Opioid Awareness Campaign

Keeping Glen Cove SAFE Opioid Awareness Campaign

The SAFE Glen Cove Coalition is conducting a opioid prevention awareness campaign entitled “Keeping Glen Cove SAFE” to educate and update the community on opioid use and its consequences.

According the National Institute of Drug Abuse, every day more than 115 Americans die after overdosing on opioids. The misuse of and addiction to opioids – including prescription pain relievers, heroin and synthetic opioids such as fentanyl – is a serious national crisis that affects public health as well as social and economic welfare.

The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.

In response to the opioid crisis, the U.S. Department of Health and Human Services is focusing its efforts on five priority areas: improving access to treatment and recovery services; promoting use of overdose-reversing drugs; strengthening our understanding of the epidemic through better public health surveillance; providing support for cutting-edge research on pain and addiction and advancing better practices for pain management.

The Coalition, composed of 12 sectors of the community (youth, youth serving organizations, parents, business community, media, school, law enforcement, faith-based organizations, civic and volunteer groups, healthcare professionals, state, county and local governmental agencies and other organizations with expertise in substance abuse) will continue to monitor and educate the community about this serious crisis. Please see below for helpful resources.

As part of the “Keeping Glen Cove SAFE” campaign, Steve Chassman, LCSW, CASAC, Executive Director of the Long Island Council on Alcoholism and Drug Dependence gave a presentation at Glen Cove City Hall to educate the public and SAFE board and coalition members about the current state of the nation’s opioid epidemic, the potential impact of the legalization of marijuana, and vaping-the latest identified trend in youth substance use.

Monitoring the Future Survey

Monitoring the Future (MTF) is one of the nation’s most relied upon scientific sources of valid information on trends in use of licit and illicit psychoactive drugs by U.S. adolescents, college students, young adults, and adults up to age 60. MTF is conducted each year by researchers at the University of Michigan, Ann Arbor, and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

The MTF survey is given annually to students in eighth, 10^th, and 12^th grades who self-report their substance use behaviors over various time periods, such as past 30 days, past 12 months, and lifetime. The survey also documents students’ perception of harm, disapproval of use, and perceived availability of drugs and has been doing so since 1975.

In 2023 7,584 12th grade students in 83 schools distributed throughout the US. Data collection took place in both public and private high schools. MTF used an electronic questionnaire format for the fifth consecutive year. Starting in 2021, students in 8th, 10th, and 12th grades completed a web-based questionnaire on their own electronic devices during class time (which may have been at home if they were schooling remotely, for example as a result of the pandemic). In both 2019 and 2020 students also completed an electronic questionnaire that was connected to the internet, although they completed the survey on electronic tablets that MTF brought to schools. It is no longer necessary for MTF to bring tablets to schools because practically all schools now have internet access and almost all students have electronic devices to complete the MTF questionnaires. In rare cases when these resources are not available at a school, MTF brings electronic devices for students, as well as a mobile server to collect their survey responses.

The survey results divide neatly into the time periods before and after the onset of the pandemic. All surveys in 2020 were completed before March 15, when national social distancing policies were enacted, and data collection was halted due to pandemic concerns. Consequently, results from 2020 and previous years are pre-pandemic, while results from 2021 and afterwards took place after the onset of the pandemic and the associated national response. The COVID-19 pandemic is a historical event of particular interest for the 2023 results. From 2020 to 2021 MTF documented some of the largest one-year declines ever recorded by the survey across a wide variety of drugs from. It is possible that these decreases will hold for future years going forward, or, instead, drug prevalence levels may bounce back to where they were before the pandemic, as recorded by MTF with the 2020 results.

Past 12-month use of Heroin has always been relatively low, with annual prevalence never higher than 2% at any time in the survey for any grade.

In 2023 the level of annual use was 0.4% or less in each grade. Prevalence levels of heroin are now at or near all-time lows, after a long decline from a peak established at the end of the 1990s drug relapse period.

One unusual pattern specific to heroin is that the late 1990s mark the highest levels of use ever recorded in the study, whereas for most other drugs the all-time highs were set near the beginning of the 1980s. This trend was due in part to the advent of heroin use without a needle. The increase in heroin use that occurred around 1995 was recognized quickly and gave rise to some ameliorative actions, including an anti-heroin campaign by the Partnership for a Drug-Free America.

