Forty-six governors have signed on to a remarkable agreement to fight the opioid epidemic with prevention and treatment, including treatment with medications and harm reduction measures such as access to naloxone. The National Governors Association (NGA) released the “Compact to Fight Opioid Addiction” on July 13.

“Bringing governors together around core strategies to end the opioid epidemic adds momentum behind state efforts and sends a clear signal to opioid prescribers and others whose leadership is critical to saving lives,” said Massachusetts Gov. Charlie Baker, chair of the NGA Health and Human Services Committee. “Massachusetts is proud to bring our plans to the table for other states as we work collaboratively to find meaningful solutions to this public health crisis.”

The compact came about as a result of a resolution passed at the NGA’s winter meeting, which focused on opioid prescribing guidelines and the need for collective guidelines (see ADAW, Feb. 29).

There are some controversial provisions. For example, the compact calls for opioid prescribers and dispensers — which includes opioid treatment programs (OTPs) — to input information about their patients into prescription drug monitoring programs (PDMPs). Federal confidentiality law does not allow this without patient consent, and OTPs have been told by the federal government not to do it (see ADAW, Oct. 24, 2011). However, the state attorneys general have asked the federal government to make an exception for OTPs.

The compact was released at the start of the NGA summer meeting, which kicked off with a session on opioid abuse in which Health and Human Services Secretary Sylvia Mathews Burwell participated.

Below is the compact:

Taking steps to reduce inappropriate opioid prescribing, which may include:

  • Partnering with health care providers to develop or update evidence-based opioid prescribing guidelines, which may be informed by CDC’s guideline, and consider prescription limits with exceptions for certain patients and circumstances;
  • Requiring that physicians, osteopaths, nurse practitioners, physician assistants, dentists, veterinarians and all other opioid prescribers receive education on pain management, opioid prescribing and addiction throughout their training and careers;
  • Integrating data from state prescription drug monitoring programs (PDMPs) into electronic health records and requiring PDMP use by opioid prescribers and dispensers; and
  • Reducing payment and administrative barriers in Medicaid and other health plans to promote comprehensive pain management that includes alternatives to opioid painkillers.

Leading efforts to change the nation’s understanding of opioids and addiction, which may include:

  • Developing a communications strategy through the governor’s office to raise awareness about the risks of abuse associated with opioid use and reduce the stigma of addiction;
  • Establishing social media campaigns and integrating education into schools, athletic programs and other community-based settings to raise awareness about opioid abuse and addiction among youth and other at-risk groups; and
  • Partnering with professional associations to improve understanding of the disease of addiction among health care providers and law enforcement.

Taking actions to ensure a pathway to recovery for individuals with addiction, which may include:

  • Reducing payment and administrative barriers in Medicaid and other health plans to promote access to a range of treatment options, including well-supervised medication-assisted treatment and comprehensive recovery services;
  • Pursuing overdose prevention and harm reduction strategies, such as Good Samaritan laws and standing orders to increase access to and use of naloxone; and
  • Implementing and strengthening programs that provide addiction treatment as an alternative for non-violent individuals charged with low-level drug-related crimes.

NASADAD collaboration

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) works closely with the NGA. NASADAD Executive Director Rob Morrison told ADAW the NGA has been “fully engaged” with NASADAD on opioid issues, and connects with NASADAD members to find out more about what they do. Of particular interest to other governors: the hub-and-spoke system of methadone clinics and buprenorphine prescribers developed in Vermont by SSA Barbara Cimaglio and Gov. Howard Shumlin.

“A lot of work goes into these summits,” said Morrison of the NGA meetings. The compact “was the culmination of a decent amount of work in which governors’ offices, their staff and leadership are talking about what their state is doing,” he told ADAW last week. Morrison added that the work done on the compact will be “very beneficial” for incoming governors after the elections in November. Ultimately, the compact shows the importance of NASADAD to the NGA on substance use disorder issues, and on the trust that governors have in the association.

At the 2017 winter meeting in Washington, D.C., the NGA will report on specific steps governors have taken to meet their commitments and build on existing efforts.

Among those not signing on to the compact: Gov. Paul LePage of Maine and Gov. Rick Scott of Florida. For the compact, and the full list of signatories, go to