Planning Ahead: Toolkit Helps Save Lives During Overdose Spikes

When a community suffers a spike in overdose-related deaths, saving lives requires quick action and seamless teamwork.

“Overdose spikes are when a jurisdiction exceeds a threshold that they would anticipate in a certain time period or geographic area,” said Sarah Ali, a CDC Foundation senior technical advisor with the Overdose Response Strategy (ORS) program. “When there are spikes, bringing together multiple agencies that may not historically work together is often the best way to address the issue quickly and prevent further overdoses.”

But creating an effective multi-sectoral response—bringing together first responders, law enforcement, public health professionals and others—requires planning and preparation well before a spike occurs. With each partner needing specific data and playing a unique role, coordination is critical.

“We saw there were limitations in how agencies prepare for these spikes. It can be challenging to come up with a multi-sector plan.” Ali said. “So creating a table-top exercise around a scenario within the range of what they might actually anticipate happening is one way to do that.”

In 2024, the ORS partnered with the Association of State and Territorial Health Officials to develop the Spike Response Exercise-in-a-Box, a customizable toolkit to help jurisdictions prepare for and conduct overdose spike response exercises. Comprised of sample scenarios, resources for response planning, a sample partner list and other tools, the toolkit is designed to get partners thinking in advance about how best to approach various scenarios.

“We make suggestions on who to include based on what we have seen to be effective over the years,” Ali said. “It's very important that these conversations are taking place before they are in crisis. It enables a much faster response.”

To pilot and refine this new resource, ORS and ASTHO partnered to host a four-part cohort series in 2025. Participants included representation from New Jersey, Delaware, Maryland, Mississippi and Tennessee, while both Idaho and Alaska ran concurrent pilots. The pilot fostered rich cross-jurisdictional learning and demonstrated the value of structured, customizable tools used to prepare for overdose spikes.

The CDC Foundation’s Overdose Response Strategy program, a nationally coordinated, cross-sector collaboration between public health and public safety, is working at the community level to help reduce fatal and non-fatal drug overdoses. Through the program, two-person teams made up of drug intelligence officers and public health analysts gather and analyze data on overdoses and advise jurisdictions on the latest prevention and protection strategies. Currently, there are 61 teams within and across sectors in all 50 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands.

This program is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $17,000,000, with 100 percent funded by CDC/HHS. A portion of this funding supported the project described in this material. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS, the U.S. Government, or the CDC Foundation.