Colorado Opioid Crisis Response Blueprint

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ColoradoOpioid CrisisResponseBlueprintA Guide forOpioid SettlementInvestmentsMARCH 2020

Table of Contents3About the Colorado Health Institute3About the Colorado Consortium for Prescription Drug Abuse Prevention3Acknowledgments4Key Takeaways5What is this Guide?5What are the Opioid Litigation Settlements?6Strategies to Address the Opioid Epidemic8How to Use This Guide9Methods10Addressing the Opioid Crisis: Colorado's Recommended Approach11Findings by Area of ExpertiseHealth and Public Health ExpertsIntervention and Recovery ExpertsLocal and State Government OfficialsLaw Enforcement Professionals16Looking Ahead –– Colorado's Settlements16The Current State of Play16Policy 2 Colorado Health InstituteColorado Opioid Crisis Response Blueprint

MARCH 2020About the Colorado Health InstituteThe Colorado Health Institute, which produced this publication, is a nonprofit and independent health policy researchorganization that is a trusted source of objective health policy information, data, and analysis for the state’s health careleaders. The Colorado Health Institute is primarily funded by the Caring for Colorado Foundation, Rose CommunityFoundation, The Colorado Trust and the Colorado Health Foundation.About the Colorado Consortium for Prescription Drug Abuse PreventionThe Colorado Consortium for Prescription Drug Abuse Prevention helps coordinate Colorado’s statewide response tothe prescription drug abuse epidemic, focusing on the opioid crisis. The consortium works with stakeholders such asgovernment agencies, community groups, law enforcement, and the medical community. The consortium is part of theColorado Center for Prescription Drug Abuse Prevention in the University of Colorado Skaggs School of Pharmacy andPharmaceutical Sciences at the CU Anschutz Medical Campus.For further information visit corxconsortium.org or contact info@corxconsortium.org.AcknowledgmentsThis report is made possible by funding from TheColorado Health Foundation. Colorado Consortium for Prescription Drug AbusePrevention: Robert Valuck, PhD, RPh, DirectorSpecial thanks to Colorado’s experts from the followingorganizations who provided input to this report: José Esquibel, Associate Director of CommunityEngagement American College of Emergency Physicians Gina Olberding, Assistant Director Blueprint Steering Committee Participants: Lindsey Kato, Consultant, Health ManagementAssociates Matthew Baca, JD, MPA, Director, Office ofCommunity Engagement, Colorado Office of theAttorney General Elizabeth Brooks, PhD, Data and EvaluationDirector, Office of Behavioral Health, ColoradoDepartment of Human Services Wendy Buxton-Andrade, Commissioner, ProwersCounty, and Chair, Health & Human ServicesSteering Committee, Colorado Counties, Inc. Colorado Counties, Inc. Colorado Department of Human Services Colorado Family Resource Center Association Colorado Medical Society Colorado Municipal League Colorado Pain Society Colorado Pharmacists Society Amy Goodman, JD, MBE, Senior Policy Director,Colorado Medical Society Colorado Providers Association Laurel Witt, Staff Attorney, Colorado MunicipalLeague County Sheriffs of Colorado Donald Stader, MD, FACEP, President, ColoradoChapter of the American College of EmergencyPhysicians Emergency Medical Services Association of Colorado Colorado School of Public Health Crossroads Turning Points Harm Reduction Action Center Colorado Association of Local Public Health Officials(CALPHO) Region Six Alcohol and Drug Abuse (RESADA) Colorado Chiefs of Police Association Step Denver Sobriety House UCHealth County commissioners and administrators of LoganCounty, Montezuma County, and Prowers County Members of the recovery communityA Guide for Opioid Settlement InvestmentsColorado Health Institute3

