Prevention

One of SAFE Project's goals is to support communities in breaking down silos by fostering greater collaboration between the numerous fields of work engaged in addressing the impacts of overdose and substance use. If you have not already, please read more about the importance of integration across the Continuum of Care and prioritizing outcomes in community work before delving into this overview.

The field of prevention emphasizes factors that contribute to one's overall health and wellbeing, aiming to promote health development and prevent problems before they occur. It is a multidisciplinary field developing strategies that prevent or reduce occurance, severity, or negative outcomes of disease, substance use, violence, injury, and mental illness. Prevention strategies can be addressed at various levels - individual, family, and community.

The prevention strategies on this platform are streamlined and organized into four primary clusters. Prevention strategies mirror the economics of supply and demand. The last two clusters are explicitly focused on the role of the medical system and law enforcement in disrupting the supply. The second cluster of articles is more oriented to the demand side of the equation — changing individual perceptions on drug use, peer relationships, family norms, and the role of the school system.

The Field of Prevention Science

The first cluster is focused on the field of prevention science. It includes the following strategies:

• "Addressing Risk and Protective Factors for Individuals, Families, and Communities" and provides examples of the two functions of prevention science — reducing risk factors and enhancing protective factors. It also covers the Socio-Ecological Model, SPF, and the National Prevention Strategy.
• "Expand Positive Recreation Opportunities" contextualizes prevention science within the behavioral health work on health and wellbeing.
• "Integrate Substance Use Prevention with Mental Health Services" unpacks co-occurring mental health and substance use disorders. The current partitioning of behavioral health care misses the interaction between substance use medication (and self-medication) related to stress management and depression.
• "Become a Trauma-Informed Community" addresses definitions of trauma and root causes, such as Adverse Childhood Experiences (ACES). It also links to social determinants of health, and it scales to the services that a trauma-informed community needs to offer and to how systems such as the school system can be more proactive in building community resilience.

Focus on Youth and Families

The second set of strategies take a deeper look at four domains of the socio-ecological ecosystem of prevention — individual youth, peers, family, and schools. It is important to note that an intentional balance is needed between efforts in all four of these domains and the broader policy domain in which these four are embedded. Early prevention strategies overemphasized education, placing the onus of burden on the individual ("Just say no"). Current prevention strategies are shifting emphasis to include more environmental strategies. It includes the following strategies:

• "Prevent First Time Use Through Education" covers the effectiveness of different types of prevention education and addresses the need to move away from fear-based tactics and toward increased emphasis on trauma and stress management.
• "Expand and Improve Support for Youth Outreach and Leadership" addresses the linkage between providing basic information and changing perception of harm by creating positive behavioral choices at the earliest age possible. It also addresses opportunities for youth leadership to offset peer pressure.
• "Empower Parents" highlights the magnitude of influence which parents have in youth perceptions and behavior. It addresses their role in engagement within the school system and the need for parents to support both prevention and recovery.
• "Educate Parents on the Risks of Prescription and Non-Prescription Drugs" covers the signs and implications of youth substance use.
• "Expand School-Based Prevention Programs" points out the power of the school system within prevention strategies. Schools are a primary point of contact to youth and have proven success in public health initiatives associated with safety and disease prevention.

Focus on Medical & Pharmaceutical Systems

The third set of strategies address the role of the medical community in reducing the supply of drugs, and includes articles on patient education, medical training, chronic pain management alternatives, and Prescription Drug Monitoring Programs (PDMPs). These strategies are as follows:

• "Reduce Over-Prescription of Prescription Drugs" documents the two-fold benefit of reducing both the number of excess pills, which could reach illicit circulation and the number of people who are at risk as a result of receiving prescriptions. It outlines four strategies to achieve this — each of which is covered in detail in separate following strategies.
• "Educate Patients on the Risks of Prescription and Non-Prescription Drugs" lists specific educational topics doctors can promote and risk factors for physicians to keep in mind when prescribing opioids. It also addresses procedures for screening and referral.
• "Improve Professional Training on Opioids and Alternative Pain Management Approaches" highlights a range of topics, which are gaps in current medical training. These include an awareness of chronic pain management and alternatives, risk factors for opioid dependency, dosage options, and patient communication skills that could lead to lower prescription use.
• "Expand and Enhance Chronic Pain Prevention and Management" documents the large number of Americans who have chronic pain and the dilemma which the medical community faces in reducing pain without increasing opioid use disorder. It shares methods to concurrently decrease prescription rates and increase alternatives for chronic pain management.
• "Increase Access to Non-Pharma Therapies" promotes public support for increased medical use of nonpharmacologic pain care and for a restructuring of insurance reimbursement standards.
• "Improve Prescribing Practices" targets the regulation of advertising, corporate influence, and the structure of Medicaid and U.S. insurance standards.
• "Expand and Enhance Prescription Drug Monitoring Programs (PDMPs)" outlines the benefits and challenges of PDMPs and provides a review of successful initiatives and funding sources.

Focus on Disrupting the Supply

The final prevention cluster is focused on strategies to disrupt supply. The sequence of strategies begins with law enforcement, expands to collaboration between law enforcement and medical professionals, and closes with community-wide participation in coalition campaigns. It includes the following:

• "Disrupt the Supply of Illegal Drugs" identifies the collaboration that needs to occur between law enforcement in local jurisdictions and federal agencies and within the international arena. It identifies historical reactivity and inconsistencies in supply disruption and points to developments reflective of more effective strategies.
• "Reduce Criminal Diversion of Prescription Drugs" covers the illegal distribution or use of prescription drugs. This strategy addresses the intersection of guidance from law enforcement and best practices within the medical community in detecting criminal diversion.
• "Expand Prescription Drug Take-Back and Disposal Programs" broadens participation in drug diversion strategies and builds upon strategies for law enforcement and medical professionals to include local businesses, citizens, and members of coalitions engaged in education campaigns. This strategy focuses (a) take-backs and drop boxes which involve law enforcement, (b) safe storage, which involves doctors and pharmacists, and (c ) disposal options, which involve coalition outreach to nursing homes, hospices, funeral homes, and the community at-large.