In 2025, Overdose Response Strategy (ORS) teams in multiple states partnered with the Association of State and Territorial Health Officials (ASTHO) to strengthen overdose spike preparedness through the Overdose Spike Exercise-in-a-Box Toolkit pilot program. Selected as part of a five-state cohort, ORS teams collaborated with public health, public safety and behavioral health partners to plan and conduct tabletop exercises designed to improve coordination and response to overdose spikes.

In Delaware, the ORS team partnered with the Delaware Division of Public Health and the Division of Substance Abuse and Mental Health to prepare for and host a statewide spike response tabletop exercise. In July 2025, 25 leaders from key state agencies convened at the state fusion center for a four-hour facilitated workshop. The Delaware Public Health Analyst (PHA) guided participants through discussions on surveillance, alert triggers, partner notifications, response coordination, drug testing and external messaging. The exercise allowed partners to examine current practices, identify gaps and validate existing strengths, generating momentum for continued collaboration. Following the workshop, partners held follow-up meetings to address unresolved questions, and the Delaware ORS team shared lessons learned with ASTHO and the ORS Overdose Spike Response Learning Community.

In Mississippi, the ORS team and state partners participated in the pilot through a series of guided planning sessions and mock scenario exercises held from March through June 2025. The exercises brought together public health and safety partners to test a coordinated response to a mock local overdose spike, including complex challenges such as emerging drugs and cross-state coordination. The effort generated a key recommendation to develop an addendum to the state’s Comprehensive Emergency Management Plan outlining a coordinated statewide response to overdose spikes, helping formalize cross-agency collaboration and strengthen preparedness.


Pictured on the right are Sullivan County partners participating in the exercise.
Similarly, in Tennessee, the ORS team partnered with Sullivan County to conduct a large tabletop exercise using the toolkit in June 2025. The exercise convened more than 50 participants from a wide range of sectors and resulted in improvements to the local overdose response plan, new partnerships and data-sharing opportunities and identification of critical gaps to inform future planning.

Pictured from left to right are MD DIO Brent Kluttz, Lt. Chad Atkins, MD PHA Sabrina Gattine, Michelle Marshall, Jessica Ellis and Shawn Dennison.

In Maryland, the ORS team partnered with Frederick County to host a hybrid spike response tabletop exercise. The event brought together public libraries, community organizations, public safety, public health, hospitals and law enforcement—uniting all sectors of the community involved in addressing overdose at the same table. The group tested potential weak spots and identified previously unrecognized gaps. The group also worked to clarify the definition of an overdose spike in their jurisdiction and strengthen the chain of communication in the event of an overdose spike. After the exercise, Frederick County continues to meet and improve their spike response framework.

In Alaska, the ORS team partnered with the Alaska Division of Public Health (DPH) and the Overdose Data to Action (OD2A) team to host a statewide spike response tabletop exercise. The exercise aimed to strengthen existing preparedness efforts and test a draft statewide spike response protocol. In March and April 2025, the Alaska PHA and the DPH Spike Response Workgroup convened more than 22 representatives from public and behavioral health, public safety and Tribal public health. Participants engaged in a two-part exercise that walked through spike surveillance, notification and response using a realistic urban scenario. Through this effort, agency roles and communication channels were clarified, and the draft spike response protocol was further refined.

Together, these exercises demonstrate how the ASTHO/ORS Spike Response Toolkit supports states and local partners in strengthening preparedness, improving cross-sector coordination and developing more effective responses to emerging overdose threats.

Pictured from left to right are ORS partners and staff including NY PHA Lisa Worden, NY DIO Jim Hawley, ORS Technical Advisor Nava Bastola, HIDTA Deputy National Coordinator Chris Jakim and NY/NJ HIDTA Director Chauncey Parker, National Police Lt. Sonthor Prum (Cambodia), National Authority for Combatting Drugs Deputy Director Chumnith Meas (Cambodia), Ministry of Interior Captain Ali Majid Al-Jaberi (Iraq), Anti-Narcotics Department Lt. Col. Mu’ath Al-Dwaikat (Jordan), Anti-Narcotics Department Major Yazan Abu Alghanam (Jordan) and Hak-Qazar Public Foundation Chairman Nurzhan Zhakupov (Kazakhstan).