Table of ContentsBetween 2000 and 2016, nearly5,000 Coloradans died due to anopioid overdose.1State leaders have created much of the infrastructureneeded to address the problem — including prevention,harm reduction, law enforcement services to addressthe opioid epidemic, and treatment and recoverysupports — but many communities lack the resourcesto deal with the magnitude of the challenge.To continue the fight against the opioid crisis,multiple states — including Colorado — sued drugmanufacturers and other companies and individualsthat contributed to the opioid epidemic. The firstsettlements in other opioid lawsuits around the countrywere announced in the spring and fall of 2019. WhileColorado’s lawsuit has not settled, there is reasonto believe that Colorado could receive settlementfunds. Depending on the specifics of the settlements,local communities and/or the Colorado Office of theAttorney General could have a measure of control overhow to spend settlement dollars.It is unlikely that settlement payments, even if largeamounts are received, can adequately cover thecosts of addressing all the negative impacts of theopioid crisis in communities. Policymakers will have toprioritize how they use the money. This guide can help.The Colorado Consortium for Prescription Drug AbusePrevention (Consortium) engaged the Colorado HealthInstitute (CHI) to help inform a spending strategy forstate and local policymakers who are expecting thesedollars. In partnership with the Consortium, ColoradoCounties Inc., the Colorado Municipal League, theColorado Medical Society, the Colorado Office of theAttorney General, the Colorado Chapter of the AmericanCollege of Emergency Physicians, the Colorado Office ofBehavioral Health, and other experts, CHI generated a“spending blueprint” on how to best address the opioidcrisis. Most items in the blueprint apply just as well toother substances, such as methamphetamines, as theydo to opioids.4 Colorado Health InstituteKey Takeaways Community leaders and policymakers want toplan now for putting anticipated settlementsfrom opioid lawsuits to the best use. Colorado’s opioid experts recommend usingthe largest portion of the opioid settlementmoney to expand treatment and recoveryefforts, particularly in rural areas. All communities are different. While thisblueprint provides a guide, investmentdecisions will need to consider issues rangingfrom local workforce capacity to sustainablefinancing.To make the blueprint, CHI and the Consortiumconvened a team of experts to identify a list of 20investment options under four categories: prevention,treatment and recovery, harm reduction, and criminaljustice. Experts working in law enforcement, clinicalcare, prevention, and other areas prioritized theseinvestment options in a survey asking how theywould allocate a hypothetical 100 million in opioidsettlement dollars.The results reveal that Colorado’s experts recommendprioritizing treatment and recovery services, followedby prevention, criminal justice, and finally harmreduction. That said, depending on their area ofexpertise, there was a range of preferences for the bestallocation of resources.This report details the findings of the survey.Colorado Opioid Crisis Response Blueprint

MARCH 2020What are the Opioid Litigation Settlements?Colorado’s lawsuit is a Colorado state court caseagainst opioid manufacturers and others. It seeksmonetary damages for harm caused to the Stateof Colorado and its citizens as a result of deceptivemarketing of opioids. If there is a settlement ofColorado’s case, funds will be available to addressthe opioid epidemic.The National Prescription Opiate MultidistrictLitigation consists of more than 2,000 federalcourt cases brought by counties, cities, tribes,and individuals against chain pharmacies andmanufacturers and distributors of prescribed opioids.The defendants are accused of exacerbating theopioid crisis by misrepresenting the risks of long-termuse of those drugs, aggressively marketing them, andfailing to prevent suspicious shipments of prescriptionopioids. A negotiating class has been formed toprovide a method for all counties and municipalitiesin the United States to join the litigation and receivefunds from settlements, as long as at least 75 percentof six different categories of local governments agreeto global settlement terms.3Settlement funds received by the state, andseparately by Colorado cities and counties, presentan opportunity to address the opioid crisis at thelocal level. While this blueprint provides one guidefor communities as they consider strategies toimplement locally, other state-level and nationalA Guide for Opioid Settlement InvestmentsWhat is this Guide?This guide, or “blueprint,” is a tool to help decisionmakers at municipal, county, and state levelsallocate the opioid settlement dollars received.Other community members — including lawenforcement, health care providers, communitycoalition members, educators, and public healthofficials — may also use this framework to assesstheir community’s available resources and gaps inaddressing drug abuse and addiction.resources exist. For example: Bringing Science to Bear on Opioids provides anaccount of current evidence-based approaches toaddressing the opioid crisis.4 The President’s Commission on CombattingAddiction and the Opioid Crisis summarizes theresults of a federal commission tasked with makingrecommendations to state and federal policymakerson how to address the addiction crisis.5For Colorado-specific strategies that are alignedwith national strategies, see Prescription DrugAbuse Prevention: A Colorado CommunityReference.6Colorado Health Institute5