An increasing number of deaths due to heroin use, is widely known.

Narcotics Other Than Heroin -Use of narcotics other than heroin without a doctor’s orders is reported only for 12th grade students. In 2023 lifetime use declined significantly, bringing prevalence to 2.4%, which is the second-lowest recorded (the lowest was 2.3% in 2021).

The 2.4% level is more than six times lower than the high of 14% in 2002. Past 12-month use also significantly declined in 2023 to 1%, which ties with 2021 as the lowest level recorded by the survey.

Past 30-day use declined, although not significantly, to a level of 0.4%, which is the second-lowest recorded by the survey.

Two patterns make trends in use of these drugs unique. First, peak use came during the 1990s relapse—and not during the 1980s as it did for so many other drugs—suggesting that its rise during the 1990s was more than just a return to drug use patterns of the past and instead represented the emergence of new, unique patterns of use for adolescents. Second, the peak established after the 1990s drug relapse stayed at a stubbornly high level for much longer than most illicit drugs.

High levels of use during the 2000s raised concern that use of these types of 41 prescription drugs had become endemic. The recent decline in prevalence since 2010 shows that efforts to reduce use among adolescents have been successful.

In 2023 the list of example narcotics in the survey question included Methadone, Codeine, OxyContin, Percodan, Opium, Demerol, Percocet, Ultram, Morphine, Oxycodone, Tylox, Tramadol, Vicodin, Hydrocodone (Lortab, Lorcet, Norco), MS Contin, and Suboxone. All results from 2020 are from surveys completed before March 15, 2020, when national social distancing policies were implemented and the survey halted due to pandemic concerns.

OxyContin- In 2023 the percentage of youth who used the specific narcotic drug OxyContin without a doctor’s orders significantly declined in 10th and 12th grade, and it was 0.8% or lower in all grades. Use of OxyContin has declined overall since first tracked by the survey in 2002. Its prevalence began a long-term decline in 2009/2010 for 10th and 12th grade students and in 2013 for 8th grade students, resulting in record or near-record lows in 2023.

Vicodin- Use of the specific narcotic drug Vicodin without a doctor’s orders had an annual prevalence of less than 1% across the three grades in 2023. Levels of use significantly declined to record lows in 2023 for 12th and 10th grade students. The low levels in 2023 are the result of a marked decline from peaks before 2010 of 3% in 8th grade, 8% in 10th grade, and 11% in 12th grade. While there was a large age difference in prevalence in earlier years, there remained practically none in 2023 as prevalence approached zero.

Local Resources

Central Nassau Guidance and Counseling Services
Outpatient detoxification (ancillary withdrawal) services for opiates, alcohol and benzodiazepines/medication assisted treatment.

New mobile treatment unit offers opioid use disorder as well as a variety of addiction services, including access to medication assisted treatment. It is the first mobile addiction treatment unit in Nassau County.

Long Island Addiction Resource Center
Long Island Addiction Resource Center provides easy-to-use access to invaluable information about providers of education, prevention, treatment, recovery and peer services in Nassau and Suffolk counties. This bi-county, collaborative effort is aimed at all populations – community members, substance use disorder and problem gambling field professionals. 24/7 Emergency hotline information, Diagnostic, Assessment and Stabilization, Crisis Center Hotline Support.

Nassau County Department of Human Services Office of Mental Health, Chemical Dependency & Developmental Disabilities Services

Nassau County Heroin Prevention Taskforce

Nassau County Opioid Treatment Program

Nassau County District Attorney’s Office Report on Fatal Heroin Overdoses

Nassau/Suffolk Treatment Programs for Opioid Addiction (PDF)

Long Island Council on Alcohol and Drug Dependence

Long Island Prevention Resource Center

North East Recovery Alliance of Long Island (NERALI)

Concerned Persons Group (PDF)

Contact: jane.fox@nerali.org (516) 589-9171
https://www.facebook.com/nerali.org

Opioid Prevention Youth Focus Group

Empirical evidence suggests that peer education is effective in changing adolescent risk behaviors and is an important part of prevention. It is necessary to engage youth regarding the harms of substance abuse, especially now, given the nation’s opioid epidemic. Because most abusers start at a young age, early prevention education is critical. The group is facilitated by SAFE’s bilingual outreach worker, Laurent Caballero and SAFE Social Worker, Nicole Giordano. Open to all Glen Cove youth between the ages of 10 and 20.

