The School Training Overdose Preparedness and Intelligence Taskforce (STOP-IT), sponsored by the Arizona Department of Education (ADE), is working to standardize opioid overdose prevention and response in Arizona schools. Without standard policies in place, many schools either lack access to naloxone or follow inconsistent guidelines for its storage, administration and training.

According to the Arizona Child Fatality Review Program, at least 80 children under the age of 18 died from an opioid overdose between 2021 and 2022, including seven middle school-aged children (ages 11–14) and up to four deaths across all age ranges occurred in school settings.¹ Between 2020 and 2022, Arizona’s youth mortality rate was nearly twice the national average.² In 2023, an additional 27 children and adolescents in Arizona died from fentanyl poisoning.¹ Recognizing the urgency of this crisis, the Arizona High Intensity Drug Trafficking Area (HIDTA) Public Health/Public Safety (PH/PS) initiative—comprised of members from the AZ HIDTA, the AZ Drug Demand Reduction Outreach (DDRO) program and the AZ ORS team—took action.

To ensure naloxone access in all schools, the AZ Drug Intelligence Officer (DIO) chaired the STOP-IT Campaign Naloxone Procurement Board and led efforts to secure 16,200 naloxone kits, enough to supply every school, including charter and tribal schools, at no cost. The AZ Public Health Analyst (PHA) also supported this effort as a member of the Procurement Subcommittee. The first success came when the Arizona Attorney General’s Office provided an initial supply of naloxone for community distribution. As soon as the shipment arrived, doses were delivered to ADE to ensure all schools in need had immediate access. However, this supply was insufficient to cover the entire state.

Recognizing the need for wider distribution, the AZ DIO and partners determined that 16,200 kits were required to meet demand across all Arizona schools. Working alongside ADE, the team submitted a formal request to the Arizona Department of Health Services (ADHS). Through interagency collaboration, leaders agreed that expanding naloxone access was critical, and ADHS approved the full request, ensuring statewide distribution at no cost to schools. The AZ National Guard’s DDRO program then facilitated distribution, ensuring naloxone reached schools in all 15 counties, including tribal communities.

Beyond naloxone distribution, STOP-IT developed a resource toolkit and a standardized training curriculum, now available statewide at no cost. Through these collaborative efforts, the AZ ORS team, AZ HIDTA and its partners have significantly expanded naloxone access in schools, creating more lifesaving opportunities and empowering communities to combat the overdose epidemic.

Lalani, K., Anderson, M., Newberry, S., Rimsza, M. E., Garlington, T., Glidden, M., & Celaya, M. F. (2024). Arizona Child Fatality Review Team: Thirty-first annual report. Arizona Department of Health Services. Https://www.azdhs.gov/documents/prevention/womens-childrens-health/reports-fact-sheets/child-fatality-review-annual-reports/cfr-annual-report-2024.pdf Friedman, J., & Hadland, S. E. (2024). The overdose crisis among U.S. adolescents. New England Journal of Medicine, 390(2), 97–100. https://doi.org/10.1056/NEJMp2312084

The South Dakota Overdose Response Strategy (ORS) team has made significant progress in expanding access to the Overdose Detection Mapping Application Program (ODMAP) and improving data quality through strong collaboration at local and state levels. Before 2022, ODMAP participation in South Dakota was limited to just three local agencies and two state agencies. Today, 61 agencies—including 43 law enforcement departments, six emergency medical service agencies, four hospital organizations with emergency departments, two post-overdose response teams and a Coroner/Forensic Examiner—have signed up for ODMAP.

