Strengthening Partnerships to Prevent Overdose: Key Actions in a Multi-State Learning Collaborative

June 29, 2026 | Clint Grant

The United States continues to face a severe and evolving overdose crisis, underscoring the need for comprehensive overdose prevention strategies. While overdose deaths have declined in recent years, the number of annual deaths remains higher than pre-pandemic levels. These trends highlight persistent gaps in prevention, treatment access, and long-term recovery support. Evidence-based interventions, including naloxone distribution and medications for opioid use disorder (MOUD), reduce overdose risk and support recovery.

Addressing the complexity of the overdose epidemic benefits from robust multisector partnerships and strong gubernatorial leadership to align priorities across public health, health care, law enforcement, and community-based organizations. States that have made progress in reducing overdose deaths often leverage cross-sector collaboration to expand access to naloxone and MOUD, integrate behavioral health with primary care, and strengthen data-sharing systems to inform timely interventions. Governors play a pivotal role in advancing these efforts by setting policy agendas, mobilizing flexible funding, and fostering interagency coordination. Coordinated state-level action grounded in partnership, leadership, and access to prevention and treatment services remains critical to reversing overdose trends and building resilient systems of care.

Recognizing the need to move from evidence to implementation, with funding from CDC, ASTHO, the National Governors Association (NGA) Center, and Safe States Alliance established the Strengthening Partnerships to Prevent Overdose Learning Collaborative — designed to help states translate shared priorities into coordinated action.

The Learning Collaborative

ASTHO, the NGA Center, and the Safe States Alliance launched the learning collaborative in 2025 as a structured, cross-sector initiative. This partnership brought together a select cohort of states to advance state-specific policy and programmatic responses to the overdose crisis. By combining technical expertise, gubernatorial engagement, and public health capacity, the learning collaborative supported states in moving from awareness to action. When selecting participants, it prioritized states with a high overdose burden, a demonstrated readiness for cross-agency collaboration, and clear alignment with the learning collaborative’s focus areas.

The learning collaborative was intentionally designed to foster cross-sector collaboration by engaging a diverse group of state leaders representing public health, behavioral health, human services, public safety, criminal justice, emergency management, data and performance infrastructure, and executive leadership. Five states were selected to participate in the 2025 cohort – Illinois, Indiana, Mississippi, Ohio, and Washington – each bringing a distinct profile of need, infrastructure, and leadership commitment. While all five states faced significant overdose burden, they varied in their primary focus areas, the depth of Governor's office engagement, and their existing policy and programmatic landscape. Together, participating agencies offered a comparative lens on how states at various stages of response could learn from one another and adapt shared strategies to their local contexts:

Illinois

• Illinois Department of Human Services
• Illinois Department of Public Health

Indiana

• Indiana Department of Health
• Indiana Criminal Justice Institute
• Indiana Family and Social Services Administration
• Indiana Judicial Branch Office of Behavioral Health
• Indiana Department of Homeland Security
• Indiana Management Performance Hub

Mississippi

• Mississippi State Department of Health

Ohio

• Office of Ohio Governor Mike DeWine
• Ohio Department of Behavioral Health

Washington

• Office of Governor Bob Ferguson
• Washington State Health Care Authority
• Washington State Department of Health

ASTHO, the NGA Center, and Safe States worked with the learning collaborative cohort to create or enhance their state overdose response action plan through a structured planning process. These plans are accountability tools, providing measurable outcomes and laying the groundwork for durable impact and sustainability.

While each state’s action plan reflected its unique priorities and context, several common themes emerged, including identifying evidence-based strategies that improve outcomes, securing sustainable funding, developing recommendations for state leadership, and advancing administrative and implementation priorities. However, all states acknowledged that leadership transitions, shifting state priorities, and an evolving federal landscape could significantly influence implementation and long-term sustainability.

State Innovations Across Key Action Areas

Each state entered the learning collaborative with existing programs and policies targeting overdose prevention across four key action areas: naloxone access, MOUD expansion, suicide prevention integration, and sustainable funding. While many of these initiatives predated the learning collaborative, states leveraged peer-to-peer learning, cross-sector partnerships, and technical assistance to refresh or accelerate these strategies within their action plans.

Naloxone Access

Expanding naloxone access remains one of the most effective strategies for reducing overdose mortality. CDC identifies naloxone distribution as a cornerstone of overdose prevention, with community-based programs consistently demonstrating reductions in fatal overdoses when the medication is widely available. To be effective, naloxone distribution strategies should be data-informed and strategically targeted, to reach high-risk populations.

Several states moved beyond general distribution toward more targeted, data-driven deployment:

• Ohio launched Project DAWN (Deaths Avoided with Naloxone), a tool that utilizes saturation mapping to identify gaps in coverage and optimize placement.
• Mississippi complemented distribution efforts with Rapid Alert Reports to notify communities of overdose spikes and advanced legislation that expanded naloxone distribution to community-based organizations and other high-risk opioid overdose touchpoints.
• Illinois focused on addressing institutional stigma as a barrier to naloxone access, particularly within health care and public safety settings. These efforts emphasized the normalization of naloxone as a standard practice of care.
• Washington has enhanced access to naloxone by partnering with the Peoples Harm Reduction Alliance to establish a free statewide mail order system for naloxone. This method of distribution has proven to be effective at increasing access in tribal communities in particular.

