Arkansas is meeting the national average on a recently released report from the National Health Security Preparedness Index. The overall preparedness level in Arkansas stands at 7.0 for 2017, a 12.9% increase from 2013. The national average is 7.1.

“This is good news for Arkansas, but we don’t need to stop our efforts,” said Arkansas Drug Director Kirk Lane. 

Although the National Health Security Preparedness Index involves multiple factors, Lane believes the opioid epidemic plays a large role in whether states are meeting, exceeding or falling behind. He said the opioid epidemic has certainly caused some states to decline in health security, such as Ohio and West Virginia (where many experts call the epicenter of the opioid epidemic).

Arkansas is second in the nation for over-prescribing opioid medications at an average of 114.6 opioid prescriptions per 100 people (the national average is 66.5 prescriptions per 100 people), but increased emphasis in education, prevention and treatment are combating the epidemic.

“We are starting to see good numbers come in for the state,” He said. “I think our emphasis to providing first responders throughout the state with Naloxone kits is also a key component to meeting the national average. While we are saving lives with those kits – 64 lives since January 1, 2018 – we are diligent in our efforts to educate the public about not only the dangers of taking opioid medications, but also about the importance of safely storing them.”

“We are earnest in promoting the Monitor. Secure. Dispose. mantra. We encourage people to monitor their medications, secure them in a locked box, and dispose of expired or unneeded prescriptions at one of our near 200 secured drop-box locations in the state.”

One of the priorities of the treatment aspect is to erase stigma. Lane said it is important that people entering an addiction treatment facility receive support and encouragement from the community at large. Dr. John Clay Kirtley, Executive Director of the Arkansas State Board of Pharmacy, has witnessed stigma first hand.

“Many people have a very stereotypical image of what a drug addict or alcoholic looks like,” He said. “I grew up in Camden, Ark. and we had people there that fit that stereotype – the town drunk or town addict – and they were shunned by society.”

But Dr. Kirtley said he has also witnessed people have an “awaking of awareness.”

“One of the best exercises we did in pharmacy school was attending addiction meetings, but a lot of students were not happy at all that they had to go to those meetings to ‘Hang out with drug addicts,’” he said. “But once [students] went, they realized that the people in those meetings look just like them. I’ve seen that even with students in my own classes I teach today.”

“I tell my students that ‘this is an us disease, not a them disease.’ Until society buys in that this is an ‘Us’ issue and not a ‘Them’ issue, it will be very difficult to make progress.”

A key component to the prevention effort is to encourage everyone to participate in the Arkansas Prescription Drug Take Back Day, which will be held at a plethora of locations throughout the state from 10 a.m. to 2 p.m. on Saturday, April 28. All locations of event sites, as well as permanent drop-box locations, can be found by click the Collection Sites tab on ardrugtakeback.org.

The medications collected from the Arkansas Prescription Drug Take Back Day will be destroyed in an environmentally safe manner. For more information about the National Health Security Preparedness Index, visit https://nhspi.org/states/arkansas/ .

U.S. Surgeon General Dr. Jerome Adams said he was “very impressed” with the work and progress being made in Arkansas in the effort to reduce effects of the opioid epidemic. Dr. Adams spoke with representatives of several state agencies, as well as a few pharmacy students from various universities in the state, at the Arkansas State Board of Pharmacy (ASBP) Offices on Thursday.

Dr. John Clay Kirtley, Executive Director of the ASBP, unveiled to Dr. Adams a new program called “Labels Save Lives” to further disseminate educational material about the opioid epidemic. Through the innovative program, blue labels will be placed on prescription bottles at pharmacies throughout the state guiding recipients of the prescriptions to log onto ardrugtakeback.org.

“As you will see on our labels, the message is clear: Protect our children. Dispose of your meds safely,” Dr. Kirtley said. “In this campaign, we are in the process of distributing 500,000 pharmacy auxiliary labels to pharmacies throughout the state to be used this month and lead people not only to our website, but to also be a flag of recognition for the Arkansas Prescription Drug Take Back Day that is being held in coordination with the national takeback day on April 28.”