 

In three South Dakota counties—Pennington, Minnehaha and Roberts—multi-sector partnerships have enabled agencies to integrate their data, creating a more comprehensive view of overdose trends. For instance, Project Recovery, a post-overdose response team operating in western South Dakota, previously faced barriers with data-sharing and referrals. By collaborating with the South Dakota Fusion Center, a statewide public safety intelligence agency, the Fusion Center now receives real-time alerts when law enforcement in Pennington County responds to an overdose. Through the shared ODMAP platform, both agencies can securely exchange basic victim information and coordinate follow-up care. The SD ORS team strengthened data-sharing efforts by fostering key partnerships and collaboration. The ORS team facilitated meetings with the Fusion Center, helped Project Recovery secure ODMAP access through the Department of Social Services and led discussions on data-sharing. These efforts ultimately gained law enforcement approval and reinforced multi-sector cooperation at state and local levels. Since this partnership began, follow-up referrals have increased by 63.6 percent.

 

The SD ORS team has also fostered strong relationships with tribal communities, working to integrate ODMAP as a tool for overdose prevention and response. On the Lake Traverse Reservation, home to the Sisseton Wahpeton Oyate Tribe, first responders and treatment professionals now meet quarterly with the ORS team to review and input cases into ODMAP. In 2024, the system captured a full year of data for the first time, providing a more accurate and complete picture of overdose trends. Given that the Reservation spans seven counties across both North and South Dakota, ODMAP has proven especially valuable in identifying cross-county and cross-state overdose patterns.

 

Further strengthening these efforts, the SD ORS team is collaborating with the Department of Tribal Relations and the South Dakota Tribal Law Enforcement Liaison to develop an ODMAP training video specifically designed for tribal communities. This initiative aims to enhance awareness and ensure effective use of ODMAP as a resource for overdose prevention and response across South Dakota.

 

“…Through the work underway with the [South Dakota] ORS team, Tribal Leadership has been and is able to alert the community about current and emerging threats when there are documented emergency response clusters. First responders in Roberts County, where most of the fatal overdoses have occurred, participated this past year and we look forward to expanding in the future to include first responders from other counties that share geography with the Lake Traverse Reservation.”

• Sara DeCoteau, Sisseton Wahpeton Oyate (SWO) Project Director for the Tribal Opioid Response (TOR) grant

 

“The Fusion Center is our top post-overdose program referral partner, comprising 63.6% of all referrals to date. Since January 2025 alone, the Fusion Center has referred 10 individuals to our program. This collaboration is an actionable step toward reducing overdose deaths by rapidly linking at-risk individuals with life-saving, evidence-based addiction treatment and [compassionate response] resources.”

• Kendra Joswiak, South Dakota Clinical Practice Director

Clinton County, a rural community in New York State, facilitated the implementation of an Overdose Fatality Review (OFR) to strengthen its overdose prevention efforts. OFRs are invaluable tools to identify systemic gaps, foster collaboration among partners and develop actionable strategies to prevent future overdoses. However, in a close-knit community with a relatively low number of overdose fatalities, privacy concerns and the absence of state-specific OFR legislation present implementation challenges.

To address these issues and support Clinton County’s efforts, the New York Overdose Response Strategy (ORS) team partnered with the Institute for Intergovernmental Research (IIR) to identify peer communities in rural areas that have successfully implemented OFRs without state legislation. The session was carefully designed to address Clinton County’s unique context. In August 2024, the New York ORS team hosted the OFR Q&A Session, featuring presentations from peer mentors and contributions from the ORS OFR Technical Advisor and IIR Senior Research Associate. The session was attended by more than 15 Clinton County partners, who actively participated in the discussions.
High Intensity Drug Trafficking Area (HIDTA) staff supporting the NY ORS team at the North Country Crime Analysis Center have also played a key role in Clinton County’s OFR planning efforts, engaging local law enforcement and leveraging data to inform planned case reviews. These efforts reflect the county’s commitment to building a collaborative OFR process tailored to their community’s needs.

