| About This Report |
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| Summary |
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1 | (34) |
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The National Context for U.S. Issues with Opioids |
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1 | (3) |
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Current Responses to U.S. Opioid Problems Are Insufficient |
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4 | (1) |
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Efforts to Address Opioids Confront Both Old and New Challenges |
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5 | (5) |
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Taking an Ecosystem Approach to Addressing Opioids |
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10 | (13) |
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Approach and Structure of This Report |
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23 | (3) |
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26 | (1) |
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26 | (9) |
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Chapter Two People Who Use Opioids |
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35 | (66) |
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35 | (2) |
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How Many People Use Opioids in the United States, and Which Opioids Are They Using? |
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37 | (3) |
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How Does the Rate of Opioid Prescriptions in the United States Compare with That of Other Developed Countries? |
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40 | (3) |
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What Share of People Who Use Opioids Transition to Opioid Use Disorder? |
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43 | (1) |
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How Many People Currently Suffer from Opioid Use Disorder? |
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44 | (2) |
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What Are the Characteristics of Those with Opioid Use Disorder and Those Who Receive Treatment? |
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46 | (4) |
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Who Is Dying from Opioid-Involved Overdoses and How Has This Changed? |
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50 | (12) |
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What Is the Scope of Other Health Harms Related to Opioid Use, Including Nonfatal Overdose? |
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62 | (6) |
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What Do We Know About the Families of Those with Opioid Use Disorder? |
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68 | (1) |
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How Many Arrests Can Be Linked to Opioids Each Year? |
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69 | (4) |
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For Those with Opioid Use Disorder Who Are Justice Involved, What Share of Their Arrests Are for Drug Law Violations Versus Other Crimes? |
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73 | (1) |
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Improving the Data Infrastructure for Describing People Who Use Opioids, Their Families, and Drug Markets |
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74 | (3) |
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77 | (11) |
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88 | (1) |
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89 | (12) |
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Chapter Three Family Members of Individuals with Opioid Use Disorder |
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101 | (18) |
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101 | (1) |
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How Are Families Affected by Opioids? |
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102 | (3) |
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How Do Families Interact with the Opioid Ecosystem? |
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105 | (3) |
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Other Considerations and Policy Options |
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108 | (4) |
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112 | (7) |
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Chapter Four Specialty Treatment System for Opioid Use Disorders |
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119 | (48) |
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119 | (3) |
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122 | (2) |
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System Components and How They Interact with Opioids |
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124 | (8) |
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Key Interactions with Other Components of the Ecosystem |
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132 | (13) |
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Policy Opportunities and Considerations |
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145 | (2) |
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147 | (1) |
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147 | (20) |
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Chapter Five Medical Care |
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167 | (52) |
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167 | (4) |
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171 | (1) |
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System Components and How They Interact with Opioids |
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171 | (20) |
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Key Interactions with Other Components of the Ecosystem |
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191 | (5) |
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Policy Opportunities and Considerations |
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196 | (4) |
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200 | (1) |
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200 | (19) |
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Chapter Six Criminal Legal System |
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219 | (54) |
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219 | (3) |
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222 | (1) |
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System Components and How They Interact with Opioids |
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223 | (14) |
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Key Interactions with Other Components of the Ecosystem |
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237 | (17) |
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Policy Opportunities and Considerations |
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254 | (6) |
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260 | (1) |
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260 | (13) |
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Chapter Seven Illegal Supply and Supply Control |
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273 | (44) |
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273 | (4) |
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277 | (3) |
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System Components and How They Interact with Opioids |
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280 | (16) |
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Key Interactions with Other Components of the Ecosystem |
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296 | (4) |
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Policy Opportunities and Considerations |
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300 | (6) |
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306 | (1) |
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306 | (11) |
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Chapter Eight Harm Reduction and Community-Initiated Interventions |
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317 | (48) |
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317 | (4) |
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321 | (1) |
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System Components and How They Interact with Opioids |
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322 | (16) |
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Key Interactions with Other Components of the Ecosystem |
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338 | (5) |
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Policy Opportunities and Considerations |
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343 | (2) |
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345 | (1) |
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345 | (20) |
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Chapter Nine First Responders |
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365 | (32) |
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365 | (3) |
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368 | (2) |
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System Components and How They Interact with Opioids |
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370 | (7) |
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Key Interactions with Other Components of the Ecosystem |
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377 | (7) |
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Policy Opportunities and Considerations |
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384 | (3) |
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387 | (1) |
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387 | (10) |
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Chapter Ten Child Welfare |
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397 | (32) |
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397 | (4) |
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401 | (2) |
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System Components and How They Interact with Opioids |
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403 | (6) |
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Key Interactions with Other Components of the Ecosystem |
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409 | (8) |
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Policy Opportunities and Considerations |
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417 | (4) |
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421 | (1) |
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421 | (8) |
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Chapter Eleven Income Support and Homeless Services |
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429 | (32) |
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429 | (6) |
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435 | (1) |
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System Components and How They Interact with Opioids |
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436 | (9) |
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Interactions with Other Components of the Ecosystem |
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445 | (6) |
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Policy Opportunities and Considerations |
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451 | (3) |
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454 | (1) |
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454 | (7) |
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Chapter Twelve Employment |
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461 | (48) |
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461 | (4) |
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465 | (2) |
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System Components and How They Interact with Opioids |
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467 | (25) |
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Key Interactions with Other Components of the Ecosystem |
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492 | (5) |
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Policy Opportunities and Considerations |
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497 | (5) |
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502 | (1) |
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502 | (7) |
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Chapter Thirteen Education |
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509 | (32) |
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509 | (3) |
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512 | (1) |
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System Components and How They Interact with Opioids |
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512 | (11) |
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Key Interactions with Other Components of the Ecosystem |
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523 | (5) |
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Policy Opportunities and Considerations |
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528 | (3) |
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531 | (1) |
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531 | (10) |
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Chapter Fourteen Synthesis: A Strategy That Reflects the Ecosystem Perspective Appendixes |
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541 | (36) |
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Cross-Sector Barriers to Change |
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542 | (4) |
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Nine Portfolios of Action |
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546 | (22) |
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Prioritizing Policy Considerations |
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568 | (1) |
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569 | (1) |
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570 | (1) |
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570 | (7) |
| A Overview of Synthesis Exhibits and Ideas |
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577 | (12) |
B Overview of
Chapter-Level Considerations |
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