Local level of social inequity moderates implementation of evidence-based practices tailored to minoritized populations to reduce opioid overdose deaths

Avik Chatterjee; Rachel P. Chase; Rouba A. Chahine; Jill Davis; Nishi Dsouza; Sylvia Ellison; Sarah M. Bagley; Tiarra Fisher; La Shawn Glasgow; Miriam T.H. Harris; Terry T.K. Huang; Ja Nae Holloway; David W. Lounsbury; Emmanuel Oga; Kat Asman; Sara M. Roberts; Nasim Sabounchi; Hilary L. Surratt; Lisa M. Lines; Henry W. Stadler; Jessica L. Taylor; Alissa Davis

doi:10.1016/j.josat.2025.209828

Local level of social inequity moderates implementation of evidence-based practices tailored to minoritized populations to reduce opioid overdose deaths

Avik Chatterjee, Rachel P. Chase, Rouba A. Chahine, Jill Davis, Nishi Dsouza, Sylvia Ellison, Sarah M. Bagley, Tiarra Fisher, La Shawn Glasgow, Miriam T.H. Harris, Terry T.K. Huang, Ja Nae Holloway, David W. Lounsbury, Emmanuel Oga, Kat Asman, Sara M. Roberts, Nasim Sabounchi, Hilary L. Surratt, Lisa M. Lines, Henry W. StadlerJessica L. Taylor, Alissa Davis

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction: Evidence-based practices (EBPs) tailored to reduce opioid-related fatalities among minoritized populations may help reduce inequities, but research elucidating the relationship between local-level inequities in social determinants of health (SDH) and selection and implementation of tailored EBPs. Methods: The HEALing Communities Study was a multisite, wait-listed, community-level cluster-randomized trial with the objective to reduce opioid overdose deaths. Community coalitions selected and partner organizations implemented EBP strategies to increase access to Overdose Education and Naloxone Distribution (OEND) and Medications for Opioid Use Disorder (MOUD). The research team utilized negative binomial and zero-inflated Poisson models to assess whether the relationship between (a) communities' need for tailored OEND and MOUD strategies, as indicated by opioid overdose death rates among minoritized groups; and (b) the selection, implementation, and reach of those strategies was moderated by local-level inequities in SDH, quantified by the Local Social Inequity in Drug Overdoses (LSI-DO) index. The analysis included data from 33 communities across four states. Results: Eleven of 33 communities implemented tailored OEND and MOUD strategies. Adjusted analysis revealed that LSI-DO scores moderated the relationship between 2021 opioid overdose death rates among minoritized groups and the proportion of community-implemented tailored strategies (p = 0.015). The research team found no moderation for the number of strategies selected or number of individuals reached by EBPs. Conclusion: Few communities selected EBPs tailored to minoritized populations. For those that did, higher local-level social inequity was associated with decreased implementation of tailored strategies. Continued research on how to address overdose inequities—and local-level social inequity—is vital. Findings highlight the need for policy approaches that pair overdose prevention strategies with investments to reduce local-level social inequities that impede equitable implementation.

Original language	English
Article number	209828
Journal	Journal of substance use and addiction treatment
Volume	180
DOIs	https://doi.org/10.1016/j.josat.2025.209828
State	Published - Jan 2026

Bibliographical note

Publisher Copyright:
© 2025 The Authors

Funding

This research was supported by the National Institutes of Health and the Substance Abuse and Mental Health Services Administration through the NIH HEAL (Helping to End Addiction Long-term®) Initiative under award UM1DA049394, UM1DA049406, UM1DA049412, UM1DA049415, and UM1DA049417 ( ClinicalTrials.gov Identifier: NCT04111939 ). This study protocol (Pro00038088) was approved by Advarra Inc., the HEALing Communities Study single Institutional Review Board. The research team wishes to acknowledge the participation of the HEALing Communities Study communities, community coalitions, community partner organizations and agencies, and Community Advisory Boards and state government officials who partnered with us on this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Substance Abuse and Mental Health Services Administration or the NIH HEAL Initiative®. This research was supported by the National Institutes of Health and the Substance Abuse and Mental Health Services Administration through the NIH HEAL (Helping to End Addiction Long-term®) Initiative under award UM1DA049394, UM1DA049406, UM1DA049412, UM1DA049415, and UM1DA049417 (ClinicalTrials.gov Identifier: NCT04111939). This study protocol (Pro00038088) was approved by Advarra Inc. the HEALing Communities Study single Institutional Review Board. The research team wishes to acknowledge the participation of the HEALing Communities Study communities, community coalitions, community partner organizations and agencies, and Community Advisory Boards and state government officials who partnered with us on this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Substance Abuse and Mental Health Services Administration or the NIH HEAL Initiative®.