Following the session, Clinton County determined that a county-specific approach to OFR implementation would be the most effective strategy. A small working group has since met multiple times to discuss logistics and plan a follow-up meeting with a broad group of community partners. These meetings are effective in sharing lessons learned, gathering input and laying the groundwork for establishing the county’s OFR team. Clinton County also expressed interest in participating in IIR’s peer mentoring program and applied for an opportunity to attend an in-person session at one of the OFR Peer Mentor Sites featured during the Q&A session. Their application was successful, and they will collaborate with two communities in Wisconsin, with a site visit planned for fall 2025. Through strategic partnerships, customized technical assistance and ongoing support, the NY ORS team has helped guide Clinton County from exploration to action, laying the foundation for a community-driven OFR process.

ORS teams play an important role in fostering collaboration among partners. The California (Los Angeles/Riverside) Overdose Response Strategy (ORS) team exemplifies this role by actively listening to the needs of different programs and organizations and identifying partnership opportunities. By connecting resources and organizations, the California (Los Angeles/Riverside) ORS team has consistently helped avoid duplicating efforts and maximize the impact of shared goals amongst their community partners from 2021 to 2024. The following examples highlight how the ORS team connected organizations, facilitated collaboration and ensured valuable resources and expertise were shared to fill gaps and strengthen the impact of overdose prevention initiatives.


End Overdose and Bell Gardens Police Department Naloxone Training Community Event
Since 2022, the California (Los Angeles/Riverside) ORS team has worked closely with End Overdose, a non-profit organization focused on overdose prevention, to improve naloxone accessibility and education. End Overdose sought a public safety partner for a National Association of County and City Health Officials (NACCHO) grant aimed at providing naloxone training to students, staff and parents in high schools, with a special focus on expanding into the community. During a meeting between the ORS team and the Chief of the Bell Gardens Police Department (BGPD), the Chief highlighted gaps in naloxone distribution within the local community. In response, the ORS team facilitated a partnership between End Overdose and the BGPD. The BGPD Neighborhood Watch Coordinator co-hosted a community event with End Overdose, where naloxone training was conducted. The event attracted over 90 participants, who received naloxone training, and facilitated the distribution of more than 50 naloxone kits.

Naloxone Training for Riverside Community Law Enforcement
In 2024, Riverside community organizations raised concerns about law enforcement interactions with people with substance use disorder (SUD). To help address these concerns and support law enforcement, the ORS team received approval to conduct naloxone training with Riverside County Law Enforcement. In collaboration with Health Management Associates (HMA), the ORS team co-hosted an evidence-based training focused on naloxone education and addiction science for law enforcement. Conducted virtually through the Los Angeles Regional Criminal Information Clearinghouse (LA CLEAR), the sessions included live virtual participation and covered key topics, including: overdose landscape in the four-county area, neurochemistry and addiction science, Good Samaritan Laws and standing order and compassion fatigue and naloxone education. These sessions are designed to be shared with sergeants across various police departments to support comprehensive all-staff training in early 2025.


Collaboration with California Department of Public Health (CDPH)
The ORS team’s new health partner, CDPH, expressed interest in understanding data trends and pulling reports using the Overdose Detection Mapping Application Program (ODMAP). The ORS team facilitated a meeting with CDPH, other California ORS partners and the Washington/ Baltimore High Intensity Drug Trafficking Area (W/B HIDTA) ODMAP Coordinator to explore alternative options for using ODMAP data, as its surveillance capabilities are limited. This collaboration helped CDPH better navigate data analysis tools for more informed decision-making.

The North Florida Overdose Response Strategy (ORS) team partnered in June 2024 with Drug Free Duval, the Jacksonville Transportation Authority (JTA) and the Community Coalition Alliance (CCA) to launch “Safety on the Move,” a Northeast Florida region initiative. This innovative program addresses the opioid crisis through targeted interventions, lifesaving training and strategic collaboration.

“Safety on the Move” provides free overdose prevention and response training, naloxone kits, medication disposal bags and community resources to at-risk communities. Leveraging data from ODMAP, the North Florida ORS team identifies areas with the highest overdose rates or recent spikes, enabling the strategic placement of buses to maximize outreach and impact.