Several states also noted the importance of tracking reach and impact, the normalization of naloxone as routine public health practice, and the need for sustainable funding streams to support naloxone.

Expanding Access to MOUD

Medications for opioid use disorder are the standard of care for treating opioid use disorder, yet access remains inconsistent across states, communities, and care settings. Addressing these gaps requires coordination between public health, public safety, and health care systems to ensure access to evidence-based treatment and recovery support, particularly in carceral settings. In addition, CDC has identified expanding MOUD access as a key overdose prevention strategy and a promising practice.

Learning collaborative participants are currently focused on expanding MOUD access across clinical, emergency, and correctional settings:

• Indiana advanced its Recovery-Oriented Access to Medication model alongside a jail-based incentive program to increase uptake among incarcerated populations.
• Washington reduced barriers to MOUD by expanding telehealth access, mobile treatment services, and emergency department initiation of buprenorphine. They have also produced standard of care guidelines on MOUD and Medications for Alcohol Use Disorder in jails. In addition, Washington launched a new resource library to support providers and emergency medical services in prescribing and administering MOUD.
• Illinois scaled up its Medication Assisted Recovery Now telehealth-based model, designed to rapidly connect individuals to treatment supports.
• Mississippi increased access to evidence-based MOUD through implementation of the Medications for Substance Use Disorders telehealth-based treatment program across the Mississippi State Department of Health’s network of county health departments in 80 of 82 counties. It established opioid education and naloxone distribution, buprenorphine initiation, and linkage to care programs in emergency departments.
• Ohio created the Ohio Jail Safety and Security Program to support capital improvements to its jails and prioritize proposals seeking to improve mental health treatment.

Several states noted the need to support rural access by expanding the scope of practice for emergency medical services to support MOUD initiation and expand access within correctional facilities and community settings.

Intersection of Suicide and Overdose

States are increasingly recognizing that certain prevention strategies can address overdose and suicide, as both share common risk factors such as trauma, mental health conditions, and social isolation.

Several states explored approaches to bridging both areas:

• Indiana advanced a three-pillar crisis response system designed to integrate behavioral health, emergency response, and follow-up care.
• Ohio is empowering local communities through the development of artificial intelligence tools. One such tool assists Ohioans, unfamiliar with industry jargon, in locating possible behavioral health providers to meet their needs. The anticipated launch of this new resource is June 2026. In addition, the RecoveryOhio Overdose Early Warning Dashboard helps communities target resources by forecasting drug poisonings by ZIP code and provides the latest information on the illicit drug supply by county.
• Washington has adapted elements of the Icelandic Prevention Model to support youth and tribal communities, with an emphasis on protective factors and community connection.
• Mississippi convened a multisector Suicide Prevention Workgroup and published the Mississippi Suicide Prevention Plan, which recognizes the importance of stigma reduction and substance use disorder treatment availability.

Common themes included strengthening resource alignment with the 988 Suicide and Crisis Lifeline, lifting up personal narratives as a means for increasing understanding, and embedding community design principles in prevention and recovery strategies.

Sustainable Funding

Sustaining overdose prevention efforts requires financing models that align incentives and remain stable through shifting federal and state funding landscapes. This can include tapping non-traditional funding sources to enhance current efforts and utilizing a flexible funding strategy (e.g., braiding, blending, and layering). With states receiving opioid settlement funds well into the next decade, many states are creating new infrastructure and collaboration points to ensure funds are used strategically and sustainably.

States demonstrated a range of approaches to building more sustainable financing structures:

• Ohio recently employed a value-based funding model for grantees that is allowing them to scale their Mobile Response & Stabilization Services from 30 to 50 counties.
• Indiana established an opioid settlement fund set aside that local communities can access for primary prevention activities in their community. 
• Illinois implemented a fund separation strategy through the Build, Amplify, Support, Empower program to ensure prevention dollars were protected. They also partnered with the CDC Foundation to enhance staffing capacity.
• Washington is in the process of transitioning MOUD in jails programming as part of the Medicaid Transformation Reentry Demonstration Initiative. This has opened up a sustainable federal funding stream to cover health care services, including MOUD.

Across states, key themes included the need for strategic use of opioid settlement funds, planning for funding uncertainty, and communicating the return on investment of prevention to funders, policymakers, and the community.

Conclusion

Meaningful progress in overdose prevention is possible when executive leadership, cross-sector partnerships, and evidence-based strategies are aligned. By embedding overdose prevention into policy agendas, formalizing accountability structures across agencies, and protecting dedicated funding streams amid a shifting federal landscape, states can build the foundation for long-term success.

Reviewed by Alison Maffey, MSW, Vice President, Social and Behavioral Health.