In response to the surging opioid prescription rates by health care providers that contributed to the opioid epidemic in the United States, US states began passing legislation to stifle high-risk prescribing practices (such as prescribing high doses of opioids or prescribing opioids long-term). These new laws fell primarily into one of the following four categories:

Prescription Drug Monitoring Program (PDMP) enrollment laws: prescribers must enroll in their state's PDMP, an electronic database containing a record of all patients' controlled substance prescriptions PDMP query laws: prescribers must check the PDMP before prescribing an opioid Opioid prescribing cap laws: opioid prescriptions cannot exceed designated doses or durations Pill mill laws: pain clinics are closely regulated and monitored to minimize the prescription of opioids non-medically

Multi-state compact In July 2016, governors from 45 US states and 3 territories entered into an interstate compact titled a "Compact to Fight Opioid Addiction" organized by Massachusetts Governor Charlie Baker where they agreed to adopt the strategies for addressing the opioid epidemic modeled after the policies implemented in Massachusetts. They agreed that collective action would be needed to end the opioid crisis, and they would coordinate their responses across all levels of government and the private sector, including opioid manufacturers and doctors."A Compact to Fight Opioid Addiction", National Governors Assoc., July 13, 2016

Responses by state Alabama In 2017 Alabama had the highest overall opioid prescribing rate in the US. The University of Alabama – Birmingham has made a commitment to battle the opioid epidemic. UAB's "Addiction Scholars Program" trains health care professionals - doctors, nurses, therapists, and social workers with insights into addiction in a 15-month course. The UAB School of Nursing offers "Nursing Competency Suites" with training on treating infants born to opioid-addicted mothers. The university also began an "Opioid Stewardship Committee" to "…consistently and frequently address opioid stewardship."

Opioid data for Alabama indicated that, from 2006 to 2014 2.3 billion pain pills were prescribed in the state. McKesson Corporation distributed 728 million of these pain pills; Par Pharmaceutical manufactured 713 million. The highest number of the pills went to Senior Care Pharmacy in Northport AL.

Arizona Arizona's Governor Doug Ducey signed the Arizona Opioid Epidemic Act on January 26, 2018, to confront the state's opioid crisis. In Maricopa County which includes Phoenix, 3,114 overdoses were reported from June 15, 2017, through January 11, 2018. The law provides $10million for treatment and limits an initial opioid prescription to five days with some exemptions. Arizona also implemented a new strategy of prescription drug monitoring programs in 2017. Since then, the number of opioid prescriptions filled has dropped nearly forty percent, while the number of opioid prescriptions written has dropped forty-three percent (King, 2018). The reductions in these numbers both show Arizona going in the right direction, although, even with the decrease, the number of deaths and overdoses continue to rise.

Arkansas In October 2016, the state began the Arkansas Naloxone Project, a partnership of the State Drug Director's Office, DHS, and the Criminal Justice Institute (CJI) to allocate kits containing the nasal spray naloxone to first responders, schools, libraries, as well as drug treatment and recovery agencies to reverse the effects of opioid overdose. The project, funded by federal grants and the Arkansas Blue & You Foundation, distributed 7,000 kits and provided training to 8,000 individuals. Additionally, the Drug Director's Office and the CJI developed an app, nARcansas, a free opioid overdose training vehicle that shows how to administer the life-saving antidote and provide other information about opioids and overdoses, in both English or Spanish versions. The project has saved lives in almost half of Arkansas' 75 counties, with the most success in Pulaski County, the state's most populated.

California

In California, SB 482 took effect on October 2, 2018, requiring doctors and other healthcare professionals to check the Controlled Substance Utilization Review and Evaluation System, also known as CURES, before issuing any opioid prescriptions. SB 1109 was signed by Governor Jerry Brown in September 2018 (to take effect on January 1, 2019), requiring certain healthcare professionals undergo mandatory continuing education courses on the risk of addiction with opioids. In addition, this law would require outpatient pharmacies to apply warning labeling on all opioid prescription bottles cautioning patients of the risk of overdose and addiction associated with the drug. SB 1109 also targets vulnerable populations like students, requiring schools to provide students participating in youth sports or athletic programs with the CDC's Opioid Factsheet for Patients, that again address the risks of opioid use. In 2019, the city of San Francisco began a program called the Drug Overdose Prevention & Education (DOPE) Project, which trains individuals with substance use disorder, their families or anyone who may live in their communities who wants to help people suffering from overdoses. The DOPE Project, the largest single city naloxone-distribution effort in the US, instructs its advocates in the use of the nasal spray naloxone, an opioid reversal antidote. The group, able to save nearly 1,800 overdosing people in 2019, is currently challenged by the rise in fentanyl and methamphetamine use.

