Overdose Spike Preparedness Exercise Tabletop in a Box

March 12, 2026

The Overdose Spike Tabletop in a Box resource is intended to assist state and local jurisdictions to plan and prepare for overdose spikes through the implementation of an overdose spike preparedness exercise. An overdose spike is broadly defined as when the total number of suspected overdoses for a defined geographic area exceeds a pre-determined threshold for a specified time. Overdose spikes are emergency events that require a coordinated response among many agencies and partners. The purpose of the exercise is to practice response scenarios with all partners who may be called upon to respond during a real-life overdose spike. The objectives of the exercise are to:

1. Discuss the necessity and urgency of preparing for overdose spikes.
2. Enhance cross-sectoral partnerships to respond to overdose spikes.
3. Practice response scenarios to support developing or enhancing overdose spike response protocols.

Resources

The tabletop in a box includes six resources to help plan for and conduct an overdose spike preparedness exercise.

• Partner List (automatic Word download): The exercise partner list includes a suggested list of key response partners who might participate in the spike response preparedness exercise. The response team may use this document to brainstorm key response partners and track contact information and invitation status for the exercise.
• Mock Scenario and Inject Inventory (PDF): This document serves as a menu of options for exercise facilitators to select from when determining what scenarios and injects, or example scenario changes, to include in their overdose spike preparedness exercise.
• Agenda (automatic Word download): This document includes two template agendas to accompany the exercises.
• Exercise Slide Deck (automatic PowerPoint download): These slides serve as a template for response teams to adapt and use to structure the exercise.
• Action Plan Template (automatic Word download): This template can be used to identify and organize key activities that strengthen your jurisdiction’s spike response protocol.
• Resource List: This list outlines key resources on overdose spike preparedness and response strategies that may assist exercise facilitators and participants before, during, and after an exercise.

Tips for Facilitating an Overdose Spike Preparedness Exercise

It is important to note that each jurisdiction has unique resources, assets, and challenges. This resource is intended to be modified by the exercise facilitators to fit the local context and priorities. Some general tips for facilitators are outlined below. We encourage facilitators to share ongoing feedback on the utility of these materials by contacting opioidpreparedness@astho.org.

Planning

Exercise facilitators and their roles in the community will vary by jurisdiction. Facilitators should generally have detailed knowledge of the overdose prevention and response landscape in their jurisdiction and feel comfortable with leading discussions among partners. Facilitators may enlist others to help organize and prepare for the exercise.

It is recommended that facilitators, as well as any others involved in exercise planning, begin the planning process by completing the Partner List resource. This list will help outline partners who should be invited to participate in the exercise. Following this step, facilitators should choose the scenario and inject that will yield the most fruitful discussion during the exercise. Once these first two steps are complete, facilitators and planners should invite participants and schedule the exercise. The general recommendation is to schedule the exercise at least six weeks after the day the invitations are sent to maximize availability.

Structure

The Overdose Spike Preparedness Exercise outlined in this resource is designed to take approximately four hours to complete, including breaks, and can be conducted virtually or in person. The exercise can be split into two sessions that take place no longer than one week apart. The benefit of splitting the exercise into two sessions is the ability to adjust and invite additional partners if gaps are identified during the first session. If the sessions are split, facilitators are encouraged to enlist timekeepers and to use their discretion in choosing when to close the first session and where to pick up for the second.

Protocol Development and Enhancement

The Overdose Spike Preparedness Exercise outlined in this resource can be used by state and local jurisdictions at any stage of spike response development, whether they have a plan or protocol in place or not. If the jurisdiction has a plan or protocol in place, it should be shared with all participants beforehand so that the plan can be appropriately tested through the exercise. If a plan or protocol has not yet been developed, exercise facilitators should give special attention to what information they would need to elicit through the exercise discussion to begin formulating a plan. Whether or not a protocol exists, the facilitators should plan to task someone with taking extensive notes during the exercise.

Action Planning

It is critical to summarize the next steps and key priorities when closing each session of the exercise, as well as identifying the person responsible for ensuring that the next steps take place and a timeline. Specific goals and objectives may vary by jurisdiction, but some potential next steps may include formalizing roles and responsibilities, drafting/modifying a response protocol, and connecting with new partners.

Resource List