Section I: Introduction

The role of local governmental health departments in Massachusetts is to promote health and equity, combat disease, increase longevity, and improve the quality of life for all residents of the Commonwealth. Over the past decade, recognition of substance use as a widespread factor that impacts health, and LBOH staff have taken the lead in addressing the needs of people with substance use disorders. Opioid and other substance use and opioid-related deaths remain  critical public health problems in the Commonwealth. While opioid-related deaths substantially dropped for the first time in nearly two decades between 2023 and 2024 from 2,114 to 1,336, respectively, the number of annual deaths remains 2.7 times higher than observed in the year 2000.

This toolkit will prepare local health departments to respond to the opioid and other substance use in their communities. We know that prevention and interventions are most successful when they are well-matched to the needs and conditions of the community. This one-stop reference guide contains the information local health departments need to create and implement public health approaches that make a difference.

Specifically, these resources will help local health departments:

• Understand the scope of the opioid epidemic in your community and its impact on the health of community members, including those members historically excluded from public health initiatives.
• Identify opportunities for leading and/or participating in public health initiatives dedicated to addressing substance use and other behavioral health problems.
• Learn how to reduce both the individual and environmental factors shown to increase the risk of new opioid or other drug use, and promote those factors that protect against initiation of substance use.
• Identify and collaborate with substance use prevention partners in your community or region to ensure alignment of services.
• Improve access to treatment services and linkages among services for individuals with opioid/substance use disorder (OUD/SUD) when those individuals reach out to the health department.
• Recognize opportunities for health department staff to reduce barriers to care and address the stigma associated with OUD/SUD.

This resource was designed for use by Massachusetts municipalities. However, much of the content is appropriate for communities outside of the Commonwealth.

How This Toolkit Is Organized

This toolkit is organized into five sections:

• Section I includes an overview of the toolkit and a short glossary. However, most terminology will be defined along the way.
• Section II includes an introduction to evidence-based opioid prevention intervention, organized by four categories: public messaging campaigns, prescriber education, harm reduction, and other strategies.
• Section III includes steps local boards of health can take to address opioid misuse, organized around the 10 Essential Public Health Services for Public Health Services.
• Section IV includes a more in-depth case example showcasing how the Northampton Board of Health is integrating opioid prevention into its work.
• Section V includes an annotated list of resources where readers can learn more about the prevention strategies included in this toolkit.

We do not anticipate that local health department staff will read this toolkit from start to finish. Instead, we anticipate staff familiarizing themselves with the menu of interventions available to them, then exploring opportunities to integrate these interventions into the important work they are already doing in their communities. Throughout the toolkit we provide examples of how cities and towns are approaching the opioid epidemic; we hope these will serve as helpful models.