Meets the second Monday of every month 6:30 p.m. to 7:30 p.m.

Trinity Lutheran Church, 74 Forest Avenue

Medication Assisted Treatment for Opioid Addiction on Long Island

CNG Mobile Recovery Unit
Call 516-396-2778 to set up an appointment or for more information

Counseling Service of Eastern District New York
Long Island
175 Fulton Avenue, Suite 300, Hempstead, NY 11550
516-481-0052

Garden City Treatment Center/Zucker Hillside Hospital (Northwell Health)
711 Stewart Avenue
Garden City, NY 11040

Nassau County Opioid Treatment Program
2201 Hempstead Turnpike
Building K on First and Second Floors, East Meadow, NY 11554
516-572-6305

NY State Resources

New York State Department of Health: Addressing the Opioid Epidemic in New York State

Reported Overdose Deaths in New York Have Reached a Record High

New York, like many states, is suffering the consequences of an opioid epidemic. The New York State Department of Health focuses on statewide prevention activities to build a coordinated approach to fight addiction, reduce deaths from overdose and evaluate state and local programs. Efforts include:

Identifying and sharing data between agencies and affected communities
Developing training for health care providers on addiction, pain management and treatment
Making the prescription drug monitoring program easier for providers to access and use
Providing resources to assist communities in combating the opioid epidemic at the local level
Coordinating statewide and community programs to improve the effectiveness of opioid prevention efforts.

As a result of these efforts, New York has restrictions on opioid and other controlled substance prescriptions. It has also established educational programs for healthcare providers on safe prescribing practices. The state is working to expand the availability of the overdose prevention drug naloxone, and buprenorphine, a type of Medication Assisted Treatment.

For more information about the Opioid Epidemic, educational resources for Substance Use Disorder please visit https://www.health.ny.gov/community/opioid_epidemic/.

NYS Office of Alcoholism and Substance Abuse Services (NYS OASAS)
The Suspect an Overdose campaign focuses on making sure individuals know how to recognize an overdose and to call 911 if they suspect someone has overdosed. Also mentioned is the importance of Naloxone as it can save a life and the Good Samaritan law. Video:
https://youtu.be/ZZRyHfX-VaE (English)

https://youtu.be/ZZRyHfX-VaE (Spanish)

NYS Office of Alcoholism and Substance Abuse Services (NYS OASAS)
New Hope, New Life: A weekly educational program focusing on addiction prevention.

New York State Department of Health Opioid Surveillance Data Dashboard
This dashboard makes opioid-related data easily accessible to health officials and the public, and displays data for opioid indicators interactively state, county, and sub-county levels. The dashboard is designed to be a key resource for enhancing the utilization of opioid surveillance data, and assisting in the response to the opioid crisis.

NYS Office of Addiction Services and Supports Addiction: The Next Step Podcast

The topics addressed in the program include important issues such as the presence and impact of fentanyl in the illegal drug supply, community understanding and acceptance of medication treatment options and growing the addiction workforce.

Federal Resources

The federal government is responding to the opioid crisis with resources relevant to all types of communities, including rural areas:

H HS.gov/Opioids: The Prescription Drug & Heroin Overdose Epidemic
U.S. Department of Health & Human Services (HHS)
Resources to help locate treatment, an overview of the opioid epidemic, and the HHS 5-point strategy to address it. Includes resources and information for prevention, treatment, and recovery.

HRSA’s Response to the Opioid Crisis
Health Resources and Services Administration (HRSA)
Highlights efforts underway at HRSA to address the opioid crisis, including expanding access, use of telehealth, primary care training, and more. Also identifies HRSA-supported resources and technical assistance centers.