Strategies to Address theOpioid EpidemicThe blueprint draws on a survey that asked expertsto prioritize 20 potential investments they could maketo address the opioid epidemic.7 The investments areorganized into four domains: prevention, treatmentand recovery, harm reduction, and criminal justice.In the survey, Colorado experts were asked how theywould allocate a hypothetical 100 million over fiveyears to address the opioid epidemic. Local decisionmakers can use this table to apply the same concept totheir hypothetical share of a settlement.Decision-makers can use the tool below as theyconsider what programs already exist in theircommunities and what gaps remain. See page 8 formore on how to use this guide.PREVENTIONInsert YourAllocation HereDeveloping Colorado’s Prescription Drug Monitoring Program toimprove usability and increase utilization via electronic healthrecords or other methods Workforce training and funding to implement evidence-basedsecondary prevention approaches that identify and intervene withproblematic use, abuse, and dependence on substances Trainings for practitioners on non-opioid pain treatments, nonaddictive chronic pain therapies, and guidelines for opioidprescribing best practices CommunityDevelopmentFunding for community development, schools, child care, familyservices, and job training to combat drug use PrimaryPreventionEvidence-based primary prevention programs and strategies,including family and youth programming, to promote protectivefactors and reduce risk factors, as well as adult educationprograms and public communications campaigns Expand universal drug take-back programs to allow drugs tobe returned to any pharmacy on any day and distribute securecontainers for prescription drugs Prescription DrugMonitoring Program(PDMP)Screening, BriefIntervention, and Referralto Treatment (SBIRT)ProviderEducationDrug Take Backand StorageCRIMINAL JUSTICELaw EnforcementCommunityCorrectionsJail-BasedAddiction TreatmentPost-IncarcerationSocial Programs6 Colorado Health InstituteInsert YourAllocation HereIncreased funding and training for local police, drug task forces,and interdiction efforts Developing or expanding drug or family courts and other prearraignment or law enforcement diversion programs Expansion of addiction treatment in jails and prisons Programs for reintegrating people recovering from substance usedisorders into communities following incarceration Colorado Opioid Crisis Response Blueprint

MARCH 2020TREATMENT AND RECOVERYSubstance Use DisorderTreatment ExpansionRecoverySupportsRural/Frontierand UnderservedTreatment ProgramsResearch andEvaluationInsert YourAllocation HereExpansion of the full spectrum of substance use disorder treatment:detox, inpatient/residential and outpatient treatment, andmedication-assisted treatmentDeveloping programs to improve access to housing and health care(other than for substance use disorders); employment opportunitiesand job training; community-based services, including peer supportsand other resources aimed at promoting recoveryExpand treatment options in rural, frontier, and underserved areas,including mobile programs and telehealth/telemedicine programsFunding for research into treatment outcomes, evaluation ofprogram effectiveness, and the impact of policy interventions inColorado HARM REDUCTIONOverdoseSurveillanceHIV And HepatitisTreatmentOverdose-Reversal rt YourAllocation HereDrug death and nonfatal overdose surveillance, including fundingfor law enforcement, medical examiners, and coroners to improveaccuracy and timeliness of autopsy drug-testing Screening, early detection, vaccines, and treatment for HIV,hepatitis, and other medical issues occurring among people whoinject drugs Increased naloxone distribution and training Production and distribution of testing strips for fentanyl and otheradulterants, and other drug-checking services Establishing, running, and expanding existing syringe exchangeprograms, including syringe disposal Support services for children and families affected by substanceuse disorders, including training for professionals such as teachers,law enforcement, and others A Guide for Opioid Settlement InvestmentsColorado Health Institute7

How to Use This GuideThis blueprint is a tool for local and state policymakers. The process requiresthree steps — prioritize your community’s needs, compare them with the blueprint,and identify next steps to address the needs.STEP ONE: Prioritize your community’s needs.Use the survey (see pages 6-7) to gather community input on needs and resources.Questions for consideration: What’s working well that needs to be scaled up? Which populations (by age, race/ethnicity, language spoken, etc.) are most inneed of these services? What outcomes are we interested in achieving? What are the priorities of the community members? What resources are already available for each investment domain?STEP TWO: Use the blueprint.Check your community’s prioritized needs and resources against the blueprint(see pages 10-15).Questions for consideration: How do our priorities line up with the results of the blueprint? Which subgroup priorities are most important in our community (e.g., lawenforcement, health care professionals, others)? Which strategies are we already addressing with our community’s resources? Which are we not?STEP THREE: Identify next steps.Based on your community’s needs and the blueprint’s guidance, decide whichstrategies are best-suited for additional investment.Questions for consideration: Which agencies have the capacity to spend the dollars? How much time do we have to deliver the programs and strategies? What will we need to implement the selected programs and strategies in termsof training and costs? Who will lead this work?8 Colorado Health Institute