In 2025, the New York Overdose Response Strategy (ORS) team in partnership with ORS leadership played a central role in an international learning exchange that brought together 17 senior law enforcement and drug policy leaders from nine countries to explore coordinated approaches to overdose prevention. Syracuse University’s Department of Public Health hosted the U.S. Department of State sponsored Distinguished Humphrey Fellowship Program to Combat Illicit Drug Trafficking, the initiative aligned seamlessly with the ORS mission to strengthen collaboration between public health and public safety. The NY ORS team and ORS staff led a full day of sessions during the Executive Academic Seminar, sharing the ORS framework and highlighting initiatives such as the Overdose Detection Mapping Application Program (ODMAP), Domestic Highway Enforcement and the Rochester Police Department’s Leave-Behind Naloxone model. The day also included a presentation from an ORS partner who is an addiction medicine expert; the expert led a discussion on the physiology of addiction and a recovery-oriented system of care. The Distinguished Humphrey Fellows engaged deeply throughout the day and received guidance on policy development, adaptations for their home countries and approaches to integrating public health strategies within enforcement systems.

Building on the Executive Education Week discussions, the exchange continued with an immersive site visit to the NY/NJ HIDTA, where fellows observed meetings to coordinate gun violence prevention and response efforts, learned from cross-sector response teams and engaged with over 15 programs addressing drug trafficking, overdose prevention, community outreach and data-driven enforcement. Fellows expressed renewed commitment to building trust with communities, advancing compassionate response strategies and adopting data-informed strategies in their own countries. Reflecting the emphasis on compassion and cross-sector collaboration, one fellow noted, “It was an inspiring visit… What really touched me wasn’t just the knowledge that was shared, but the passion behind it. Every speaker had a story that reflected true dedication, sacrifice and deep care. Seeing agencies work hand in hand was incredibly powerful and gave me real hope. I will take what I’ve learned, share it in my country, and work to put it into action.” The NY ORS team and partners also gained valuable insight from the global perspectives of the fellows, reinforcing that sustainable progress depends on collaboration, compassion and measurable outcomes. By uniting international partners, the New York ORS team and ORS leadership strengthened cross-border relationships and demonstrated how the ORS model can inform global efforts to build coordinated, data-driven overdose prevention and response while bridging public safety and public health.

Pictured left to right are New England HIDTA Deputy Director Dave Kelley, Peer Recovery Coach Donald Rose, Sharece Sellem-Hannah, David Hannah, CT PHA Anna Gasinski, CT DIO Bobby Lawlor, New England HIDTA ORS Coordinator Jack Foster, URI Provost and Executive Vice President for Academic Affairs Barbara Wolfe, URI President Marc Parlange and RI PHA Tom Chadronet.

In November 2025, the Connecticut and Rhode Island Overdose Response Strategy (ORS) teams partnered with the University of Rhode Island (URI), New England HIDTA and filmmaker and community educator Sharece Sellem-Hannah to host a week-long storytelling residency designed to advance overdose prevention education among college-aged young adults. Held in recognition of the 30th Anniversary of the John Hazen White Sr. Center for Ethics and Public Service, the residency demonstrated how culturally grounded storytelling can deepen understanding of the overdose crisis and strengthen collaboration across public health, law enforcement and higher education.

Working closely with URI faculty and leadership, the CT and RI ORS teams developed a learning series that blended creative arts, ethics, research, public health and public safety. CT and RI ORS teams, alongside New England HIDTA leadership, jointly planned and delivered the residency, modeling the collaborative approach that defines the ORS network.

Across five days, ORS teams and partners engaged more than 500 students, faculty and community members through facilitation of classroom discussions, creative workshops, student forums and community panels. Students from criminal justice, theatre, film arts and related fields explored how data and lived experience inform one another, how creative expression can support community-based overdose prevention and how compassionate, non-judgmental communication reduces barriers to care. Engagement extended beyond the classroom as faculty and tribal leaders joined lunch and learn sessions on drug trends and prevention gaps. Students also led conversations that opened space for honest dialogue on race, trauma, substance-use misconceptions and access to care. These sessions surfaced opportunities for future curriculum development and campus-based prevention work.