Colorado Overdose death from the drug fentanyl increased by 300% from 2018 to 2019, according to the Denver Department of Public Health and Environment. Overall death from all drug overdoses increased slightly over the same time period. Denver has created an "early warning system" to let drug rehab organizations know if fentanyl has been found in the area's recreational drug supply. The Harm Reduction Action Center, one of those organizations, provides substance users with a needle exchange and fentanyl-testing strips. In 2016, then Colorado Attorney General Cynthia Coffman launched the Naloxone for Life Initiative which initially distributed 7,000 naloxone kits around the state. The state medical director then issued an order to make the drug available without prescription. Applying the drug has been successful. Denver's paramedics administered the opioid-overdose reversal drug to over 700 individuals in 2018. Colorado experienced a small decrease in opioid overdose deaths between 2017 and 2018.

Connecticut In 2019 there were 1,200 opioid deaths in the state, a figure that will be reached shortly as 2020 has seen a 22% increase in opioid overdose mortality. The isolation of the COVID-19 pandemic, compounded by personal financial and other anxieties, has caused intense difficulty for people coping with addiction disorders as well as depression. Most traditional businesses have been affected by the pandemic, and the narcotic channel has remained active.

Delaware Delaware, which has the 12th-highest overdose death rate in the US, introduced bills to limit doctors' ability to over-prescribe painkillers and improve access to treatment. In 2015, 228 people had died from overdose, which increased 35%to 308in 2016."Delaware lawmakers tackle opioid addiction epidemic", Newsworks, March 23, 2017

District of Columbia The District began a program of free distribution of the nasal spray naloxone in 2018 with 17 locations dispensing the non-injection overdose-reversing drug. In 2020, due to a 50% increase in opioid overdose deaths, the District doubled the distribution to 35 locations in every ward throughout the city. The death statistics from D.C.'s Office of the Chief Medical Examiner are grim: 75% of overdose mortality are individuals 40–69, 70% are male, 84% are Black.

Florida In 2011, Florida passed a law creating a program that would provide monitoring and enforcement against illegal diversion of prescription pills in Florida (sometimes called the "Flamingo Express"). The law had not yet been enacted when Governor Rick Scott took office, and Scott proposed to repeal it before it came into practice. Scott told reporters the program "had no state funding, is complicated by contract challenges, is unproven and could infringe on innocent people's privacy."

Georgia The isolation accompanying the COVID-19 pandemic is hurting Georgians with opioid use disorder. Nationwide, overdoses of opioids jumped 42% in May 2020, according to the Overdose Detection Mapping Application Program, a United States government operation that tracks data from hospitals, ambulance, and police reports. The Georgia Council on Substance Abuse advised all first responders in the state to carry and be conversant with the administration of naloxone "…at all times." The nasal version of naloxone is critical for first responders during the pandemic as it can be dispensed at arm's length very quickly. The council further brought forth a substantial increase in Emergency Department visits due to opioid overdose. Because of the COVID-19 pandemic, individuals, they said, are missing personal counseling and 12-step meetings. The group also stated that calls to its CARES Warm line grew by 65 percent in three months with a higher intensity than ever experienced.

Hawaii In 2020, the Overdose Detection Mapping Program noted an 18% increase in opioid overdoses, prompting the US Department of Health and Human Services (HHS) to provide Hawaii with a $2 million (US) grant to increase opioid use disorder treatments. The grant will be divided between the Hawaii State Rural Health Association and the West Hawaii Community Health Center to develop new addiction therapy programs or grow access to existing initiatives.

Illinois The 2020 coronavirus pandemic resulted in a crisis within a crisis in Chicago as opioid overdose mortality doubled in the first five months of the year, compared to 2019 from 416 deaths to 924. Overdose deaths increased throughout the state, with the largest upturn in Cook County. Fentanyl, usually combined with heroin, was the drug at the center of 81% of the deaths, up from 74% in 2019.

Indiana Indiana has been one of the states seriously affected by the epidemic. In 2015, 1,600 people died from drug overdose; 1,000 of those deaths were opioid-related. By 2017, opioid-related deaths had increased to over 1,200, followed by a small, measured decline since then. In 2018, drug overdose deaths fell 12.9%, almost three times the US average decline, as the state government focused on evidence-based, transformative programs to continue the decline. In 2020, SAMSHA provided a $1 million grant to the state of Indiana and its Social Services Administration to distribute the nasal spray naloxone to individuals in the state whom the ISSA determined were at risk from opioid overdose.

The Chief of Police of Lawrence, IN, (pop.40,000) ordered his officers to cease the administration of the opioid antagonist nasal spray naloxone during the Coronavirus pandemic, fearing that his first responders risk COVID-19 infection exposure by dispensing the intra-nasal drug. The Indiana Department of Homeland Security rejected the chief's order as not being evidence-based and encouraged the administration of the drug by the city's police. A near-by city, Ft. Wayne's (pop.267,000), police continue to disburse the drug which resulted in 233 individuals restored by Narcan in the first quarter 2020.

Kansas