Funders	Funder number
Substance Abuse and Mental Health Services Administration
National Institutes of Health (NIH)	UM1DA049412, Pro00038088, UM1DA049394, UM1DA049415, NCT04111939, UM1DA049406, UM1DA049417

Keywords

Community engagement
Disparities
Health equity
Racial equity
Special populations
Strategy selection

ASJC Scopus subject areas

Medicine (miscellaneous)
Psychiatric Mental Health
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.josat.2025.209828

Cite this

Chatterjee, A., Chase, R. P., Chahine, R. A., Davis, J., Dsouza, N., Ellison, S., Bagley, S. M., Fisher, T., Glasgow, L. S., Harris, M. T. H., Huang, T. T. K., Holloway, J. N., Lounsbury, D. W., Oga, E., Asman, K., Roberts, S. M., Sabounchi, N., Surratt, H. L., Lines, L. M., ... Davis, A. (2026). Local level of social inequity moderates implementation of evidence-based practices tailored to minoritized populations to reduce opioid overdose deaths. Journal of substance use and addiction treatment, 180, Article 209828. https://doi.org/10.1016/j.josat.2025.209828

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abstract = "Introduction: Evidence-based practices (EBPs) tailored to reduce opioid-related fatalities among minoritized populations may help reduce inequities, but research elucidating the relationship between local-level inequities in social determinants of health (SDH) and selection and implementation of tailored EBPs. Methods: The HEALing Communities Study was a multisite, wait-listed, community-level cluster-randomized trial with the objective to reduce opioid overdose deaths. Community coalitions selected and partner organizations implemented EBP strategies to increase access to Overdose Education and Naloxone Distribution (OEND) and Medications for Opioid Use Disorder (MOUD). The research team utilized negative binomial and zero-inflated Poisson models to assess whether the relationship between (a) communities' need for tailored OEND and MOUD strategies, as indicated by opioid overdose death rates among minoritized groups; and (b) the selection, implementation, and reach of those strategies was moderated by local-level inequities in SDH, quantified by the Local Social Inequity in Drug Overdoses (LSI-DO) index. The analysis included data from 33 communities across four states. Results: Eleven of 33 communities implemented tailored OEND and MOUD strategies. Adjusted analysis revealed that LSI-DO scores moderated the relationship between 2021 opioid overdose death rates among minoritized groups and the proportion of community-implemented tailored strategies (p = 0.015). The research team found no moderation for the number of strategies selected or number of individuals reached by EBPs. Conclusion: Few communities selected EBPs tailored to minoritized populations. For those that did, higher local-level social inequity was associated with decreased implementation of tailored strategies. Continued research on how to address overdose inequities—and local-level social inequity—is vital. Findings highlight the need for policy approaches that pair overdose prevention strategies with investments to reduce local-level social inequities that impede equitable implementation.",

keywords = "Community engagement, Disparities, Health equity, Racial equity, Special populations, Strategy selection",

author = "Avik Chatterjee and Chase, \{Rachel P.\} and Chahine, \{Rouba A.\} and Jill Davis and Nishi Dsouza and Sylvia Ellison and Bagley, \{Sarah M.\} and Tiarra Fisher and Glasgow, \{La Shawn\} and Harris, \{Miriam T.H.\} and Huang, \{Terry T.K.\} and Holloway, \{Ja Nae\} and Lounsbury, \{David W.\} and Emmanuel Oga and Kat Asman and Roberts, \{Sara M.\} and Nasim Sabounchi and Surratt, \{Hilary L.\} and Lines, \{Lisa M.\} and Stadler, \{Henry W.\} and Taylor, \{Jessica L.\} and Alissa Davis",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2026",

month = jan,

doi = "10.1016/j.josat.2025.209828",

language = "English",

volume = "180",

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Chatterjee, A, Chase, RP, Chahine, RA, Davis, J, Dsouza, N, Ellison, S, Bagley, SM, Fisher, T, Glasgow, LS, Harris, MTH, Huang, TTK, Holloway, JN, Lounsbury, DW, Oga, E, Asman, K, Roberts, SM, Sabounchi, N, Surratt, HL, Lines, LM, Stadler, HW, Taylor, JL & Davis, A 2026, 'Local level of social inequity moderates implementation of evidence-based practices tailored to minoritized populations to reduce opioid overdose deaths', Journal of substance use and addiction treatment, vol. 180, 209828. https://doi.org/10.1016/j.josat.2025.209828

TY - JOUR

T1 - Local level of social inequity moderates implementation of evidence-based practices tailored to minoritized populations to reduce opioid overdose deaths

AU - Chatterjee, Avik

AU - Chase, Rachel P.