[On April 28, nearly 200 locations across Arkansas will host a site for the Arkansas Prescription Drug Take Back Day from 10 a.m. to 2 p.m. in which people are encouraged to drop off expired or unneeded prescription drugs. These medications will later be destroyed in an environmentally safe manner.]

Dr. Adams was also updated on the status of the state’s naloxone program for first responders. Arkansas Drug Director Kirk Lane was not available for the meeting, but he sent information to Dr. Adams stating that, “We have more than 3,000 naloxone kits out to first responders in Arkansas, and there have been 64 lives saved since Jan. 1, 2018 with naloxone kits.”

Dr. Kirtley also talked about working with drug rehabilitation/treatment facilities to receive naloxone kits and training on the administration to their staff. He further said that the training needs to be extended to family members once a person is released from a treatment facility, in the event that a relapse and an overdose occurs.

U.S. Surgeon General Adams was also introduced to Dr. Cheryl May, director of the Criminal Justice Institute in Little Rock, who Dr. Kirtley said has been “a critical component to our success” in providing first responders with naloxone kits and with training.

“Dr. May has taken a distinct lead on educating law enforcement about the necessity for and appropriate use of naloxone in communities,” Dr. Kirtley said. “She has also been on the front line of combining courses co-taught with the DEA and ASBP on how to deal with opioid drug issues.”

Dr. May spoke with Dr. Adams about Opioid Prevention Education Kick Off summits that are being held in communities throughout the state, where local residents hear educational facts and statistics, as well as personal stories from local residents about the opioid epidemic plaguing the state. She also told Dr. Adams about her passion, plans and goals for helping Drug Endangered Children.

“There are so many epidemics within this [opioid] epidemic,” said U.S. Surgeon General Dr. Jerome Adams. “I think one thing we need to ask is, how can we build resiliency in communities? We have a real opportunity here if we grab it and seize it today.”

Those in attendance also heard personal stories from Dr. Adams, including that members of his own family have been affected by the opioid epidemic. He said he has a brother who is currently serving time in a Maryland state prison for a burglary sentence, which was prompted by a drug addiction. [Read more of this story here: https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/ ]

Dr. Adams told the crowd that he was very pleased with the work and efforts Arkansans are making toward reversing the opioid epidemic in the state, so much so, that he plans to have his own staff mirror pages he glanced over from a information packet provided to him. He also encouraged those in attendance to speak out if they see someone having a possible issue with opioid medications.

“If you see something, say something,” Dr. Adams said. “I also encourage everyone to urge people to carry naloxone. It’s asafe drug, a readily available drug in Arkansas, and a drug which can save a life.”

Others in attendance at the meeting included: Carlton Saffa, Office of Arkansas Governor senior strategist and Board of Pharmacy liaison; Kaushik Kotecha, Smith Drug Wholesale Company in Spartanburg (partner in Labels Saves Lives campaign); Laura Monteverdi, KTHV 11 news reporter; and Matt Burks, Office of Arkansas Drug Director media specialist.

University of Arkansas student Trevor Villines envisions a future in which college campuses throughout the state tackle the opioid epidemic with expanded educational programs, medication drop-boxes on campuses, and through college recovery programs. As the Director of External Relations for the university’s Student Government Association (SGA) and President of the Registered Student Organization, Villines is seizing the opportunity to bring the vision to fruition.

“The opioid epidemic is a problem at every campus across the state and nation,” he said. “We have an opportunity to lead the state in addressing this issue. You’re going to hear, in the next coming months, that we are working on forming a joint effort.”

“We are going to try and work with student governments at other college campuses. Specifically we want to start within the U of A system, such as the University of Arkansas at Little Rock and other campuses across the state. We want to team up and talk with [university] administrators about college recovery programs and policies, as well as educational programs.”

To ensure this vision takes the correct course of action, Villines frequently communicates with state leaders, including Arkansas Drug Director Kirk Lane.

“Mr. Trevor Villines is a unique leader who has a vision to improve the quality of life of his student body, as well as communities throughout Arkansas,” Lane said. “The challenges of the opioid epidemic require unique leadership skills to build collaborative efforts and encourage change. I am proud of [Villines] achievements thus far, and those still to come.”

