A Compact to Fight Opioid Addiction

Governors have long been at the forefront of efforts to prevent and treat opioid addiction, working with health care providers, law enforcement and other stakeholders to mount a comprehensive response to the opioid crisis. Although there has been progress in recent years, inappropriate opioid prescribing continues to fuel one of the deadliest drug epidemics in our nation’s history, claiming the lives of 78 people every day. More Americans died from drug overdoses in 2014 than in any year on record. Driven by a spike in opioid-related deaths, drug overdose now surpasses motor vehicle crashes as the leading cause of injury death in the United States. While most opioid-related overdoses involve prescription painkillers, an increasing number are linked to heroin and fentanyl, a powerful synthetic opioid often packaged and sold as heroin. The consequences of the opioid epidemic continue to reverberate through society, ruining lives, devastating families and overwhelming the health care system, law enforcement and social services.

During the 2016 NGA Winter Meeting, governors agreed that collective action is needed to end the opioid crisis. With more lives lost every day, governors are redoubling their efforts to combat the epidemic with bold and thoughtful new strategies. While states play a central role in ending this public health and safety emergency, they cannot do it alone. Turning the tide on the epidemic requires a coordinated response across all levels of government and strong leadership from the private sector, including opioid manufacturers and prescribers.

With this compact, the undersigned commit to build on their efforts to fight opioid addiction by

  • Taking steps to reduce inappropriate opioid prescribing, which may include:
    • Partnering with health care providers to develop or update evidence-based opioid prescribing guidelines, which may be informed by CDC’s guideline, and consider prescription limits with exceptions for certain patients and circumstances;
    • Requiring that physicians, osteopaths, nurse practitioners, physician assistants, dentists, veterinarians and all other opioid prescribers receive education on pain management, opioid prescribing and addiction throughout their training and careers;
    • Integrating data from state prescription drug monitoring programs (PDMPs) into electronic health records and requiring PDMP use by opioid prescribers and dispensers; and
    • Reducing payment and administrative barriers in Medicaid and other health plans to promote comprehensive pain management that includes alternatives to opioid painkillers.
  • Leading efforts to change the nation’s understanding of opioids and addiction, which may include:
    • Developing a communications strategy through the governor’s office to raise awareness about the risks of abuse associated with opioid use and reduce the stigma of addiction;
    • Establishing social media campaigns and integrating education into schools, athletic programs and other community-based settings to raise awareness about opioid abuse and addiction among youth and other at-risk groups; and
    • Partnering with professional associations to improve understanding of the disease of addiction among health care providers and law enforcement.
  • Taking actions to ensure a pathway to recovery for individuals with addiction, which may include:
    • Reducing payment and administrative barriers in Medicaid and other health plans to promote access to a range of treatment options, including well-supervised medication-assisted treatment and comprehensive recovery services;
    • Pursuing overdose prevention and harm reduction strategies, such as Good Samaritan laws and standing orders to increase access to and use of naloxone; and
    • Implementing and strengthening programs that provide addiction treatment as an alternative for non-violent individuals charged with low-level drug-related crimes.

During the 2017 NGA Winter Meeting, NGA will report on specific steps governors have taken to meet the above commitments and build on their existing efforts. These actions may include examining policies in Medicaid and other state health programs, such as corrections and state employee health programs; convening stakeholders; establishing new coalitions; and incorporating the above commitments into the governor’s budget and legislative priorities.


Governor Robert Bentley

Governor Bill Walker

Governor Lolo Matalasi Moliga
American Samoa

Governor Doug Ducey

Governor Asa Hutchinson

Governor Edmund G. Brown, Jr.

Governor Daniel Malloy

Governor John Hickenlooper

Governor Jack Markell

Governor Eddie Calvo

Governor David Ige

Governor Mike Pence

Governor Terry Branstad

Governor Sam Brownback

Governor Matt Bevin

Governor John Bel Edwards

Governor Larry Hogan

Governor Charlie Baker

Governor Rick Snyder

Governor Mark Dayton

Governor Phil Bryant

Governor Jay Nixon

Governor Pete Ricketts

Governor Brian Sandoval

Governor Maggie Hassan
New Hampshire

Governor Chris Christie
New Jersey

Governor Susana Martinez
New Mexico

Governor Andrew Cuomo
New York

Governor Pat McCrory
North Carolina

Governor Jack Dalrymple
North Dakota

Governor John Kasich

Governor Mary Fallin

Governor Kate Brown

Governor Tom Wolf

Governor Alejandro Padilla
Puerto Rico

Governor Gina Raimondo
Rhode Island

Governor Nikki R. Haley
South Carolina

Governor Dennis Daugaard
South Dakota

Governor Bill Haslam

Governor Gary Herbert

Governor Peter Shumlin

Governor Terry McAuliffe

Governor Jay Inslee

Governor Earl Ray Tomblin
West Virginia

Governor Scott Walker

Governor Matthew Mead