AU - Chahine, Rouba A.

AU - Davis, Jill

AU - Dsouza, Nishi

AU - Ellison, Sylvia

AU - Bagley, Sarah M.

AU - Fisher, Tiarra

AU - Glasgow, La Shawn

AU - Harris, Miriam T.H.

AU - Huang, Terry T.K.

AU - Holloway, Ja Nae

AU - Lounsbury, David W.

AU - Oga, Emmanuel

AU - Asman, Kat

AU - Roberts, Sara M.

AU - Sabounchi, Nasim

AU - Surratt, Hilary L.

AU - Lines, Lisa M.

AU - Stadler, Henry W.

AU - Taylor, Jessica L.

AU - Davis, Alissa

PY - 2026/1

Y1 - 2026/1

N2 - Introduction: Evidence-based practices (EBPs) tailored to reduce opioid-related fatalities among minoritized populations may help reduce inequities, but research elucidating the relationship between local-level inequities in social determinants of health (SDH) and selection and implementation of tailored EBPs. Methods: The HEALing Communities Study was a multisite, wait-listed, community-level cluster-randomized trial with the objective to reduce opioid overdose deaths. Community coalitions selected and partner organizations implemented EBP strategies to increase access to Overdose Education and Naloxone Distribution (OEND) and Medications for Opioid Use Disorder (MOUD). The research team utilized negative binomial and zero-inflated Poisson models to assess whether the relationship between (a) communities' need for tailored OEND and MOUD strategies, as indicated by opioid overdose death rates among minoritized groups; and (b) the selection, implementation, and reach of those strategies was moderated by local-level inequities in SDH, quantified by the Local Social Inequity in Drug Overdoses (LSI-DO) index. The analysis included data from 33 communities across four states. Results: Eleven of 33 communities implemented tailored OEND and MOUD strategies. Adjusted analysis revealed that LSI-DO scores moderated the relationship between 2021 opioid overdose death rates among minoritized groups and the proportion of community-implemented tailored strategies (p = 0.015). The research team found no moderation for the number of strategies selected or number of individuals reached by EBPs. Conclusion: Few communities selected EBPs tailored to minoritized populations. For those that did, higher local-level social inequity was associated with decreased implementation of tailored strategies. Continued research on how to address overdose inequities—and local-level social inequity—is vital. Findings highlight the need for policy approaches that pair overdose prevention strategies with investments to reduce local-level social inequities that impede equitable implementation.

AB - Introduction: Evidence-based practices (EBPs) tailored to reduce opioid-related fatalities among minoritized populations may help reduce inequities, but research elucidating the relationship between local-level inequities in social determinants of health (SDH) and selection and implementation of tailored EBPs. Methods: The HEALing Communities Study was a multisite, wait-listed, community-level cluster-randomized trial with the objective to reduce opioid overdose deaths. Community coalitions selected and partner organizations implemented EBP strategies to increase access to Overdose Education and Naloxone Distribution (OEND) and Medications for Opioid Use Disorder (MOUD). The research team utilized negative binomial and zero-inflated Poisson models to assess whether the relationship between (a) communities' need for tailored OEND and MOUD strategies, as indicated by opioid overdose death rates among minoritized groups; and (b) the selection, implementation, and reach of those strategies was moderated by local-level inequities in SDH, quantified by the Local Social Inequity in Drug Overdoses (LSI-DO) index. The analysis included data from 33 communities across four states. Results: Eleven of 33 communities implemented tailored OEND and MOUD strategies. Adjusted analysis revealed that LSI-DO scores moderated the relationship between 2021 opioid overdose death rates among minoritized groups and the proportion of community-implemented tailored strategies (p = 0.015). The research team found no moderation for the number of strategies selected or number of individuals reached by EBPs. Conclusion: Few communities selected EBPs tailored to minoritized populations. For those that did, higher local-level social inequity was associated with decreased implementation of tailored strategies. Continued research on how to address overdose inequities—and local-level social inequity—is vital. Findings highlight the need for policy approaches that pair overdose prevention strategies with investments to reduce local-level social inequities that impede equitable implementation.

KW - Community engagement

KW - Disparities

KW - Health equity

KW - Racial equity

KW - Special populations

KW - Strategy selection

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U2 - 10.1016/j.josat.2025.209828

DO - 10.1016/j.josat.2025.209828

M3 - Article

AN - SCOPUS:105020877505

SN - 2949-8767

VL - 180

JO - Journal of substance use and addiction treatment

JF - Journal of substance use and addiction treatment

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ER -

Local level of social inequity moderates implementation of evidence-based practices tailored to minoritized populations to reduce opioid overdose deaths

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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