Villines said this semester, he’ll introduce a 3-step plan through the SGA: (1) Expand student policy to protect students in the event of an opioid overdose; (2) Create a College Recovery Program; and (3) To have a secure, permanent medicine drop box location on campus.

The first step includes the expansion of the Joshua Ashley-Pauley Act (an Arkansas good Samaritan law which gives immunity from prosecution for drug possession to someone seeking medical assistance due to a drug overdose) to further protect university students.

“The Joshua Ashley-Pauley Act can safeguard someone from an arrest and charges, but what about keeping them from being expelled from school or kicked off campus?,” Villines asked. “There are limitations to the Joshua Ashley-Pauley Act, and will be [limitations] to the student policy; however, we value saving lives most importantly.”

Arkansas Drug Director Kirk Lane and Villines have also been in communication with law enforcement agencies in Washington County, including the University of Arkansas Police Department, to supply officers with Narcan kits (which contain Naloxone medication designed to temporarily reverse an overdose due to an opioid).

The second step is to create a College Recovery Program for the University of Arkansas System. Villines has been researching and studying The Center for Collegiate Recovery Communities at Texas Tech University as a program to model. He said the Student Government Association “Definitely wants to do more in-depth research” of their program to learn its functions and how they’re funded.

“We’ve got to find a solution and a place in helping students overcome addiction,” Villines said. “We want them to build friendships on campus with people who encourage and support them during treatment. We want to see them saved and have a life change, and if we have a recovery program in place, we can get them the proper help they need.”

The third step is to expand education and awareness about the opioid epidemic. Aside from posting fliers around campus and starting awareness week campaigns, Villines envisions reaching out to various students at the places they congregate.

“We’ll go talk to people at the Greek-life houses, both sororities and fraternities,” he said. “But, we’ll also talk to various organizations. We want to meet with architect majors and engineers to discuss feasibility of project ideas. We’d like to get pharmacy and nursing students involved with volunteer work for the Arkansas Drug Take Back Day. We definitely want to get students involved.”

Villines is also in the discussion phase of having permanent medicine drop-boxes installed on college campuses in the near future. Though there are drop-box locations near many college campuses, he believes having them on campus would increase student participation in dropping off medicines.

“They could be placed securely in a student union or in a campus library, or any centralized area of campus,” Villines said. “We are going to work with the authorities to make sure it is a secure location, but also where students can easily drop them off so that [medications] aren’t floating around campus causing more harm to our students.”

These are just the first several steps Villines is taking toward initiating positive change against the opioid epidemic on college campuses. Not one to stop and rest for very long, he is constantly looking for new ideas to better improve communities throughout Arkansas.

“In my Student Government Association role, I’m responsible for meeting with legislators and state officials, such as Arkansas Drug Director Kirk Lane and the Governor’s staff,” Villines said. “I’m also planning to spend time with the Pulaski County Coroner to see the process for handling an opioid overdose.”

“I haven’t taken a decent break in 3 or 4 years because I’m always working and seeing how I can get involved. I’m always looking to take it up a notch. The bare minimum just doesn’t do it for me.”

Arkansas was well represented at the 2018 National Prescription Drug Abuse & Heroin Summit in Atlanta. We are all working together to make a difference! #ReverseTheOpioidEpidemic

https://twitter.com/ARdrugCzar/status/981597475093057536

By Nicholas Bakalar

March 7, 2018 New York Times

Opioids are no better than nonopioid pain relievers for treating the chronic pain of osteoarthritis, a clinical trial has found.

Researchers randomized 240 patients with moderate to severe chronic back pain or hip or knee osteoarthritis to either an opioid (morphine, oxycodone or hydrocodone) or to nonopioid pain relievers (such as Tylenol, topical lidocaine or nonsteroidal anti-inflammatory drugs). The study, in JAMA, used 11-point pain and function scales to measure the effect of treatment, with higher scores indicating poorer results. This is, the authors write, the first randomized trial of opioid therapy to report long-term pain and function outcomes.

At the end of 12 months, the opioid group scored an average 3.4 on the function scale, and the nonopioid group 3.3, an insignificant difference. On the pain scale, the nonopioid group did slightly better — 3.5, compared with 4.0 for the opioid group.

Unsurprisingly, there were significantly more medication side effects in the opioid group than in those who took nonopioids.