MARCH 2020MethodsTo prepare the survey, the Consortium and CHI “Colorado-ized” a 2018 New York Times survey thatasked experts how they would allocate 100,000,000 to fund 20 investment options in prevention,treatment and recovery, harm reduction, and criminal justice to address the opioid epidemic.8Staff of the Consortium conferred with Daniel Ciccarone, MD, of the University of California Schoolof Medicine, and Josh Katz, a journalist with The New York Times, about the questions used in thesurvey and received permission to use and adapt the questions. Additionally, the survey included awrite-in portion, in which experts could allocate funding toward an area not already mentioned.CHI gathered and analyzed 24 responses via email from a group of experts identified in partnershipwith the Consortium. The respondents represented four general professional groups:Health and Public Health: Health care, prevention, public health, educationIntervention and Recovery: Substance Use Disorder (SUD) treatment, SUD recovery, harmreduction, behavioral healthLocal and State Government: Elected officials and local and state government employeesrepresenting various departments and agenciesLaw Enforcement: Law enforcement professionalsCHI and the Consortium convened the experts who completed the survey and facilitated adiscussion using the Delphi method to adjust initial findings. The Delphi method aggregatesexperts’ opinions through a series of questions and discussions, with the goal of coming to a groupconsensus. Experts reviewed and adjusted their own set of priorities based on the collective expertiseof the group.9 Following the application of the Delphi method, the results were adjusted to reflect therevised priorities of the experts.Colorado Health Institute9

Addressing the Opioid Crisis:Colorado’s Recommended ApproachColorado’s opioid experts identified treatment andrecovery (41.3 percent) as the most urgent areas ofinvestment to address the opioid crisis. They devotedless to prevention (21.8 percent) and criminal justicestrategies (21.7 percent). Respondents allocatedthe least amount to harm reduction strategies (14.2percent).Each box represents a potential investment area, suchas naloxone expansion or primary prevention. Thesize and color intensity correspond to the share ofproposed spending.There was substantial agreement among the groupto allocate the most funding towards treatment andrecovery. Within this domain, substance use disordertreatment expansion (18.1 percent) was heavilyemphasized, with recovery supports (10.4 percent) anda focus on rural/frontier programs (9.6 percent) almostequally considered as the second priority.Although given the option to write in investmentsuggestions, most experts surveyed did not add to thelist — suggesting that this list is a comprehensive viewof the options available. Experts allocated only onepercent of their potential investment to other strategiesnot listed below.The percentages of funding allocated to theinvestment domains and items is an average, asexperts’ opinions differed in a few of the domains.Below, the results are illustrated in a series of charts.Figure 1: Aggregate Survey Results18.1%10.4%6.6%7.1%6.3%4.2%Substance Use DisorderTreatment sCommunityCorrectionsn Treatment and Recovery (41.3 percent)n Prevention (21.8 percent)n Criminal Justice (21.7 percent)n Harm Reduction (14.2 percent)n Other (1.0 percent)10 Colorado Health eening, BriefIntervention, andReferral to ngeExchangesOverdoseSurveillance1.8%1.2%2.7%HIV andHepatitisTreatmentNaloxoneDrug Take Back andStorageOtherLaw Enforcement1.0%Rural/Frontierand UnderservedTreatment ProgramsResearch Evaluation3.6%DrugChecking9.6%3.2%4.0%n Treatment and Recovery (41.3 percent)n Prevention (21.8 percent)n Criminal Justice (21.7 percent)n Harm Reduction (14.2 percent)n Other (1.0 percent)Colorado Opioid Crisis Response Blueprint

