HEALing Communities Study Consortium , Samet JH, El-Bassel N, Winhusen TJ, Jackson RD, Oga EA, Chandler RK, Villani J, Freisthler B, Adams J, Aldridge A, Angerame A, Babineau DC, Bagley SM, Baker TJ, Balvanz P, Barbosa C, Barocas J, Battaglia TA, Beard DD, Beers D, Blevins D, Bove N, Bridden C, Brown JL, Bush HM, Bush JL, Caldwell R, Calver K, Calvert D, Campbell ANC, Carpenter J, Caspar R, Chassler D, Chaya J, Cheng DM, Cunningham CO, Dasgupta A, David JL, Davis A, Dean T, Drainoni ML, Eggleston B, Fanucchi LC, Feaster DJ, Fernandez S, Figueroa W, Freedman DA, Freeman PR, Freiermuth CE, Friedlander E, Gelberg KH, Gibson EB, Gilbert L, Glasgow L, Goddard-Eckrich DA, Gomori S, Gruss DE, Gulley J, Gutnick D, Hall ME, Harger Dykes N, Hargrove SL, Harlow K, Harris A, Harris D, Helme DW, Holloway J, Hotchkiss J, Huang T, Huerta TR, Hunt T, Hyder A, Ingram VL, Ingram T, Kauffman E, Kimball JL, Kinnard EN, Knott C, Knudsen HK, Konstan MW, Kosakowski S, Larochelle MR, Leaver HM, LeBaron PA, Lefebvre RC, Levin FR, Lewis N, Lewis N, Lofwall MR, Lounsbury DW, Luster JE, Lyons MS, Mack A, Marks KR, Marquesano S, Mauk R, McAlearney AS, McConnell K, McGladrey ML, McMullan J, Miles J, Munoz Lopez R, Nelson A, Neufeld JL, Newman L, Nguyen TQ, Nunes EV, Oller DA, Oser CB, Oyler DR, Pagnano S, Parran TV, Powell J, Powers K, Ralston W, Ramsey K, Rapkin BD, Reynolds JG, Roberts MF, Robertson W, Rock P, Rodgers E, Rodriguez S, Rudorf M, Ryan S, Salsberry P, Salvage M, Sabounchi N, Saucier M, Savitzky C, Schackman B, Schady E, Seiber EE, Shadwick A, Shoben A, Slater MD, Slavova S, Speer D, Sprunger J, Starbird LE, Staton M, Stein MD, Stevens-Watkins DJ, Stopka TJ, Sullivan A, Surratt HL, Sword Cruz R, Talbert JC, Taylor JL, Thompson KL, Vandergrift N, Vickers-Smith RA, Vietze DJ, Walker DM, Walley AY, Walters ST, Weiss R, Westgate PM, Wu E, Young AM, Zarkin GA, Walsh SL
BACKGROUND : Evidence-based practices for reducing opioid-related overdose deaths include overdose education and naloxone distribution, the use of medications for the treatment of opioid use disorder, and prescription opioid safety. Data are needed on the effectiveness of a community-engaged intervention to reduce opioid-related overdose deaths through enhanced uptake of these practices.
METHODS : In this community-level, cluster-randomized trial, we randomly assigned 67 communities in Kentucky, Massachusetts, New York, and Ohio to receive the intervention (34 communities) or a wait-list control (33 communities), stratified according to state. The trial was conducted within the context of both the coronavirus disease 2019 (Covid-19) pandemic and a national surge in the number of fentanyl-related overdose deaths. The trial groups were balanced within states according to urban or rural classification, previous overdose rate, and community population. The primary outcome was the number of opioid-related overdose deaths among community adults.
RESULTS : During the comparison period from July 2021 through June 2022, the population-averaged rates of opioid-related overdose deaths were similar in the intervention group and the control group (47.2 deaths per 100,000 population vs. 51.7 per 100,000 population), for an adjusted rate ratio of 0.91 (95% confidence interval, 0.76 to 1.09; P = 0.30). The effect of the intervention on the rate of opioid-related overdose deaths did not differ appreciably according to state, urban or rural category, age, sex, or race or ethnic group. Intervention communities implemented 615 evidence-based practice strategies from the 806 strategies selected by communities (254 involving overdose education and naloxone distribution, 256 involving the use of medications for opioid use disorder, and 105 involving prescription opioid safety). Of these evidence-based practice strategies, only 235 (38%) had been initiated by the start of the comparison year.
CONCLUSIONS : In this 12-month multimodal intervention trial involving community coalitions in the deployment of evidence-based practices to reduce opioid overdose deaths, death rates were similar in the intervention group and the control group in the context of the Covid-19 pandemic and the fentanyl-related overdose epidemic. (Funded by the National Institutes of Health; HCS ClinicalTrials.gov number, NCT04111939.).