Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths

Jeffrey H. Samet, Nabila El-Bassel, T. John Winhusen, Rebecca D. Jackson, Emmanuel A. Oga, Redonna K. Chandler, Jennifer Villani, Bridget Freisthler, Joella Adams, Arnie Aldridge, Angelo Angerame, Denise C. Babineau, Sarah M. Bagley, Trevor J. Baker, Peter Balvanz, Carolina Barbosa, Joshua Barocas, Tracy A. Battaglia, Dacia D. Beard, Donna BeersDerek Blevins, Nicholas Bove, Carly Bridden, Jennifer L. Brown, Heather M. Bush, Joshua L. Bush, Ryan Caldwell, Katherine Calver, Deirdre Calvert, Aimee N.C. Campbell, Jane Carpenter, Rachel Caspar, Deborah Chassler, Joan Chaya, Debbie M. Cheng, Chinazo O. Cunningham, Anindita Dasgupta, James L. David, Alissa Davis, Tammy Dean, Mari Lynn Drainoni, Barry Eggleston, Laura C. Fanucchi, Daniel J. Feaster, Soledad Fernandez, Wilson Figueroa, Darcy A. Freedman, Patricia R. Freeman, Caroline E. Freiermuth, Eric Friedlander, Kitty H. Gelberg, Erin B. Gibson, Louisa Gilbert, La Shawn Glasgow, Dawn A. Goddard-Eckrich, Stephen Gomori, Dawn E. Gruss, Jennifer Gulley, Damara Gutnick, Megan E. Hall, Nicole Harger Dykes, Sarah L. Hargrove, Kristin Harlow, Aumani Harris, Daniel Harris, Donald W. Helme, Ja Nae Holloway, Juanita Hotchkiss, Terry Huang, Timothy R. Huerta, Timothy Hunt, Ayaz Hyder, Van L. Ingram, Tim Ingram, Emily Kauffman, Jennifer L. Kimball, Elizabeth N. Kinnard, Charles Knott, Hannah K. Knudsen, Michael W. Konstan, Sarah Kosakowski, Marc R. Larochelle, Hannah M. Leaver, Patricia A. Lebaron, R. Craig Lefebvre, Frances R. Levin, Nikki Lewis, Nicky Lewis, Michelle R. Lofwall, David W. Lounsbury, Jamie E. Luster, Michael S. Lyons, Aimee Mack, Katherine R. Marks, Stephanie Marquesano, Rachel Mauk, Ann Scheck Mcalearney, Kristin Mcconnell, Margaret L. Mcgladrey, Jason Mcmullan, Jennifer Miles, Rosie Munoz Lopez, Alisha Nelson, Jessica L. Neufeld, Lisa Newman, Trang Q. Nguyen, Edward V. Nunes, Devin A. Oller, Carrie B. Oser, Douglas R. Oyler, Sharon Pagnano, Theodore V. Parran, Joshua Powell, Kim Powers, William Ralston, Kelly Ramsey, Bruce D. Rapkin, Jennifer G. Reynolds, Monica F. Roberts, Will Robertson, Peter Rock, Emma Rodgers, Sandra Rodriguez, Maria Rudorf, Shawn Ryan, Pamela Salsberry, Monika Salvage, Nasim Sabounchi, Merielle Saucier, Caroline Savitzky, Bruce Schackman, Elizabeth Schady, Eric E. Seiber, Aimee Shadwick, Abigail Shoben, Michael D. Slater, Svetla Slavova, Drew Speer, Joel Sprunger, Laura E. Starbird, Michele Staton, Michael D. Stein, Danelle J. Stevens-Watkins, Thomas J. Stopka, Ann Sullivan, Hilary L. Surratt, Rachel Sword Cruz, Jeffery C. Talbert, Jessica L. Taylor, Katherine L. Thompson, Nathan Vandergrift, Rachel A. Vickers-Smith, Deanna J. Vietze, Daniel M. Walker, Alexander Y. Walley, Scott T. Walters, Roger Weiss, Philip M. Westgate, Elwin Wu, April M. Young, Gary A. Zarkin, Sharon L. Walsh, HEALing Communities Study Consortium The HEALing Communities Study Consortium

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)989-1001
Number of pages13
JournalNew England Journal of Medicine
Volume391
Issue number11
DOIs
StatePublished - Sep 19 2024

Bibliographical note

Publisher Copyright:
Copyright © 2024 Massachusetts Medical Society.

ASJC Scopus subject areas

  • General Medicine

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