The effectiveness of the communities that HEAL intervention on reducing non-fatal opioid overdoses: A prespecified secondary analysis of a waitlist cluster control randomized controlled trial

Introduction: Along with a surge of opioid overdose deaths in the United States, the rates of nonfatal opioid overdose (NFOO) emergency department (ED) visits and hospitalizations have been sharply increasing. Methods: In the HEALing Communities Study (HCS), we conducted a pre-specified secondary analyses to evaluate the effectiveness of the Community that HEALS (CTH) intervention on reducing the count of NFOO ED visits and hospitalizations in a multi-site cluster randomized multi-site, two-arm, parallel, community-level, open, wait list-controlled trial study, Sixty-seven communities in Kentucky, Massachusetts, New York, and Ohio were randomized to the intervention (N = 34) or waitlist control condition (N = 33) stratified by state and balanced by urban/rural classification, fatal opioid overdose rate and population size of communities. We compared the rate of NFOO per 100,000 adults aged ≥18 years between intervention and control communities from July 1, 2021, to June 30, 2022. Rates were calculated in per 100,000 or per 100 adult population measured by inpatient and ED records for intervention community residents with an ICD-10-CM code for opioid poisoning. Results: Compared to control communities, intervention communities had 15 % fewer NFOO per capita (aRR = 0.85; 95 % CI = [0.74,0.96]; p-value=0.013). Effect modifications by state, urban/rural status, sex, age, race and ethnicity were not significant. Discussion: These findings suggest the intervention reduced NFOO ED visits and hospitalizations. The lack of effect modifications suggests that the intervention may be effective in a wide range of communities in the U.S. Further research is needed to identify the mechanisms through which the intervention reduces NFOO. Trial Registration: ClinicalTrials.gov Identifier: NCT04111939.