MARCH 2020Findings by Area of ExpertiseTo address the unique needs of their community, local decision-makersshould consider the priorities and perspectives of different groups ofexperts. Figure 2 illustrates the blueprint survey results by area of expertise.Most groups identified treatment and recovery as their top priority and gavethe least allocation to harm reduction. The exception was respondentsidentifying as law enforcement professionals. Those individuals allocatedless funding to treatment and recovery (31.8 percent) than the three othergroups and more to criminal justice (34.5 percent).Two groups ranked prevention as the second highest funding priority, butthe other two prioritized criminal justice over prevention.Harm reduction scored lowestamong all groups. Experts mayprioritize treatment and recoveryover other strategies becausethose services and supportsgenerally cost more and thereforeneed additional resources.On the following pages, fourgraphics illustrate the results fromeach of the four expert groups.Though there was agreementacross the groups to prioritizetreatment and recovery or criminaljustice, some groups emphasizeddifferent strategies. Thosevariations are highlighted in eachgraphic.Figure 2: Funding Allocated by Area of %Health andPublic Health45.5%44.2%41.3%31.8%Interventionand RecoveryLocal andState Gov.LawEnforcementAggregaten Treatment and Recovery n Preventionn Criminal Justice n Harm Reduction n Other*Due to rounding, percentages may not sum to 100 percent.A Guide for Opioid Settlement InvestmentsColorado Health Institute11

Health and Public Health ExpertsFigure 3: Funding Allocation from Health and Public Health Experts9.5%Substance Use DisorderTreatment ExpansionRural/Frontier portsResearch Evaluationn Treatment and Recovery (36.9 percent)n Prevention (27.7 percent)n Criminal Justice (21.0 percent)n Harm Reduction (14.2 percent)n Other (0.3 tionJail-Based PostAddiction IncarcerationTreatment ngProgram(PDMP)CommunityDevelopmentScreening, BriefIntervention, andReferral to ons3.3%Law oseSurveillanceDrug Take Back andStorage2.4%SyringeExchanges1.9%HIV andHepatitisTreatment0.8%DrugCheckingPOINTS OF INTEREST AMONGHEALTH AND PUBLIC HEALTHEXPERTSCHI found that responses of health care andpublic health professionals were consistent with Prescription Drug Monitoring Programsthose of the overall group. That said, this grouprecommended investing more in the Prescription Provider EducationDrug Monitoring Program (PDMP) with 4.7percent of the allocation. They emphasized thatlinking drug prescribing to electronic healthrecords is critical to addressing the epidemic, and that Colorado is far fromhaving a statewide system in place.During the Delphi discussion, this group of experts also recommendedtraining allied professionals on reducing access to opioids, such as theinvestment of funds to promote best practices in opioid prescribing amongveterinarians and trainings for employers. In addition, other members of thisgroup recommended training employers on best practices for preventionthrough workplace health promotion programs and to meet the needs ofworkers prone to injury and prescription drug use.12 Colorado Health InstituteColorado Opioid Crisis Response Blueprint

MARCH 2020Intervention and Recovery ExpertsIntervention and recovery professionals and advocates prioritized treatmentand recovery — services that directly affect their work –– with 45.5 percent of theallocation. The group also allocated the least to harm reduction, though theydirected as many resources to syringe exchanges (2.4 percent) as most othergroups. Meeting participants felt that syringe exchanges were helpful in thedowntown areas of large cities but less so in rural areas with sparse populations.Several respondents wanted to improve the quality of facilities. For instance, onerespondent put 14 million toward renovating and purchasing facilities for treatmentservices. Another respondent recommended 8 million to support those who don’tqualify for Medicaid to obtain treatment and housing assistance.Figure 4: Funding Allocation from Intervention and Recovery Experts20.0%11.9%6.6%7.2%5.2%3.9%Substance Use DisorderTreatment sCommunityCorrectionsn Treatment and Recovery (45.5 percent)n Prevention (19.9 percent)n Criminal Justice (19.5 percent)n Harm Reduction (13.4percent)n Other (1.8 percent)Research .8%2.4%Community Screening, BriefDevelopment Intervention,and Referral toTreatment (SBIRT)1.6%Drug Take Backand Storage3.2%Law gesOverdoseSurveillance2.7%Naloxone1.7%1.0%HIV and Hepatitis DrugCheckingTreatmentOtherRural/Frontierand UnderservedTreatment TS OF INTEREST AMONGINTERVENTION AND RECOVERYEXPERTS Treatment and Recovery Syringe ExchangesA Guide for Opioid Settlement InvestmentsColorado Health Institute13