Drug Overdose Deaths in the United States
NORC at the University of Chicago, U.S. Department of Agriculture
Interactive map providing access to county-level drug overdose deaths, including deaths due to opioid overdose. Includes the option to overlay socioeconomic data, limit to rural or urban counties, and view by timeframe for 2007-2011 and 2012-2016.

CMS Roadmap to Address the Opioid Epidemic
Centers for Medicare and Medicaid Services
Highlights the efforts underway at CMS to address the opioid epidemic focused on prevention, treatment, and data utilization to target prevention and treatment activities. Includes some information specific to rural areas.

CDC Opioid Overdose
Centers for Disease Control and Prevention (CDC)
Information to help patients, providers, and the public understand opioids and learn how to prevent opioid overdose. Provides access to data and CDC reports on the opioid crisis.

CDC
Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students –Youth Risk Behavior Survey, United States, 2019

NIDA Opioid Overdose Crisis
National Institute on Drug Abuse (NIDA)
Provides background information on how the opioid crisis developed, as well as an overview of what the National Institutes of Health (NIH) is doing to address it. Includes related NIDA/NIH resources, as well as resources from other federal sources.

Evidence-Based Practices Resource Center
Substance Abuse and Mental Health Services Administration (SAMHSA)
A collection of resources to help incorporate evidence-based practices into communities and clinical settings. Includes opioid-specific resources (select under Topic Area).

SAMHSA: Tips for Teens: The Truth About Opioids

This fact sheet for teens provides facts about opioids. It describes short- and long-term effects and lists signs of opioid use. The fact sheet helps to dispel common myths about opioids. Access sources cited in this fact sheet.

SAMHSA-Opioid Response Network

In response to the nation’s opioid crisis, SAMHSA awarded a two-year grant to provide technical assistance via local experts across the country, focusing on applying evidence-based practices in prevention, treatment and recovery to meet locally identified needs.

SAMHSA-Guidebook on Substance Misuse Prevention Among Young Adults
This guide supports health care providers, systems, and communities seeking to prevent substance misuse among young adults. It describes relevant research findings, examines emerging and best practices, identifies knowledge gaps and implementation challenges, and offers useful resources.

SAMHSA Grantee Stories, Tools, and Resources: Prescription Drugs/Opioids
Substance Abuse and Mental Health Services Administration (SAMHSA)
Highlights videos, online courses, tools, and SAMHSA grantee stories related to addressing the opioid crisis.

SAMHSA-HRSA Center for Integrated Health Solutions
Substance Abuse and Mental Health Services Administration (SAMHSA)
Health Resources and Services Administration (HRSA)
Resources, models, training, and technical assistance for developing integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions.

SAMHSA National Survey on Drug Use and Health 2022: Shows how people living in America reported about their experience with mental health conditions, substance use, and pursuit of treatment in 2022.

SAMSHA Overdose Prevention and Response Toolkit

SAMSHA: The Opioid Crisis and the Black/African American Population: An Urgent Issue

Facing Addiction in America
U.S. Surgeon General
Reports and information related to addiction, with a special focus on resources to address the opioid crisis.

Combatting the Opioid Epidemic
Office of the Inspector General (OIG), U.S. Department of Health & Human Services (HHS)
Describes efforts underway at the OIG to address the opioid crisis by identifying opportunities to improve HHS programs, detecting and addressing fraud, and sharing data and methods with partners. Includes related reports and resources.

Action Collaborative on Countering the U.S. Opioid Epidemic
National Academy of Medicine, Aspen Institute, 30+ Additional Organizations
A public-private partnership focused on sharing knowledge related to the opioid crisis, aligning initiatives, and advancing shared solutions.

CDC TRAIN: Opioid Training
Public Health Foundation
A wide range of public health training opportunities related to the opioids, including recorded webcasts and self-study. Includes training from the federal agencies and national organizations.

National Resources

Addiction Policy Forum

The Addiction Policy Forum was created by families impacted by Opioid Use Disorder, working in states and communities across the country to end stigma, help patients and families in crisis and translate the science around addiction and is a nationwide nonprofit organization dedicated to eliminating addiction as a major health problem.

American Medical Association:2021 Overdose Epidemic Report

American Medical Association: Physicians’ progress toward ending the nation’s drug overdose and death epidemic

ATLAS
Directory of addiction treatment facilities across the state with transparent data on the use of evidence-based medical practices and patient experiences.

