of all appropriated overdose funds were awarded to state health departments for prevention activities.

With additional funding, CDC invested nearly $245 million in states – almost tripling their support. Forty-four states and the District of Columbia continued to maximize the use of PDMPs, improve data collection and analysis, and expand surveillance of opioid overdoses, while also improving linkage to care and collaboration with public safety partners.

CDC launched a Notice of Funding Opportunity, Overdose Data to Action (OD2A), which built on previous surveillance and prevention programs to foster an interdisciplinary, comprehensive, and cohesive public health approach to the complex and changing nature of the drug overdose crisis. Funded recipients were required to expand surveillance data collection to include all drug overdose deaths. OD2A jurisdictions translate this data into action through prevention programs. Some examples of prevention program activities include strengthening prescription drug monitoring programs (PDMPs), improving partnerships between state and local health departments and organizations, and establishing programs for linking people to care and treatment.

The COVID-19 pandemic greatly impacted programs dedicated to drug overdose surveillance and prevention. Funded jurisdictions faced multiple priorities and had to determine when and where to divert time and resources to address COVID-19 in their communities. CDC provided flexibilities in funding requirements where possible to support recipients’ abilities to address the multiple demands faced during the pandemic.

CDC’s congressional appropriations language was expanded to include prevention activities that address stimulants, such as cocaine and methamphetamine, in addition to opioids. Additionally, CDC announced that overdose funding could be used to purchase rapid fentanyl test strips (FTS) in an effort to help curb the dramatic spike in drug overdose deaths largely driven by the use of strong synthetic opioids, including illicitly manufactured fentanyl.

CDC expanded support for harm reduction activities, including the allowance of purchasing naloxone with CDC funding by states and localities in the final year of the Overdose Data to Action (OD2A) funding period. OD2A’s initial three-year funding was extended by one year to accommodate needs and delays caused by the COVID-19 pandemic. In preparation for the next five-year period of funding, CDC announced two new funding opportunities, Overdose Data to Action in States (OD2A-S) and Overdose Data to Action: Limiting Overdose through Collaborative Actions in Localities (OD2A: LOCAL). For additional information, please see Overdose Data to Action.