A large-scale, community-based intervention known as Communities That HEAL (CTH) has demonstrated a significant reduction in overdose deaths involving opioids combined with psychostimulants other than cocaine. The study, a parallel-group cluster-randomized clinical trial, spanned 67 communities across Kentucky, Massachusetts, New York, and Ohio, and aimed to combat the escalating opioid crisis through targeted, evidence-based strategies. While the intervention did not yield a statistically significant reduction in overall drug overdose deaths, the notable decrease in specific polysubstance-related fatalities highlights the potential of community-driven approaches in addressing the complex dynamics of the opioid epidemic.
Impact on Polysubstance Overdose Deaths
The CTH intervention focused on implementing evidence-based practices (EBPs) such as increased overdose education and naloxone distribution (OEND), medications for opioid use disorder (MOUD), safer opioid prescribing practices, and communication campaigns designed to reduce stigma and increase demand for treatment. These strategies were implemented in intervention communities between January 2020 and June 2022.
The primary outcome measured was the number of drug overdose deaths among adults (aged 18 years or older). Secondary outcomes included overdose deaths involving combinations of opioids with psychostimulants other than cocaine, cocaine, or benzodiazepines. The results, analyzed in 2023, revealed an 8% lower rate of overdose deaths in intervention communities compared to control communities, though this difference was not statistically significant (adjusted rate ratio [aRR], 0.92; 95% CI, 0.78-1.07; P = .26).
However, a statistically significant 37% reduction (aRR, 0.63; 95% CI, 0.44-0.91; P = .02) was observed in death rates involving an opioid and psychostimulants other than cocaine. Non-significant reductions were noted in overdose deaths involving an opioid with cocaine (6%) and an opioid with benzodiazepines (1%).
Community-Engaged Approach
The CTH intervention employed a community-engaged approach, utilizing local coalitions to make data-driven decisions and guide the implementation of EBPs. This tailored approach allowed communities to address their unique needs based on local data. Communications campaigns were also designed to increase demand for EBPs and reduce stigma related to opioid use disorder (OUD) and its treatment.
Limitations and Considerations
The study acknowledges several limitations that may have influenced the results. The COVID-19 pandemic led to a substantial increase in overdose death rates across all communities, potentially obscuring the effects of the intervention. The expansion of fentanyl in the drug supply also increased the risk of overdose fatalities, even among individuals not intending to use opioids.
Furthermore, delays in EBP implementation due to the pandemic meant that only 38% of EBPs were implemented before the comparison period. The availability of outside funding to control communities during the study period may have also confounded the results.
Implications for Future Interventions
Despite these limitations, the study's findings suggest that community-focused, data-driven interventions can be effective in reducing specific types of opioid-involved polysubstance overdose deaths. The success in reducing deaths involving opioids and non-cocaine psychostimulants highlights the importance of tailored strategies that address the evolving nature of the drug crisis.
"Population-level interventions that utilize local community coalitions to help implement proven EBPs to reduce opioid-involved overdose deaths can also be effective at reducing polysubstance overdoses that include an opioid," the researchers noted. They also emphasized that resources that help local communities identify their needs and implement practices known to reduce opioid overdose deaths would be worthy of resources, and that continued research of the model that is powered for smaller reductions in opioid overdose deaths is also warranted.
The study underscores the need for ongoing research and adaptation of strategies to combat the opioid crisis, with a focus on addressing polysubstance use and leveraging community resources to implement evidence-based interventions.
