NACo's Opioid Solutions Center empowers local leaders to invest resources in effective treatment, recovery, prevention and harm reduction practices that save lives and address the underlying causes of substance use disorder.

Counties are on the frontline of the opioid epidemic, providing public services that save lives and support recovery. Our 911 call centers and county-run crisis lines are the first to receive calls for help when an overdose happens. Our first responders, and increasingly mental health clinicians, are the first to arrive on the scene to stabilize the crisis and offer support. Our local crisis triage centers serve as safe places before, during and after a behavioral health crisis to access services, treatment and immediate and ongoing care.

Funding from the national opioid settlements presents an opportunity for counties to sustain and strengthen our response to the ongoing opioid epidemic. To help counties maximize the impact of this unique funding stream, NACo is developing custom planning, implementation and peer learning resources through the Opioid Solutions Center.

Strategy Briefs

The national opioid settlement agreements include parameters for how funds can be spent. To help counties assess and prioritize the various types of eligible expenditures, NACo is summarizing the evidence behind a subset of opioid abatement strategies that are high impact and under county authority. 

adult in therapy session

Comprehensive Services for People With Co-Occurring Disorders: A NACo Opioid Solutions Strategy Brief

Co-occurring disorders are any combination of mental or substance use disorders (SUDs) that affect someone at the same time. People who live with co-occurring disorders, including post-traumatic stress disorder, anxiety, depression, bi-polar disorder and ADHD, are at greater risk of developing opioid use disorder (OUD). Similarly, people with OUD are at greater risk of developing co-occurring disorders.

Physician at desk looking at computer talking on phone

Linkage to Care Across County Systems: A NACo Opioid Solutions Strategy Brief

Counties operate and fund systems of service that regularly interface with people affected by substance use, such as hospitals, jails, courts and community colleges. As the owners and operators of these systems, counties are well positioned to link community members with evidence-based options for care, especially medications for opioid use disorder.

Doctor in plain clothes discussing document with patient

Warm Hand-Offs: A NACo Opioid Solutions Strategy Brief

A warm hand-off is a form of referral to treatment or other services. A typical referral gives someone information about how to reach the services they need but may leave them to contact those services on their own. In contrast, a warm hand-off is a transfer of care between service providers through face-to-face, phone or video interaction in the presence of the person being helped.

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Syringe Services Programs: A NACo Opioid Solutions Strategy Brief

Syringe Services Programs (SSPs) provide low-barrier access to sterile supplies for safer substance use, naloxone and overdose prevention tools like fentanyl test strips and drug checking services.

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Effective Treatment for Opioid Use Disorder for Incarcerated Populations

Medication-assisted treatment is considered the “gold standard” of care for opioid use disorder (OUD). The FDA has approved three medications for treating OUD: methadone, buprenorphine and naltrexone.

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Treatment and Recovery for Pregnant and Parenting People

During pregnancy, the evidence-based standard of care for opioid use disorder (OUD) is treatment with methadone or buprenorphine. 

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Naloxone to Reverse Opioid Overdose

Naloxone is a “rescue” drug that quickly and safely reverses opioid overdose. It is available as an injectable solution and as a nasal spray. Naloxone works by blocking the effects of opioids in the body. Virtually all opioid overdose deaths are preventable if naloxone is administered in time.

Quick Guides

The Principles for the Use of Funds From the Opioid Litigation are nationally recognized guidance for states, counties and cities receiving opioid settlement funds. These resources serve as a quick reference to help counties operationalize the Principles in our administration of opioid settlement funds.  

individuals at white board

The Principles Quick Guide to Removing Policy Barriers

After decades of research into effective interventions for opioid use disorder, there are now many evidence-based solutions to the prevention, treatment, recovery, and reduction of harms associated with opioid use. For an evidence-based program to produce the intended results, it may first be necessary to remove laws and regulations that interfere with proper implementation of the program. By conducting a policy review, county leaders can proactively identify and amend policies that may otherwise limit the impact of opioid settlement investments.

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The Principles Quick Guide to Creating a Settlement Council

The Principles for the Use of Funds From the Opioid Litigation are nationally recognized guidance for states, counties and cities receiving money from the lawsuits against entities that contributed to the opioid epidemic.

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The Principles Quick Guide to Conducting a Needs Assessment

The Principles for the Use of Funds From the Opioid Litigation are nationally recognized guidance for states, counties and cities receiving money from the lawsuits against entities that contributed to the opioid epidemic.

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Advancing Health Equity Through County Opioid Abatement Strategies

To support counties with utilizing opioid settlement funds to advance health equity, NACo developed case studies on five counties that are integrating opioid settlement funds into ongoing health equity initiatives. This resource details steps taken by these counties during the first year of opioid settlement payments and considerations for counties in other jurisdictions.

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Opioids: How Settlement Dollars Advance City and County Opioid Abatement

Building on a strong history of collaboration, including the National City-County Task Force on Opioids, NACo and the National League of Cities examined preliminary data on the distribution of opioid settlement dollars across cities, counties and states. This brief highlights how cities and counties are working together to abate the overdose crisis, including pooling opioid settlement funds to create a more comprehensive system of care for people with substance use disorder. 


Counties in Action

Counties are working commendably to ensure that opioid settlement funds make the greatest possible difference in our communities. These examples provide a snapshot of how counties prepared to receive and administer funds from this novel funding source. 

Featured News

Tony McDowell (right), executive director, Virginia Opioid Abatement Authority, speaks to Stephen Acquario, executive director, New York State Association of Counties and Gina Nikkel, executive director, Association of Oregon Counties Jan. 10 in Washington, D.C.  Photo by Charlie Ban
County News

Opioid fight gets resources, faces pitfalls after settlement

Counties are receiving a sizable amount of money from the national opioids settlement, but the needs generated by the crisis continue to grow.

Travis Landry, regional vice president of WestCare Wisconsin,Inc. speaks about treatment services in Milwaukee County, Wis. Photo by Jennifer Anderson
County News

Family response is key to treating opioid disorders

Milwaukee County, Wis. is taking steps to make sure those resources are as close to the people who need them as possible, including strategic placing of harm-reduction vending machines in historically underinvested neighborhoods.

Dr. Branch speaking to an audience

County Officials Discuss Harm Reduction as a Path Forward through the Overdose Epidemic

At NACo’s 2023 Legislative Conference, county officials discussed harm reduction as a path forward through the opioid epidemic. Three participants in NACo’s Opioid Solutions Leadership Network served as panelists at the workshop. 

Press Release

Counties Form National Network of Opioid Settlement Decision Makers

30 counties selected to represent county excellence in opioid settlement implementation

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Program Contact

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Samantha Karon

Senior Program Manager – Substance Use Disorder