Local and State Government OfficialsFigure 5: Funding Allocation from Local and State Government Officials25.0%12.8%10.0%4.8%2.8%2.5%Substance Use DisorderTreatment ExpansionRecoverySupportsLaw ntion,and Referralto nSocial Programs6.3%Rural/Frontier and UnderservedTreatment k seSurveillance0.2% Research and HIV and HepatitisTreatmentn Treatment and Recovery (44.2 percent)n Prevention (17.8 percent)n Criminal Justice (23.7 percent)n Harm Reduction (14.4 percent)n Other (0.0 percent)Compared with other groups, local and state governmentofficials invested more in substance use disorder treatmentexpansion (25.0 percent). They also recommended investingmore in family support (6.6 percent) in the harm reductiondomain than any other group. Respondents in this groupalso allocated significant funding to law enforcement (10.0percent) — the same amount allocated by law enforcementprofessionals themselves.This group also noted several benefits of allocating moredollars toward overdose surveillance. Withgreater surveillance, policymakers couldtarget areas of need rather than producinga nontargeted response that is less costeffective.POINTS OF INTERESTAMONG LOCAL AND STATEGOVERNMENT OFFICIALS Family Support SUD Treatment Expansion Law Enforcement Overdose Surveillance14 Colorado Health InstituteColorado Opioid Crisis Response Blueprint

MARCH 2020Law Enforcement ProfessionalsLaw enforcement professionals allocated more funding toward criminaljustice (34.5 percent) than other groups. Members of this group alsoallocated less than a quarter of the amount of funding to substance usedisorder treatment expansion compared with other respondents. Othergroups devoted around 20 percent of funds to that strategy, while this groupallocated 4.3 percent.Compared with other groups, law enforcement professionals devoted moreto rural/frontier and underserved treatment programs (15.3 percent).Meeting participants noted that the group’s strong emphasis on rural/frontierprograms was possibly due to the high costs of building the infrastructure inrural and frontier counties to address treatment needs.Figure 6: Funding Allocation from Law Enforcement Professionals10.0%8.8%15.3%4.3%3.0%3.0%Law ier and UnderservedTreatment akeBack andStorage3.0%2.5%2.0%Prescription DrugMonitoring tyCorrectionsPost-IncarcerationSocial Programs9.3%RecoverySupports4.3%SubstanceUse DisorderTreatmentExpansion2.8%2.6%NaloxoneHIV and ly SupportSyringeExchanges3.0%3.0%Research andEvaluationn Treatment and Recovery (31.8 percent)n Prevention (17.8 percent)n Criminal Justice (34.5 percent)n Harm Reduction (16.0 percent)n Other (0.0 percent)3.0%DrugCheckingPOINTS OF INTEREST AMONGLAW ENFORCEMENTPROFESSIONALS Criminal Justice SUD Treatment Expansion Rural/Frontier and UnderservedTreatment ProgramsA Guide for Opioid Settlement InvestmentsColorado Health Institute15

Looking Ahead ––Colorado’s SettlementsAs state and local decision-makers anticipate potentialsettlement dollars, they should consider differentmechanisms to fund, allocate, and leverage thesefunds. Several examples are described below:Competitive fundingCompetitive funding is a process of proposal selectionbased on the evaluation of a team of reviewers.Noncompetitive funding allocation tocommunitiesIn contrast to competitive funding, this form of funding isgiven to predetermined recipients based on population, theseverity of the local drug problem, or other census criteria,as well as government-to-government transfer of funds.Pay for Success ContractsThese contracts are an innovative approach toimproving outcomes and reducing costs to government.A pool of government funds are leveraged to secureupfront capital from private investors to implementservices aimed at achieving specific outcomes.If outcomes are met, investors receive performancebased payments and a portion of savings togovernment.Matching FundsFunds are provided by the government, foundations, orother sources by matching the community contributionto a project. For instance, private foundations couldmatch community settlement funds to leverage andsupport the blueprint’s strategies.The Current State of PlayAt the time of publication, no opioid settlementshave been finalized. It is not known how much moneyColorado can expect from opioid settlements or whensettlement funds may be received.Any settlement negotiated by the Colorado AttorneyGeneral’s Office will benefit the entire state.Colorado local governments, cities, and counties canalso follow the National Prescription

"spending blueprint" on how to best address the opioid crisis. Most items in the blueprint apply just as well to other substances, such as methamphetamines, as they do to opioids. To make the blueprint, CHI and the Consortium convened a team of experts to identify a list of 20 investment options under four categories: prevention,

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