“Should we use opioids if nonopioids don’t work?” asked the lead author, Dr. Erin E. Krebs of the Minneapolis Veterans Affairs Health Care System. She answered her own question: “No. We tried four different nonopioids — don’t give up on them too soon — and we should also be using exercise and rehab for most osteoarthritic pain.”

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Actual Report below

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Question For patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, does opioid medication compared with nonopioid medication result in better pain-related function?

Findings In this randomized clinical trial that included 240 patients, the use of opioid vs nonopioid medication therapy did not result in significantly better pain-related function over 12 months (3.4 vs 3.3 points on an 11-point scale at 12 months, respectively).

Meaning This study does not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

Importance Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain.

Objective To compare opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects.

Design, Setting, and Participants Pragmatic, 12-month, randomized trial with masked outcome assessment. Patients were recruited from Veterans Affairs primary care clinics from June 2013 through December 2015; follow-up was completed December 2016. Eligible patients had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use. Of 265 patients enrolled, 25 withdrew prior to randomization and 240 were randomized.

Interventions Both interventions (opioid and nonopioid medication therapy) followed a treat-to-target strategy aiming for improved pain and function. Each intervention had its own prescribing strategy that included multiple medication options in 3 steps. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response.

Main Outcomes and Measures The primary outcome was pain-related function (Brief Pain Inventory [BPI] interference scale) over 12 months and the main secondary outcome was pain intensity (BPI severity scale). For both BPI scales (range, 0-10; higher scores = worse function or pain intensity), a 1-point improvement was clinically important. The primary adverse outcome was medication-related symptoms (patient-reported checklist; range, 0-19).

Results Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, −0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5]).

Conclusions and Relevance Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

For more information click here.

After serving more than 20 years on the Arkansas Alcohol and Drug Abuse Coordinating Council, Chief Ron Burks officially retired this week. Attending his last council meeting, this time as a private citizen, Burks was honored with a plaque of recognition for his dedicated service to improving the quality of life for all Arkansans. 

“I’m very humbled by this. Twenty years flew by and I enjoyed every minute I served on the council,” Burks said.

Arkansas Drug Director Kirk Lane presented the plaque to Burks, alongside special guest – former Arkansas Drug Director Fran Flener.

“Chief Burks leaves a legacy of outstanding contributions given to this council, which has directly impacted Arkansans in a positive manner,” Lane said. “The wisdom he shared for more than 2 decades is immeasurable, and so is the amount of people he mentored in both his role on the council and through his law enforcement career.”

Burks recently retired as chief of the Arkansas Highway Police, where he served for more than 20 years. He previously served more than 23 years at the North Little Rock Police Department where he earned the rank of Captain of the Investigations Division. Burks said serving on the Arkansas Alcohol and Drug Abuse Coordinating Council was “fantastic” even through times of funding concerns.

“I think more so now, with the opioid crisis at the national level, I think that has not only grabbed the attention of the politicians in Washington DC, but also our state and local politicians,” he said. “I think they see the need to have appropriate funding to address this problem. I just wish there was more funding out there, because they work they do is very important, especially now with the opioid epidemic.”

Burks said the council has three sections of support toward improving the state: treatment, prevention and law enforcement.

“Their main importance is to ensure funding is directed to the areas that need to be addressed,” he said. “Not all the money goes to law enforcement. Not all the money goes to treatment. Not all the money goes to prevention. It needs to be a collaborative effort of all and I think the council is crucial in ensuring that the funding is spread out evenly, and we address the problem as a whole.”

Burks said he feels confident that the council will continue to improve and progress. He said he’ll miss serving with other board members, but he’s ready to enjoy retirement.

“I’m going to miss being on the council,” he said. “I felt like we did a lot of good work and I’ll miss the people, but just like anything else, there will be others to step in and continue the work of the council.”

Arkansas Drug Director Kirk Lane spoke to a large crowd from the steps of the Arkansas State Capitol today about how the Opioid Epidemic is affecting thousands of Arkansans everyday. Beyond the facts and statistics, including how the state is #2 in the nation for over-prescribing opioids (114.6 opioid prescriptions per 100 people; the national average is

66.5 prescriptions per 100 people), Lane spoke to the heart of his passion – saving lives. He said one way to battle the epidemic is by providing first responders across the state with life-saving naloxone kits (which contain medicine to temporarily reverse an overdose due to an opioid), and with partners in the state, they are distributing hundreds of kits with the goal to reach every first responder.

Lane also said educating everyone on the dangers/risks of opioids and how to properly dispose of them, is also key to reversing the epidemic. Here is a brief video of his message:

In response to Lane’s message, several other state and city leaders spoke about a lawsuit that was recently filed. From the Arkansas Association of Counties:

In a unified and unprecedented approach against the opioid drug industry, the state of Arkansas, Arkansas counties and Arkansas cities announced that together they have filed a lawsuit in the Circuit Court of Crittenden County.

This unique litigation approach is unlike any others in the country and will represent 90 percent of Arkansas’s population, with 72 counties and 210 cities participating. It is believed that it will cost billions to stop the Arkansas opioid epidemic and that this money should come from the companies that caused the problem instead of taxpayers.

“Though other lawsuits have been filed in federal courts across the country, Arkansas is the only state that has united in this fashion,” said Chris Villines, executive director of the Association of Arkansas Counties. “Instead of fighting and competing with each other on critically needed settlement dollars for our cities and counties, all of the cities and counties are working together to do what’s best for Arkansas.”

The epidemic is real and has ravaged Arkansas families for years. While the U.S. experiences more than 42,000 fatal overdoses a year, Arkansas experiences over 400, a number that has increased nearly 300 percent since 2000 and coincides with opioid sales quadrupling. Additionally, Arkansas ranks second in the nation for ages 12-17 in misuse of opioids (4.67%) behind Alabama, which is also the only other state with a higher opioid prescribing rate than Arkansas, according to the U.S. Centers for Disease Control and Prevention.

“It is hard to find anyone who hasn’t felt the effects of an opioid addiction from family, friends or even in themselves,” said Kirk Lane, Arkansas State Drug Director. “Though great strides have been made recently to curb the epidemic – especially helping cities fund necessary resources like the opiate antagonist Naloxone (Narcan) – much more could be done to fund ongoing programs for education and prevention.”

In 2017, there were more opioid prescriptions than people – enough for every man, woman and child to have 80 pills per year. Hospitals and rehabilitation systems cannot keep pace with the influx of victims. The resources of public safety officials are constantly strained to meet the overwhelming needs of opioid-related emergencies. As a result, the state of Arkansas, its counties, cities and taxpayers have funded the enormous societal costs of the opioid epidemic, but have had insufficient revenue to turn the tide of the epidemic.

“Arkansas’s one-voice approach to this lawsuit is one that gives us a seat at the table,” said Don Zimmerman, executive director of the Arkansas Municipal League. “Neither the state or any county or city is big enough alone; this litigation approach ensures that recovered damages remain in Arkansas.”

For more information about the lawsuit, or to find additional resources on the opioid epidemic in Arkansas, please visit ARCounties.org, ARML.org or APERMA.com.

APPENDICES

1. List of Arkansas counties participating
2. List of Arkansas municipalities participating
3. List of named defendants

“We will work to strengthen vulnerable families and communities, and we will help to build and grow a stronger, healthier, and drug-free society.” – President Donald J. Trump

ADDRESSING THE DRIVING FORCES OF THE OPIOID CRISIS: President Donald J. Trump’s Initiative to Stop Opioids Abuse and Reduce Drug Supply and Demand will confront the driving forces behind the opioid crisis.

 President Trump’s Initiative to Stop Opioid Abuse will address factors fueling the opioid crisis, including over-prescription, illicit drug supplies, and insufficient access to evidence-based treatment, primary prevention, and recovery support services.

 The President’s Opioid Initiative will:

o Reduce drug demand through education, awareness, and preventing over-prescription.

o Cut off the flow of illicit drugs across our borders and within communities.

o Save lives now by expanding opportunities for proven treatments for opioid and other drug addictions.

REDUCE DEMAND AND OVER-PRESCRIPTION: President Trump’s Opioid Initiative will educate Americans about the dangers of opioid and other drug use and seek to curb over-prescription.

 Launch a nationwide evidence-based campaign to raise public awareness about the dangers of prescription and illicit opioid use, as well as other drug use.

 Support research and development efforts for innovative technologies and additional therapies designed to prevent addiction and decrease the use of opioids in pain management.

o This will include supporting research and development for a vaccine to prevent opioid addiction and non-addictive pain management options.

 Reduce the over-prescription of opioids which has the potential to lead Americans down a path to addiction or facilitate diversion to illicit use.

 Implement a Safer Prescribing Plan to achieve the following objectives:

o Cut nationwide opioid prescription fills by one-third within three years.

o Ensure that 75 percent of opioid prescriptions reimbursed by Federal healthcare programs are issued using best practices within three years, and 95 percent within five years.

o The President also calls on Congress to pass legislation that reduces the threshold amount of drugs needed to invoke mandatory minimum sentences for drug traffickers who knowingly distribute certain illicit opioids that are lethal in trace amounts.

HELP THOSE STRUGGLING WITH ADDICTION: President Trump’s Opioid Initiative will help those struggling with addiction through evidence-based treatment and recovery support services:

 Work to ensure first responders are supplied with naloxone, a lifesaving medication used to reverse overdoses.

 Leverage Federal funding opportunities to State and local jurisdictions to incentivize and improve nationwide overdose tracking systems that will help resources to be rapidly deployed to hard-hit areas.

 Expand access to evidence-based addiction treatment in every State, particularly Medication-Assisted Treatment for opioid addiction.

 Seek legislative changes to the law prohibiting Medicaid from reimbursing residential treatment at certain facilities with more than 16 beds.

o In the meantime, continue approving State Medicaid demonstration projects that waive these barriers to inpatient treatment.

 Provide on-demand, evidence-based addiction treatment to service members, veterans and their families eligible for healthcare through the Departments of Defense or Veterans Affairs.

 Leverage opportunities in the criminal justice system to identify and treat offenders struggling with addiction.

o Screen every Federal inmate for opioid addiction at intake.

o For those who screen positive and are approved for placement in residential reentry centers, facilitate naltrexone treatment and access to treatment prior to and while at residential reentry centers and facilitate connection to community treatment services as needed.

o Scale up support for State, Tribal, and local drug courts in order to provide offenders struggling with addiction access to evidence-based treatment as an alternative to or in conjunction with incarceration, or as a condition of supervised release.

o Ensure that at least half of all Federally-employed healthcare providers adopt best practices for opioid prescribing within two years, with all of them doing so within five years.

o Leverage Federal funding opportunities related to opioids to ensure that States transition to a nationally interoperable Prescription Drug Monitoring Program network.

CUT OFF THE SUPPLY OF ILLICIT DRUGS: President Trump’s Opioid Initiative will crack down on international and domestic illicit drug supply chains devastating American communities:

 Keep dangerous drugs out of the United States.

o Secure land borders, ports of entry, and water ways against illegal smuggling.

o Require advance electronic data for 90 percent of all international mail shipments (with goods) and consignment shipments within three years, in order for the Department of Homeland Security to flag high-risk shipments.

o Identify and inspect high-risk shipments leveraging advanced screening technologies and by using drug-detecting canines.

o Test and identify suspicious substances in high-risk international packages to quickly detect and remove known and emerging illicit drugs before they can cause harm.

o Engage with China and expand cooperation with Mexico to reduce supplies of heroin, other illicit opioids, and precursor chemicals.

 Advance the Department of Justice (DOJ) Prescription Interdiction and Litigation (PIL) Task Force to fight the prescription opioid crisis. The PIL Task Force will:

o Expand the DOJ Opioid Fraud and Abuse Detection Unit’s efforts to prosecute corrupt or criminally negligent doctors, pharmacies, and distributors.

o Aggressively deploy appropriate criminal and civil actions to hold opioid manufacturers accountable for any unlawful practices.

 Shut down illicit opioid sales conducted online and seize any related assets.

o Scale up internet enforcement efforts under DOJ’s new Joint Criminal Opioid Darknet Enforcement (J-CODE) team.

 Strengthen criminal penalties for dealing and trafficking in fentanyl and other opioids:

o DOJ will seek the death penalty against drug traffickers, where appropriate under current law.