The initiative has strengthened local partnerships, increased community awareness and preparedness, reduced stigma around overdose response and saved lives. “Safety on the Move” demonstrates how data-driven, collaborative efforts can effectively address the opioid crisis and foster community resilience.

The North Carolina Overdose Response Strategy (ORS) team, in collaboration with community leaders, worked to introduce naloxone into the Wake County School System—the largest in North Carolina, serving approximately 160,000 students across 208 schools—to inspire other school districts to follow suit.

After extensive discussions to secure administrative approval, the school administration agreed to place naloxone in all schools, including elementary, middle and high schools. The Wake County School Board approved the plan, ensuring naloxone would be available district wide. As of 2024, 103 schools have trained staff and are equipped with naloxone, with the remaining 105 schools scheduled to complete training and receive naloxone by February 2025. The NC ORS team partnered with the mayor, an influential advocate, to train and supply naloxone to two local high schools in Apex. Upon learning that the decision to implement naloxone rested with the Wake County School Board rather than individual schools, the mayor engaged school board members and persistently advocated for the initiative.

Throughout the process, the NC ORS team served as subject matter experts, providing evidence on the benefits of naloxone in schools and addressing questions and concerns from stakeholders. They maintained ongoing communication with the mayor, who played a key role in keeping the initiative on the school board’s agenda.

This collaborative effort highlights the impact of partnerships between public health experts and community leaders in advancing overdose prevention and response initiatives within educational settings.

Incorporating a population health lens is crucial to understand community needs, address disparities and develop effective overdose prevention and response strategies. To better inform outreach and overdose response efforts, the Kansas Overdose Response Strategy (ORS) team integrated socioeconomic indicators and resource data into the Overdose Detection Mapping Application Program (ODMAP) and Overdose Fatality Review (OFR) mapping tools by developing demographic layers. The OFR Tool enables users to visualize the proximity of these resources to overdose locations and generate infographics that highlight key socioeconomic data. This functionality has become integral to the OFR process in Reno County, KS, allowing the OFR review board to better understand overdose outcomes and make more informed recommendations for improving community health.

When the Illinois ORS team sought to address community needs and highlight disparities through enhanced data visualization, the team partnered with the KS PHA to adapt that work for IL by launching new mapping overlays. The Illinois ORS team trained partners across the state to utilize six new updates and two new layers on ODMAP, including a naloxone saturation layer initially piloted in Chicago. With support from the Kansas PHA, the IL ORS team also added several additional layers to their data toolkit, such as locations of lodging facilities, gas stations, shelters, apartments and substance use and mental health services. These updates were shared through webinars for state partners, virtual presentations, in-person trainings and highlighted at the Illinois Prevention Summit, reaching 130 decision-makers across the state. Furthermore, the Illinois ORS team intends to launch a Data Academy with partners across the state where persons with lived experience will be trained to use these data overlays to share their community’s story and guide their community’s decision-making and prioritization efforts to reduce health gaps. This initiative will elevate populations of focus to use data effectively, guiding community decisions and improving outcomes.

In New York State, law enforcement agencies often face challenges accessing information and resources to support leave-behind naloxone implementation. While several pathways exist for obtaining naloxone, there is no centralized platform for registration or comprehensive guidance to navigate these options. In response, the NY Overdose Response Strategy (ORS) team collaborated with a partner from Albany Medical College to deliver an informational session on leave-behind naloxone programs.

The session provided guidance and enhanced coordination for agencies interested in initiating these programs. The NYS Division of Criminal Justice Services distributed the invitation statewide, resulting in a response from over 150 law enforcement representatives and more than 100 participants. The session included an overview of the ORS program, strategies being implemented in New York and actionable steps for starting leave-behind naloxone initiatives. As a result, the NY ORS team developed a comprehensive Leave-Behind Naloxone Toolkit to support law enforcement agencies. The toolkit included an outline of program benefits and steps to secure naloxone at no cost through local organizations supplied by the NYS Department of Health, a standard operating procedure, sample roll call training and a quick reference card for officers. These materials were disseminated to session participants, along with a follow-up survey for agencies interested in receiving technical support for implementing leave-behind naloxone programs. Approximately 20 law enforcement agencies have requested technical assistance from the NY ORS team, which continues to provide individualized support.