The residency concluded with a screening of the Silence on the Streets documentary that drew more than 350 attendees and sparked student interest in continued engagement, volunteer opportunities and campus-based prevention initiatives. By pairing creative storytelling with public health strategy, the residency strengthened cross-state ORS collaboration, expanded university partnerships for long-term prevention work and advanced efforts to counter perceptions surrounding substance use.

Demonstrating how collaboration can turn funding into impactful action, South Dakota is expanding access to naloxone through innovative partnerships, resource investments and coordinated community engagement. Using opioid settlement funds, the Attorney General’s Office, the Department of Social Services and Emily’s Hope (a non-profit organization) acquired 20,000 naloxone kits. Emily’s Hope spearheaded the first statewide distribution effort, installing AED retrofits and newspaper-style naloxone distribution boxes to reach communities with the greatest need. With support from the South Dakota Overdose Response Strategy (ORS) team, who connected partners with local organizations to identify priority sites, 10,385 kits (20,770 doses) have been distributed and 28 naloxone boxes installed across the state, including six on tribal reservations.

The SD ORS team also identified an opportunity to expand naloxone access during the Sturgis Rally, the world’s largest annual motorcycle gathering with more than 500,000 attendees, marking the first time naloxone was distributed at the event. The ORS team convened planning meetings and coordinated logistics while strengthening community engagement through partnerships with security teams at high-traffic bars and by providing education and support to local organizations to address misinformation and engage businesses unfamiliar with naloxone. In partnership with Action for the Betterment of the Community (ABC) and Emily’s Hope, 461 naloxone kits were distributed through 47 participating businesses. Law enforcement partners received 50 kits for foot patrol teams, while a naloxone distribution box at the Sturgis Armory dispensed 182 kits during the event and 39 more once relocated to a local hospital. Three reported overdose reversals directly linked to naloxone access during the Rally highlighted the lifesaving impact of this work. Direct engagement with local businesses also surfaced valuable insight on the perspective and understanding of naloxone, helping shape future outreach strategies and highlighting the need for ongoing education and support among business owners who may be hesitant to engage.

Through sustained collaboration between public health agencies, community partners and law enforcement, South Dakota strengthened naloxone access statewide and built infrastructure that supports ongoing overdose prevention.

When a suspected opioid overdose case in southwest Virginia raised alarms about a potentially dangerous substance spreading across state lines, the Tennessee and Virginia Overdose Response Strategy (ORS) teams enabled rapid cross-state coordination that strengthened partnerships and sparked efforts to improve overdose response processes. In September 2025, emergency department staff at a community hospital in southwest Virginia discovered a small package containing a yellow powdery substance during treatment for a suspected opioid overdose. This substance closely resembled material connected to recent overdose spikes in West Virginia and Kentucky. Concerned the same substance could be circulating in Virginia, the hospital’s director of security reached out to Tennessee task force partners who contacted the TN Public Health Analyst (PHA). The TN PHA connected the hospital security with the Appalachia HIDTA team, who then also connected with Washington/Baltimore HIDTA and the Virginia Drug Intelligence Officer (DIO). This rapid cross-state chain of communication occurred in less than 30 minutes.

While the substance was not ultimately recovered for testing, the incident led to a new direct connection between the hospital and the Virginia DIO, highlighted areas to expand hospital and law enforcement communication protocols and initiated planning conversations around evidence-handling and information-sharing. This event demonstrated the value of the ORS network in enabling rapid cross-state coordination during an emerging threat, with the established task forces and the I-81 Work Group providing streamlined communication and response.

Youth substance use continues to be a key focus of public health efforts in Colorado, and prevention professionals across the state are working to create environments where young people can thrive. Recognizing the power of relationships in shaping youth wellbeing, Rocky Mountain High Intensity Drug Trafficking Area (HIDTA), A Division for Advancing Prevention & Treatment (ADAPT) and the Colorado Overdose Response Strategy (ORS) team co-hosted the Youth Prevention Institute—a two-day event focused on helping professionals activate relationships as a fundamental component of prevention and flourishing in youth.

