National Call for Commitment Statements on Countering the U.S. Opioid Epidemic

The Action Collaborative on Countering the U.S. Opioid Epidemic is a one-of-a-kind public-private partnership that comprises government, communities, health systems, provider groups, payers, industry, nonprofits, academia, and more - all committed to sharing knowledge, aligning ongoing initiatives, and advancing collective, multi-sector solutions.

We understand that the opioid epidemic is complex and multi-sectoral, and that it will take all of us to ensure that solutions reach those who need them most. Therefore, we invite you to join our expanding group of Network Organizations to help disseminate and translate promising approaches to reversing the trends of the opioid epidemic.

Criteria for Network Organizations:

Participation is restricted to legal entities organized and recognized in accordance with applicable federal and state law.
Individuals and groups of individuals are not eligible.
Legal entities with a primary financial interest in developing, manufacturing, producing, distributing, or marketing any drug or device (as defined by FDA law) are not eligible.
Participation is restricted solely to the Action Collaborative's Network Organizations and does not include membership in the Action Collaborative itself, its steering committee, or any of its working groups.
Participation is subject to the approval of a Commitment Statement by the National Academy of Medicine submitted in accordance with the criteria described below.

Criteria for Commitment Statements:

The commitment statement must be submitted on the entity's official letterhead.
The commitment statement must begin with a paragraph that clearly describes the mission and purpose of the entity, including a description of any services it provides and/or the products it produces.
The commitment statement must include a paragraph that specifically relates work the entity has underway with one of the four focus areas of the Action Collaborative:
- Health Professional Education and Training
- Pain Management Guidelines and Evidence Standards
- Prevention, Treatment, and Recovery Services
- Research, Data, and Metrics Needs
The commitment statement may not include any promotional or marketing language about products, services, or material that the entity may develop, support, produce, or distribute.
The commitment statement may reference the entity's participation as a Network Organization within the National Academy of Medicine's Action Collaborative on Countering the U.S. Opioid Epidemic. The commitment statement may not refer to the entity as a member of the Action Collaborative, its steering committee, or one of its working groups; as a partner of the National Academy of Medicine; or otherwise state or imply adoption or endorsement by the National Academy of Medicine of the entity or its products or services.
The National Academy of Medicine has sole discretion to determine if these criteria have been met, including a determination of what is promotional or marketing material.

Please direct all questions or comments to OpioidCollaborative@nas.edu. A member of the National Academy of Medicine's staff will respond to your inquiry within 14 business days of receipt.

1. Name of organization: *This question is required.

2. Has your organization been incorporated for longer than one year? *This question is required.

3. How would you best categorize your organization? (Please select more than one option if appropriate.) *This question is required.

4. Describe, in 50 words or less, what your organization does. *This question is required.

5. Which one (or more than one) of the Action Collaborative's four areas of focus is your organization working in? *This question is required.

Health Professional Education and Training
Pain Management Guidelines and Evidence Standards
Prevention, Treatment, and Recovery Services
Research, Data, and Metrics Needs

6. Please provide any relevant links to websites or webpages relevant to your organization's work on the opioid epidemic. Include links to specific webpages only - links to general organizational webpages will be discarded. *This question is required.

7. Upload any files relevant to your organization's work on countering the opioid epidemic. Word documents and PDFs will be accepted.

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8. Name of organizational liaison:
Note: The name of this liaison will be listed on the NAM's website to help create a self-facilitating network unless you prohibit the NAM from listing this person's name. This person should be able to direct inquiries and/or allocate resources if requested, ut does not need to be a subject matter expert or in a leadership position. *This question is required.

9. Business title for organizational liaison: *This question is required.

10. Email address for organizational liaison: *This question is required. This question requires a valid email address.

11. Contact information for the organizational liaison will be posted on the NAM website to facilitate outreach and information sharing among network organizations. Please indicate whether or not you agree to share this information. *This question is required.

12. Name of a communications or media contact at the organization, if different from the liaison specified:
Note: This information will not be shared publicly and will be used by NAM staff to share products and communications materials of the Action Collaborative.

13. Email address for the communications/media contact:
Note: This information will not be shared publicly. This question requires a valid email address.

14. Please upload your organizational commitment statement as a Word or PDF document. Please refer to the submission guidelines above. *This question is required.

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15. Please affirm that you have read and agreed to the below Terms of Engagement for Network Organizations.

Terms of Engagement for Network Organizations for the National Academy of Medicine's Action Collaborative on Countering the U.S. Opioid Epidemic

The Network Organization agrees to support the work of the Action Collaborative by communicating and disseminating the Collaborative's materials and products.
At the request of the National Academy of Medicine, the Network Organization may be asked to provide expertise to the Action Collaborative that cannot be obtained through existing member organizations.
The Network Organization may acknowledge its participation solely in the Action Collaborative's Network Organizations. It may not represent that it is either a sponsor of the Action Collaborative or a member of the Action Collaborative, its steering committee, or one of its working groups.
The Network Organization acknowledges that it has no formal affiliation with the National Academy of Medicine, and as such, agrees to refrain from characterizing its association with the National Academy of Medicine or the Action Collaborative as a "partnership" or any other legal or official relationship.
The Network Organization will not represent that any material produced by the Action Collaborative, including any of its publications or public statements, has been produced by the Network Organization or that the Network Organization has otherwise been involved with the development of such material.
The Network Organization shall provide to the National Academy of Medicine, in advance of release, a draft of any press release (or other public statement) announcing or referencing its association with the Action Collaborative, or other materials that use the National Academy of Medicine's name, trademarks, or logos. All such press releases, public statements, and materials are subject to prior written approval by the National Academy of Medicine.
The National Academy of Medicine has sole discretion to terminate a Network Organization's participation in the Action Collaborative's Network Organizations and to remove the organization's commitment statement from the National Academy of Medicine's website without prior notice.

*This question is required.

I have read and agreed to the Terms of Engagement.