The NY ORS team also collaborated with ORS technical advisors to host a national brainstorming session on best practices for overdose education and naloxone distribution. Insights from this session, coupled with evidence-based research, were used to develop a new resource guide entitled “Eight Best Practices for Quality Public Safety Leave Behind Naloxone Programs”. The findings will be used to refine the toolkit, develop new resources, enhance coordination and expand effective leave-behind naloxone programs across New York State.

In 2022, the Black/African American population in North Dakota made up approximately 3.8% of the state’s population, according to U.S. Census data.¹ However, from January to August 2024, preliminary data revealed that 10.61% of the state’s drug overdose fatalities occurred among the Black population in the state according to data collected through the ND Violent Death Reporting Program.² This statistic highlights a need for targeted outreach and prevention efforts within these communities. To address this disparity, the North Dakota Public Health Analyst (PHA) contacted organizers of the 2nd Annual Juneteenth celebration in Bismarck, ND to be part of the community outreach event. Leveraging her experience in compassionate response, the ND PHA worked directly with community members to build trust and raise awareness about drug overdose prevention. The ND PHA distributed business cards and QR codes linking to the Department of Health and Human Services (DHHS) website, which may have contributed to an increase in naloxone orders (individual requests rose from 13 during the month of July 2023 to 134 during the month of July 2024). As a result, 29 boxes of naloxone were distributed, and live demonstrations on naloxone administration were provided to interested individuals. In addition, the PHA shared resources on substance use disorder treatment and support services available in North Dakota. During the event, community members offered valuable insights into areas outside Bismarck where additional naloxone distribution and educational outreach could have a significant impact. This event also marked the rollout of a new QR code created by the DHHS, a project initiated by the ND Overdose Response Strategy (ORS) team. The event garnered media attention, with local news broadcasts and live streams on social media featuring the outreach effort, increasing the reach of the ORS in the community. This successful initiative not only increased access to life-saving resources but also strengthened relationships within the community, laying the groundwork for future prevention efforts.



1. U.S. Census Bureau. (n.d.). QuickFacts North Dakota. U.S. Department of Commerce. Retrieved October 2024, from https://www.census.gov/quickfacts/table/PST045216/38

2. Drug Overdose Death Report. (October 10, 2024). ND Violent Death Reporting Program. Department of Health and Human Services—Public Health.

Overdose Detection Mapping Application Program (ODMAP) agencies can benefit from tools that enhance data use and incorporate a population health lens in decision-making. To support this work, the Kansas Overdose Response Strategy (ORS) team created a new demographics layer in ArcGIS Online, Esri’s web-based mapping software. This layer, which became an embedded ODMAP layer, includes additional data, such as socioeconomic indicators, to better inform outreach, education and response plans.

 

With this demographics layer, organizations can identify the language resources needed in specific areas, pinpoint communities at higher risk of overdose and recognize prevalent types of trauma. To further assist stakeholders, the KS ORS team created 16 additional layers which became the Overdose Fatality Review (OFR) Tool, covering data including but not limited to lodging facilities, schools, correctional facilities, pharmacies and more. Combined, these layers help users identify overdose spike locations and target naloxone distribution more efficiently.

In July 2024, the KS Public Health Analyst (PHA) attended the Esri User Conference in San Diego, California, where he received the Special Achievement in GIS Award. This award, given by Esri leadership, recognizes his impactful work in aiding community responses to the opioid epidemic through the development of GIS tools.

The Kansas PHA’s contributions, along with those of other awardees, have set new standards in the GIS community.