American Lung Association: Opioids and Lung Health

American Lung Association: Brief: Tobacco and Opioids

CADCA Practical Theorist 13: Fentanyl: Why Fentanyl/Why Now

Fentanyl is one of the most dangerous substances circulating in communities across America. It is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine (DEA Fentanyl Factsheet, 2020). As little as 2mg of fentanyl – the equivalent of a few grains of salt – can be lethal, particularly for youth, young adults, or others who have not previously used fentanyl.

Given the urgency and magnitude of the opioid crisis, which is currently being driven by increases in the availability of highly lethal illicitly manufactured fentanyl, it is critical to focus on primary prevention how it can be utilized to address fentanyl in our nation’s communities.

Community Anti Drug Coalitions of America (CADCA)

This Practical Theorist is part of a series of publications designed to summarize field research on key drug abuse issues, and to present it in a concise, practical format, with strategies for using the data to mobilize communities and support the mission of coalitions. CADCA is proud to release their latest Practical Theorist: Addressing the Opioid Crisis through Community Prevention – An Application of the Seven Strategies for Community Change.

The publication covers important topics related to the opioid epidemic:

Brief history of opioid addiction
Types and classifications of opioids
Physiological basis of opioid addiction
Individual and environmental factors related to misuse
Seven strategies for community change

Lock Up Your Meds

The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS)

Every Step of the Way– a new statewide awareness campaign to direct the public to critical addiction resources and help reduce overdose rates and save lives.

Available addiction treatment including crisis/detox, inpatient, community residence, or outpatient care can be found using the NYS OASAS Treatment Availability Dashboard at FindAddictionTreatment.ny.gov or through the NYS OASAS website. Visit CombatAddiction.ny.gov to learn more about the warning signs of addiction, review information on how to get help, and access resources on how to facilitate conversations with loved ones and communities about addiction. For tools to use in talking to a young person about preventing alcohol or drug use, visit the state’s Talk2Prevent website.

MedicineSafe: A coalition of national and state public and private partners, to provide expert information and tools for safely managing prescription drugs and opioid addiction.

RAND-USC Schaeffer Opioid Policy Tools and Information Center (OPTIC)
A national resource, fostering innovative research in opioid policy science, and developing and disseminating methods, tools, and information to the research community, policymakers, and other stakeholders. Focus is on policy effects at multiple levels, the health care consequences of opioid misuse, and treatment access and effectiveness.

Shatterproof: Shatterproof is a national nonprofit dedicated to reversing the addiction crisis in the United States.

Substance Abuse and Mental Health Services Administration

National Institute on Drug Abuse

National Library of Medicine – Opioid Use and Information Resources

National Safety Council: Get Help for Opioid Use Disorder

Words Can Work: Knowing the Issues and Talking with Kids info@wordscanwork.com

U.S. Department of Health & Human Services: Overdose Prevention Strategy

The Overdose Prevention Strategy expands the scope of the crisis response beyond opioids to include other substances that are often involved in overdoses, including stimulants such as methamphetamine and cocaine. This new strategy promotes groundbreaking research and evidence-informed methods to improve the health and safety of our communities.

The Strategy is guided by four principles:

Equity
Data and evidence
Coordination, collaboration, and integration
Reducing stigma

Additional Resources for Healthcare Providers, Educators and Parents

American Journal of Public Health: Targeting Youth to Prevent Later Substance Use Disorder: An Underutilized Response to the U.S. Opioid Crisis

Best Practices. The American Academy of Pediatrics’ Committee on Substance Use and Prevention outlines best practices for the health sector to screen, treat, and refer adolescents with substance use issues.

Drug Enforcement Administration: Drugs of Abuse 2022

CDC Guideline for Prescribing Opioids for Chronic Pain. The CDC aims to save lives and prevent opioid misuse, opioid use disorder, and overdose by equipping providers with the knowledge, tools, and guidance they need. With these goals in mind, CDC developed the Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain resource, which is intended to help healthcare systems integrate the Guideline and associated quality improvement (QI) measures into their clinical practice.

