A Division for Advancing Prevention & Treatment (ADAPT) provides substance use prevention Training and Technical Assistance to High Intensity Drug Trafficking Area (HIDTA)

communities across the nation. The Prevention Post keeps HIDTA communities

up-to-date with the latest advances and opportunities in the field.

Director's Message

Dear HIDTA Communities,


2023 was a year of growth in so many ways for substance use prevention, and what excites me most is all the forethought that has gone into setting up 2024 for success! This issue of The Prevention Post brings forward a variety of “shims” being put in place for the new year and presents some very promising outcomes. Our HIDTA Spotlight features four HIDTAs thoughtfully integrating prevention efforts by starting with a strong foundation characterized by engagement with their unique areas and partners, assessment of where they are needed most, and strategic support based on the best available evidence. All these HIDTAs are embarking on either a starting point or an enhancement to their prevention work and ADAPT cannot wait to help in any way we can. In addition to the great work being done by these four HIDTAs, outcomes from Arizona HIDTA’s Fentanyl Prevention Toolkit (see HIDTA News!) are presented and are incredible. 


Many of you attended our HIDTA Prevention Summit in October, and special items from the Summit are sprinkled throughout this issue such as an innovative way of sharing substance-related information with youth which incorporates considerations for protecting from unintended harm (see our Prevention Tip!). Many of our prevention partners are hosting wonderful events in 2024 to keep conversations moving along, and we have made it easy for you to register by including the links here. Other prevention partners including the National Emerging Threats Initiative and ODMAP have provided updates on their efforts, data, or program. Finally, the Resources/Science from the Field section of this issue is one will want to review, as I think you will find several items for consideration in 2024 from NIDA, SAMHSA, and the CDC. 


The ADAPT team values the opportunities we have had to support your impactful work throughout 2023. You inspire us. Your input, feedback, and important conversations have informed our planning for 2024. We will make sure we support you where you need us most. Thank you for investing in the hard work of prevention!

Keep Cultivating,

Lora Peppard, PhD, DNP, PMHNP-BC
Director of ADAPT
Deputy Director for Treatment & Prevention
Washington/Baltimore HIDTA

HIDTA Spotlight

Advances in HIDTA Prevention!

Appalachia, New England, New Mexico, and Oregon-Idaho HIDTAs are laying down a foundation to build their substance use prevention infrastructures over the next year with discretionary funding from the National HIDTA Program. Their approaches all look a little different, but they share a common purpose – to reduce demand for substances in their areas by implementing strategies based on the best available evidence. 

Covering communities in New Mexico, Kentucky, Tennessee, West Virginia, Connecticut, Rhode Island, Massachusetts, New Hampshire, Maine, and Vermont, a variety of strategies unique to the individual HIDTA areas will be implemented. New England, New Mexico, and Oregon-Idaho HIDTAs will hire a Prevention/Demand Reduction Coordinator to oversee a process of understanding the landscape of prevention needs and existing interventions, engaging key stakeholders and partner organizations, facilitating collaboration with Drug Free Community and other substance use prevention coalitions, promoting integration of the best available evidence, and evaluating the impact of HIDTA-supported prevention interventions. Appalachia HIDTA will fund a specific prevention program, which will be implemented in multiple schools across its region.

ADAPT is supporting prevention activities for these HIDTAs in ways that make sense to each of the individual HIDTAs based on the interests and visions of the HIDTA Directors and their Boards, capacity, and available resources. All four HIDTAs are committed to complementing their primary mission of disrupting and dismantling drug trafficking with strategic prevention efforts that address gaps in the systems of prevention in their communities.  

Prevention Tip

"Flipping The Conversation" When Sharing Substance-Related Information with Youth 

Unintended harm can arise when sharing information about substances when that information unintentionally creates incorrect beliefs that substance use is common and/or more acceptable among peers than it actually us. These “misperceived norms” could contribute to increased substance use. To reduce the risk of unintentionally increasing misperceived norms, broadly disseminated substance-related information should “flip the conversation”.

That is, messaging should highlight protective peer norms (e.g., most youth do not use substances) instead of only focusing on risk behavior such as the prevalence of youth using a substance and/or associated outcomes. A social norms approach to sharing information suggests packaging substance-related information within messages about true positive norms in the opening (beginning), middle, and closing (end) of the communication.  

The Opening: Begin with presenting actual positive norms that most youth do not use substances and most do not view substance use favorably.

  • Ex. “Over 90% of Fairview students choose to never use alcohol, tobacco, or other drugs.” 

The Middle: Integrate a variety of positive norms messages when sharing substance-related information. Avoid including risk statistics, scare tactics, or distracting images.

  • Ex. “Fairview High School students value their friends. Most say they discourage friends from alcohol, tobacco, and other drug use.”

The Closing: Conclude with a final positive norms statement.

  • Ex. “Most students disapprove of their peers using substances. At the same time, students care for each other and can be resources to help prevent others from using or getting hurt. While the majority of students are not taking a risk, most would actively intervene to reduce harm and protect their peers.” 