The Colorado Public Health Analyst (PHA) and Drug Intelligence Officer (DIO) worked closely to identify and recruit youth-centered programs across the state, ensuring the event reflected a diverse range of voices and experiences. More than 120 participants attended the two-day event, including representatives from prevention, public health, law enforcement, corrections, education and youth from across the United States. During the event, participants engaged in interactive sessions, panels and trainings that explored how relationships can be leveraged to prevent mental and behavioral health risks and promote well-being. The Institute emphasized evidence-based strategies for building trust and connection—skills that participants could immediately apply within their communities.

Post-event surveys showed that 90 percent of attendees reported an increased understanding of the science behind relationships in prevention and youth wellbeing. 94 percent said they gained new knowledge of evidence-based strategies to foster connection, and 97 percent felt more confident in their ability to build connection with others.

The success of the Rocky Mountain HIDTA Youth Prevention Institute demonstrated what can happen when public health, prevention and public safety come together with a shared goal: to support young people through connection, understanding and community. By equipping professionals with the tools to build strong, protective beliefs through their relationships, the Colorado ORS team and ADAPT helped lay the foundation for healthier, more resilient youth across the state.

“The “Be in the Know” campaign—developed by the Pima County Health Department, law enforcement partners, the Arizona Overdose Response Strategy (ORS) team and university partners—was recently featured in the Drug Enforcement Administration (DEA)’s Views from the Field series for its innovative approach to overdose prevention and student engagement.

Launched at the University of Arizona in fall 2024, the campaign equips students with the knowledge and tools to prevent overdoses, including training on naloxone and awareness of the Good Samaritan law. In the campaign’s first semester, 75 student ambassadors were provided training to share information about the campaign as they led orientation tours for incoming students. Campaign information was shared with more than 11,000 students, 450 students received naloxone training, 160 naloxone kits were distributed to students to take home and 810 posters and QR code cards were shared across campus. Naloxone was also co-located at all 308 Automated External Defibrillator (AED) sites, making lifesaving resources more accessible throughout the university.

The Arizona ORS team played a key role from the initial implementation of the campaign, meeting with partners early in the process to shape the campaign’s direction and rollout. The Arizona Public Health Analyst (PHA) worked closely with the Pima County Health Department and the Counter Narcotics Alliance to sustain and expand the initiative by providing training to student orientation leaders, building relationships with student prevention organizations, assisting in campaign material design and participating in numerous tabling and training events. As the campaign entered its second year, the AZ ORS team and partners completed additional orientation activities in July and August 2025, training another 75 student ambassadors and distributing campaign materials to 9,000 incoming freshmen and transfer students. Nearly 440 students received prevention education and resources, 200 students participated in naloxone trainings and 36 naloxone kits were distributed to students to take home.

Building on this momentum, the Arizona ORS team partnered with law enforcement partners in Pima County to bring “Be in the Know” to additional campuses—further expanding the reach of this collaborative effort to promote awareness, preparedness and community safety.

Recognizing the importance of collaboration between public health and public safety, the four Overdose Response Strategy (ORS) teams in the Rocky Mountain High Intensity Drug Trafficking Area (RMHIDTA) region—Wyoming, Montana, Utah and Colorado—implemented annual Drug Information Opportunity Symposiums (DIOS). These annual events are designed to bring partners together to share information, highlight effective strategies and strengthen relationships that help prevent overdoses and respond to emerging threats.

Since 2021, the RMHIDTA ORS teams have hosted 15 DIOS events across the region. Each year, the teams build on one another’s efforts by sharing lessons learned, refining agendas and introducing new formats to strengthen engagement. This coordinated approach has improved facilitation, expanded reach and ensured that each symposium offers practical, actionable takeaways.

DIOS events feature expert speakers and sessions on prevention, treatment and recovery, policy and emerging drug trends. The events also highlight innovative state and local programs, connect participants with community resources and include interactive components such as panel discussions, open Q&A sessions and K-9 demonstrations that foster dialogue between public health and public safety. By rotating venues and offering virtual access, the teams have broadened participation across both rural and urban areas, attracting an average of 60–70 participants per event with a growing virtual audience.

Now in its fourth year as a coordinated four-state series, DIOS has become a cornerstone for regional partnership—strengthening relationships, increasing shared situational awareness and fostering new opportunities for joint initiatives. Participant feedback highlights improved understanding between sectors, and annual briefings from task force commanders have provided valuable insights that inform local policy and practice. Together, the RMHIDTA ORS teams are building a more connected and coordinated approach to preventing overdose and expanding partnerships across the Rocky Mountain region.