This resource offers primary care providers, practices, and healthcare systems a framework for managing patients who are on long-term opioid therapy.

Latest Research and Resources. The NIH Public-Private Initiative to Address the Opioid Crisis researches “new and improved” approaches to prevent, detect, and reverse overdoses as well as identify nonaddictive treatments for chronic pain. Also, OAH’s Adolescent Health Library has a range of relevant resources on illicit and non-illicit drug use.

Lesson Plans. Educators can find lesson plans from the National Institute on Drug Abuse for Teachers that help them inform their students and answer questions about the nature of prescription drug abuse.

National Institute of Drug Abuse (NIDA). Results of the Monitoring The Future (MTF) survey 2020, released by the National Institute of Drug Abuse (NIDA). The MTF survey has measured drug and alcohol use and related attitudes among adolescent students nationwide since 1975. Survey participants report their drug use behaviors across three time periods: lifetime, past year, and past month. The survey is funded by the NIDA and conducted by the University of Michigan.

National Institute on Drug Abuse for Teachers – Mind Matters Series: Teach middle school students the facts about how nicotine, opioids and marijuana affect the brain and body with the new Mind Matters series. These free booklets are available in English and Spanish.

Partnership for Drug-Free Kids:Heroin, Fentanyl and Other Opioids e-Book

Relationship Building. Keeping Youth Drug Free provides parents and caregivers tips on building strong relationships with teens, guidance for tough conversations about substance use, and a list of common drugs and their street names. OAH also has tips on how parents and caregivers can start these conversations with their teen.

State Laws. The Prescription Drug Abuse Policy System keeps track of important state laws about prescription drug abuse such as prescription drug monitoring programs, opioid prescribing guidelines, and Good Samaritan overdose prevention laws.

Operation Prevention. The DEA has joined forces with Discovery Education to create a comprehensive, no-cost program to combat opioid misuse – available in every school, home, and state in the nation. With Virtual Field Trips, Parent Resources, English & Spanish language standards aligned K-12 tools, and a national peer-to-peer video challenge, look no further to kick-start life-saving actions today.

Opioid Overdose Prevention Toolkit: This toolkit from SAMHSA includes facts for community members, five essential steps for first responders, information for prescribers and safety advice for patients and family members recovering from opioid overdose. Spanish version: Manual de Instrucción de SAMHSA Para la Prevención de Sobredosis de Opioides.

SAMHSA Update on Opioid Crisis – SAMHSA’s latest update on the opioid crisis.

SAMHSA – Finding Quality Treatment for Substance Use Disorders: This Treatment Locator serves as a guide for individuals seeking behavioral health treatment. It provides three necessary steps to complete prior to utilizing a treatment center and the five signs of a quality treatment center, which include a review of the accreditation, medication, evidence-based practices, position on the role of families, and support networks.

SAMHSA – Medications for Opioid Use Disorder: This manual will benefit people with substance use or abuse problems, public health professionals, professional care providers, policymakers, parents and caregivers, family and advocates.

SAMHSA – Decisions in Recovery: Handbook for the treatment of opioid use disorder for individuals seeking to cut down or stop use of narcotics, prescription painkillers, heroin or any other opioid drug.

SAMHSA – Opioid Facts for Teens

SAMHSA – The following resources are offered online only. Please click on the link to obtain a variety of information regarding prescription medications. Topics include but are not limited to: treatment of opioid overdose with naloxone, common names for prescription opioids, know the risks of prescription opioids and for doctors – facts for prescribing opioid medications.

SAMHSA– Medications for Opioid Use Disorder. For Healthcare and Addiction Professionals, Policymakers, Patients and Families. This updated Treatment Improvement Protocol (TIP) reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat OUD—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support recovery for people with OUD.

SAMHSA – Behavioral Health Treatment Services Locator

Surgeon General’s Spotlight on Opioids – The Surgeon General Spotlight on Opioids assembles opioid-related information from the Surgeon General’s Report on Alcohol, Drugs, and Health into one document to better inform the general public, especially family and friends of people with an elevated risk of opioid overdose, opioid misuse, and/or opioid use disorder.

U.S. Department of Health & Human Services Overdose Prevention Strategy

The Strategy is guided by four principles: