From Silos to Synergy: Public Health and Public Safety Collaborations to Reduce Drug Overdose : Journal of Public Health Management and Practice

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From Silos to Synergy: Public Health and Public Safety Collaborations to Reduce Drug Overdose

Mital, Sasha PhD, MPH; O'Brien, Mallory PhD, MS

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Journal of Public Health Management and Practice: November/December 2022 - Volume 28 - Issue Supplement 6 - p S271-S272
doi: 10.1097/PHH.0000000000001627
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The drug overdose crisis has greatly impacted communities across the country as deaths continue to rise.1 Multisectoral collaboration is critical to saving lives and addressing this epidemic. Two key partners in this response are public health and public safety (PH/PS) agencies, which share missions of improving community safety and well-being and are on the frontlines of the drug overdose crisis. Each sector has a critical role to play and offers resources that can strengthen prevention and response efforts when jointly engaged.

In a report on the rise of emergency department visits for opioid overdoses, the US Centers for Disease Control and Prevention (CDC) described the importance of coordinated, informed efforts with public safety, including first responders and law enforcement.2 Since 2015, CDC has awarded millions in funding to support overdose prevention and surveillance efforts through Overdose Data to Action, the Overdose Response Strategy, and the Opioid Rapid Response Program.3,4 Improving partnerships between PH/PS to reduce drug overdose deaths is a core component of these signature CDC programs.5–7

CDC's Division of Overdose Prevention is sponsoring this supplement, Partnerships Between Public Health and Public Safety to Reduce Drug Overdose Deaths, to describe programs and systems resulting from these partnerships, present evidence on their impact, and guide the implementation of these partnerships at the local level. Despite significant increases in funding for PH/PS partnerships at the federal, state, and local levels, few publications on the topic exist. This supplement aims to provide practitioners from both sectors with examples, descriptions, and lessons learned to guide their work and advance these collaborations.

We selected a practice-based journal for this supplement to highlight practical information for those who design and implement programs. The articles that follow illustrate the range of work and actors that contribute to these efforts, along with how PH/PS partnerships can contribute to a reduction in overdose deaths.

This issue begins with words from leaders in PH/PS, providing the foundation for this supplement. Leaders share their perspective on the value of these partnerships to address the overdose crisis at the federal level and ensure the safety and health of communities locally. The supplement then highlights emerging research on initiatives where PH/PS agencies partner to prevent overdose deaths. First, Ray and colleagues assess practices used in overdose fatality reviews (OFRs), where teams comprising staff from both sectors examine overdose death cases to provide multidisciplinary recommendations for overdose prevention. Next, Ross and Taylor provide key findings from a national survey of first responder deflection programs, and, finally, Worthington and colleagues present a review of public safety–led linkage to care programs. These assessments are timely and important, as findings can guide localities across the country that are initiating OFRs, deflection, and linkage to care efforts.

Most of this issue is made up of practice-based reports meant to guide the “explosion of PH/PS collaboration,” a phrase coined by Worobiec and Firesheets in their report presenting a framework for navigating privacy and policy issues. Some of these 11 reports provide experiential knowledge on and outcomes of local-level initiatives such as reports from Formica et al on post-overdose outreach across Massachusetts, Gosney et al on countywide pre-arrest diversion and deflection efforts in Ohio, and Firesheets et al on quick response teams in an Ohio township. The report by Carter et al examines a statewide initiative in Maine encompassing several of these initiatives. Fontanilla and colleagues offer an example of a PH/PS data linkage project designed to track and improve service delivery for justice-involved populations. In 2 reports, Green and colleagues outline different strategies for drug checking led by public safety agencies, which could be adapted by other jurisdictions. Wisdom et al describe an effort to address adverse childhood experiences as a risk factor for drug overdose, an emerging area of interest. Finally, 2 reports from CDC authors describe federal efforts to reduce drug overdose deaths through PH/PS partnerships.

This supplement concludes with 2 case studies undertaken by multisector partners to prevent and respond to overdoses locally. The first by Roe and colleagues lays out the contents of a toolkit designed to facilitate PH/PS partnerships at the local level and describes findings from an initial piloting of this toolkit. In their case study, Rubel et al detail how a federal program that supports patients who lose access to a prescriber of opioids was implemented in one state and how the program can assist others in preparing for such an event.

Readers of this supplement will walk away with a more robust understanding of the breadth and depth of collective efforts implemented by PH/PS partners to prevent and respond to drug overdoses, along with practical implementation strategies. As the drug overdose epidemic continues to affect communities and is complicated by changes in the drug supply and polysubstance use patterns,8,9 innovative and multisector approaches stemming from partnerships between PH/PS are needed now, more than ever.


1. Ahmad F, Rossen L, Sutton P. Provisional Drug Overdose Death Counts. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention (CDC); 2021.
2. Vivolo-Kantor AM, Seth P, Gladden RM, et al. Vital signs: trends in emergency department visits for suspected opioid overdoses—United States, July 2016-September 2017. MMWR Morb Mortal Wkly Rep. 2018;67(9):279–285.
3. Centers for Disease Control and Prevention. Overdose data to action. Accessed May 21, 2022.
4. Centers for Disease Control and Prevention. Partnerships between public health and public safety. Accessed May 19, 2022.
5. Diriba K, Whitlock E. Deflection to harm reduction: public health and public safety collaborative responses to the overdose epidemic in the United States. J Public Health Manag Pract. 2022;28(3):321–323.
6. Bagley SM, Schoenberger SF, Waye KM, Walley AY. A scoping review of post opioid-overdose interventions. Prev Med. 2019;128:105813.
7. Cherico-Hsii S, Bankoski A, Singal P, et al. Sharing overdose data across state agencies to inform public health strategies: a case study. Public Health Rep. 2016;131(2):258–263.
8. Park JN, Rashidi E, Foti K, Zoorob M, Sherman S, Alexander GC. Fentanyl and fentanyl analogs in the illicit stimulant supply: results from US drug seizure data, 2011-2016. Drug Alcohol Depend. 2021;218:108416.
9. Cicero TJ, Ellis MS, Kasper ZA. Polysubstance use: a broader understanding of substance use during the opioid crisis. Am J Public Health. 2020;110(2):244–250.
© 2022 The Authors. Published by Wolters Kluwer Health, Inc.