To learn more about flipping the conversation with youth, view ADAPT’s NEW resource, Sharing Substance Related Information with Youth.


Arizona HIDTA Shares Two Year Outcomes of the Fentanyl Toolkit

Three years ago, Arizona experienced a drug threat like never before. An alarming number of youth under the age of 18 were overdosing and dying from fake pills containing fentanyl. In response to this crisis, nearly 30 substance use prevention coalitions, the Substance Abuse Coalition Leaders of Arizona, MATFORCE and Arizona HIDTA set out to change the trajectory of these tragedies. Over the course of the next six months, coalitions worked together to create our nation’s first Fentanyl Prevention Toolkit.

Modeled after another successful initiative to reduce youth opioid misuse, the Fentanyl Toolkit included information, presentations to parents and youth, social media and traditional media such as television and radio messages to get the word out with urgency. The toolkit was implemented by coalitions across the state in the summer of 2021. Now, with two years of work, focus and dedication, communities are seeing the success of their efforts. 

Parents now understand what fentanyl is and the risks even a tiny amount of fentanyl can have on a child. The data showed a whopping 185% increase in parental knowledge about where to get naloxone and a 146% increase in knowledge about how to administer naloxone. 91% of participants, youth and adults indicated they intended to make behavioral changes consistent with the intended objectives of the of the project.

  • For adults, this included: talking to their children/youth about risks, monitoring youth social media, carrying naloxone, changing the way that they talk about SUD and sharing the information with others.
  • For youth, this included staying away from pills not prescribed by their doctor, offering to help a friend who is struggling and calling 911 if they believe a friend is overdosing.

Since the project launched, non-fatal overdoses for youth under 18 have decreased 58%. Fatal fentanyl overdoses in that same age group are down 40%. Full 2023 fatal fentanyl overdose data will be available in 2024. Fentanyl toolkit materials are available at no charge to localize, use and download at Toolkit - SACLA (saclaz.org).

For more information on the toolkit or to learn more about the initiative contact AZ HIDTA Demand Reduction Coordinator Shelly Mowrey at smowrey@azhidta.org

Two New Resources Released at the 2023 HIDTA Prevention Summit

This year’s Summit, titled “Youth Substance Use Prevention: Addressing the Issues of Our Time,” delivered on its goals to share information and resources to support communities in addressing the ever-changing landscape of substance use. Two key messages were streamlined throughout the Summit: 


1. Ground prevention activities addressing current or new substances into a comprehensive strategy and,

2. Thoughtfully develop and evaluate prevention activities using the best available evidence to prevent unintended harm.  


The Summit served as a direct response to the multiple requests from HIDTA communities seeking guidance on these topics. The day-long event provided participants with key lessons learned from prevention science, including i) a rationale for why upstream prevention must be made a priority , ii) recognition that preventing substance use is multifaceted and requires a comprehensive community-based strategy that addresses a range of risk and protective factors, iii) awareness of how to share substance-related information while preventing from unintended harm, and iv) the need to engage communities in order to achieve effective prevention.


The Summit also released two new tools:

  1. Developing a Comprehensive Community-Based Strategy. This purpose of this brief is to 1) summarize key lessons learned from prevention science that highlight what works to prevent substance use and promote positive development in youth, and 2) present a five-phase approach to support the development and implementation of a comprehensive community-based prevention strategy.
  2. Sharing Substance-Related Information with Youth 11-18: Integrating the Best Available Evidence to Prevent Unintended Harm. This resource provides evidence-informed considerations for how to share substance-related information with youth 11-18 grounded in the science of social norms to reduce the risk of unintended harm.


Access both tools under the ‘Tools Released by ADAPT’ heading @ the

Prevention Intervention Resource Center.


An overwhelming 100% of Summit participants walked away having learned something new and 77% left ready to apply what they had learned!


In case you missed the Summit, read a detailed account HERE and visit our website to access Summit recordings and resources!

Mark Your Calendars

SAMHSA'S 20th Prevention Day on January 29th

SAMHSA's 20th Prevention Day will be held on January 29th in National Harbor, MD. The day-long event is free, but registration is required.


Get Connected

To view subscription links to all previously listed resources in this section, such as substance use prevention newsletters, click HERE and scroll to GET CONNECTED

Public Health/Public Safety Updates

Ketamine Update from NETI

Ketamine is classified as a dissociative anesthetic with abuse potential. Examination of ketamine-related fatalities in CDC Wonder shows a 1,196 percent increase in fatalities from 1999 through 2022. The data also show growing levels of fentanyl contamination of ketamine as evidenced by increased ketamine-related overdose deaths co-occurring with fentanyl.

However, when observed in the context of all overdose deaths, ketamine is not a significant cause of mortality, with only 298 deaths (.3 percent of all overdose fatalities) recorded for the calendar year 2022.

While deaths attributable to ketamine remain low, the trajectory of the increase is of concern. Recent interest in expanding the off-label use of ketamine for the treatment of pain and depression may result in increased availability of ketamine in the licit and illicit markets. Taken together, the trajectory of increased fatalities, co-occurrence with fentanyl, and the new interest in this substance for the treatment of additional disorders suggest further monitoring is warranted over time.

The graph displays U.S. overdose deaths for the category “other and unspecified general anesthesia, including ketamine.” The period of overdose analysis spans from 1999 through 2022.

Total Ketamine Deaths Per Year

ODMAP Newest Features

ODMAP is a free web-based tool that provides near real-time surveillance of suspected overdose events to support public safety and public health efforts to mobilize an immediate response to overdose events. The ODMAP team is always looking to improve how agencies use the system by enhancing the quality and characteristics of the tools on ODMAP. In November 2023, ODMAP released three new features, including: Polysubstance filters, the Demographics Layer, and the Spike Alert Layers.

The first feature, polysubstance filters, allows users to filter by primary suspected drug and additional suspected drugs. The filters can also be added to custom bookmarks. ODMAP users can now view additional suspected drugs on the incident pop up when clicking on a data point on the National Map, as well as viewed on the chart feature.

The second feature, the demographics layer, provides users with a county-level data dashboard that include information and charts on demographic and socio-economic data directly from the US Census. ODMAP users can toggle on the demographics layers by clicking on the layers button in the toolbar on the National Map.

The last new feature, Spike Alert Layers, are intended to provide ODMAP users a view of where current and recent spikes are directly on the National Map. Each layer is color coded based on how long ago the spike occurred. Current spikes will appear bright yellow on the National Map, whereas recent overdose spikes vary in color depending on the timeframe of the spike. Recent overdose spikes range from 0-3 days ago (shaded dark orange), 3-5 days ago (shaded peach), and 5-7 days ago (shaded beige).

Resources/Science from the Field

Drug Use Among Adolescents Continued to Hold Below Pre-Pandemic Levels in 2023

Latest results from The Monitoring the Future survey out of The National Institute on Drug Abuse found that the percentage of adolescents (8th, 10th, and 12th graders) reporting illicit substance use in 2023 has continued to hold steady below pre-pandemic levels. Additionally, the majority of adolescents reported abstaining from marijuana, alcohol, and nicotine in the past month.

Learn more HERE.

New Strategic Prevention Technical Assistance Center and Updated Strategic Prevention Framework

SAMHSA has launched a new resource center, the Strategic Prevention Technical Assistance Center (SPTAC), which serves as a national training and technical assistance system dedicated to culturally responsive, evidence-informed substance use prevention efforts. Visit the center here to request services and access resources.

The Strategic Prevention Framework (SPF) developed by SAMHSA was recently updated to include the concept of equity throughout the entire framework. The framework aids prevention practitioners in understanding and addressing substance use effectively.

For more on the SPF and to see its updated image, click HERE

Prevention Efforts are Working

To kick off Prevention Month in October, SAMHSA highlighted advancements in the field worth celebrating amidst the complicated landscape of substance use. Prevention efforts are working. The majority of youth 12 – 17 have never used substances, and youth substance use, including alcohol, have continued to decline in the past decade.

For more on how to optimize the impact of prevention and available resources to effectively put prevention science into practice, click HERE.

Tobacco Product Use Among U.S. Middle and High School Students

Findings from the 2023 National Youth Tobacco Survey show that most youth are not engaging in tobacco use whereas 10% of middle and high school students report current tobacco use, with e-cigarettes remaining the most commonly used product. Notably the use of e-cigarettes declined 4% from 2022.

Read the full study HERE.

Also available is a resource for educators on how they can support tobacco prevention and cessation. That resource can be found HERE. 

Employers Advancing Whole-Person Health

The National Institute on Drug Abuse recently highlighted the unique opportunity of employers to recognize and build employee health through a whole-person approach – considering the multiple factors that promote health. A culture of whole-person health in the workplace can be fostered through openness and acceptance, and ensuring access to services, such as employee wellness programs.

For more on this important topic, access the article HERE.

Retail Strategies to Promote Healthy Equity

The CDC brief, “Tobacco Where You Live: Retail Strategies to Promote Health Equity”, describes the tobacco industry’s tactics to promote its products within stores and sheds light on effective retail strategies that can be used to reduce the burdens of tobacco use and promote health equity. This brief can be used to help you understand the retail environment in your community, learn about retail strategies and how to implement them equitably to reduce disparities, overcoming opposition and enforcement challenges, and evaluating retail strategies.

Read the brief HERE.

2022 State-Level Data from Mental Health Agencies

2022 state-level mental health data is now available from SAMHSA. Metrics available include the number of clients who received services from State Mental Health Agencies, client demographics, percentage with a co-occurring substance use disorder, evidence-based practices implementation, perception of care, change in social connectedness, outcomes of services, such as improved school attendance, and readmission rates.

Specific state data can be found HERE, under “2022 Uniform Reporting System (URS) Table.”

The Basics of Social Media Management in Prevention

The Prevention Technology Transfer Center (PTTC) released an infographic designed to help prevention professionals use social media to maximize their prevention efforts. Guidance is provided for choosing the right platform, cross-posting, and other social media best practices.

The infographic can be found HERE.

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The ADAPT Team


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