In July 2025, swift coordination between law enforcement and public health partners enabled Baltimore City to respond rapidly to a suspected mass casualty overdose event. The Maryland Overdose Response Strategy (ORS) Drug Intelligence Officer (DIO) was alerted by the Baltimore Police Department (BPD) to a suspected overdose event at the intersection of Pennsylvania Avenue and North Avenue. The MD DIO and a BPD Detective responded to the scene while the MD DIO also notified the Maryland Public Health Analyst (PHA), who quickly engaged the public health entities involved with overdose response in Baltimore City–ensuring a unified, multi-agency response.

At the scene, a BPD detective collected suspected controlled substance packaging from an overdose victim. The MD DIO and BPD detective then transported the sample to the Washington/Baltimore HIDTA office to conduct presumptive testing using the investigative support center (ISC)’s MX-908 device, which identified the presence of acetylfentanyl, an opioid analgesic drug that is an analog of fentanyl. Results were immediately shared with the BPD Major to guide law enforcement efforts, and the MD ORS team relayed the information to Baltimore City public health partners to inform ongoing prevention and response measures. The Maryland Overdose and Drug Awareness Coordinators were also notified, and the incident details were disseminated through the state’s communication network. The MD DIO provided real-time updates to promote situational awareness across agencies, while the MD PHA alerted surrounding ORS teams and two working groups that focus on overdose prevention along the I-81 and I-95 interstate highway corridors.

Within four to five hours, agencies identified the likely substance and mobilized a coordinated response–out of the 27 individuals who were hospitalized during this mass overdose event there were no fatalities. This demonstrates how rapid communication and cross-sector collaboration can protect lives and strengthen overdose prevention in Baltimore City.

The New York Overdose Response Strategy (ORS) team developed and piloted a Mock Overdose Fatality Review (OFR) Toolkit—a first-of-its-kind resource designed to help communities prepare for real OFRs through a hands-on, multidisciplinary tabletop exercise (TTX). This practice-based toolkit gives jurisdictions a safe, supportive environment to build capacity, strengthen cross-sector relationships and walk through the OFR process from start to finish.

 

Since 2024, the NY ORS team has piloted the toolkit in three counties—Oswego, Putnam and Essex—using participant feedback to refine and enhance the resource. Grounded in national OFR standards and emergency preparedness principles, the toolkit guides participants through a fictional but realistic overdose fatality case review, drawing on real-world trends and challenges to foster meaningful engagement. It is particularly suited for jurisdictions in the early stages of OFR planning, offering a structured yet low-pressure setting to practice case discussions, identify system gaps and develop actionable recommendations.

 

The Mock OFR Toolkit comes complete with a fictional case profile, communication templates, discipline-specific incident reports, role-based narratives and a detailed handbook covering every step—from assembling the planning team to conducting a post-exercise debrief. These ready-to-use materials not only help demystify the OFR process but also reduce anxieties about launching complex reviews by providing clear guidance and planning support.

 

Feedback from pilot counties has been overwhelmingly positive. Participants reported a stronger understanding of the OFR model, improved collaboration and greater confidence in leading real OFRs. Essex County OFR Planning Team shared, “The Mock OFR Toolkit has been invaluable, providing a structured guide that made the tabletop exercise real, impactful, and actionable. Thanks to ORS leadership, we are moving forward confidently toward our first official OFR.” Putnam County Suicide and OFR (SOFR) Planning Team echoed this sentiment, noting, “The OFR TTX empowered us to formalize this new process, and our partners are eager to participate in our first official fatality review.”  Moreover, Oswego County Public Health and Safety Team (PHAST) reported, “We worked with NYS ORS to conduct a Mock OFR for our OFR partners to experience how the process works before starting actual reviews.  The ORS team provided the scenario with case materials, with modeling based on local data.  Conducting the exercise helped to demonstrate to our partners the value of the review process.” This innovative toolkit is an important stepping stone for New York communities—helping them prepare effectively to review overdose deaths, strengthen prevention strategies and ultimately save lives.

 

For more news on the New York ORS team’s OFR efforts, read Supporting Rural Communities: New York ORS Team Assists in Developing an Overdose Fatality Review.