Research shows that data-driven intervention had no impact on opioid-related death rates during the evaluation period

A data-driven intervention that prompted communities to quickly adopt evidence-based practices to reduce opioid-related deaths — such as increasing naloxone distribution and improving access to medications for opioid use disorder — did not result in a statistically significant reducing the number of opioid-related deaths. overdose death rates during the evaluation period, according to results from the National Institutes of Health HEALing (helping to end addiction long term) community study.

Researchers identified the COVID-19 pandemic and the increased prevalence of fentanyl in the illicit drug market – including in mixtures with cocaine and methamphetamine – as factors that likely weakened the intervention’s impact on reducing opioid-related overdose deaths.

The findings have been published in the New England Journal of Medicine and presented at the Meeting of the Board for Problems of Drug Addiction (CPDD). on Sunday, June 16, 2024. Launched in 2019, the HEALing Communities Study is the largest study of addiction prevention and treatment implementation ever conducted and took place in 67 communities in Kentucky, Massachusetts, New York and Ohio – four struggling states have been affected by the opioid crisis.

Despite facing unforeseen challenges, the HEALing Communities Study successfully engaged communities in selecting and implementing hundreds of evidence-based strategies over the course of the intervention, demonstrating how leveraging community partnerships and using data to inform public health decisions, can effectively support the uptake of evidence. based strategies at local level.

“This study brought together researchers, providers and communities to break down barriers and promote the use of evidence-based strategies that we know to be effective, including opioid use disorder medications and naloxone,” said NIDA Director Nora D. Volkow, MD

“Yet, especially in the age of fentanyl and its increasing mixing with psychostimulants, it is clear that we must continue to develop new tools and approaches to address the overdose crisis. Continued analysis of the rich data from this study will be critical to guiding our efforts. in the future.”

NIH launched the HEALing Communities Study, a four-year, multi-site study to test a range of evidence-based interventions for reducing overdose deaths in health care, justice, and behavioral health settings. More than 100,000 people now die from drug overdoses every yearwith over 75% of deaths involving an opioid.

Many evidence-based practices have been proven to prevent or reverse opioid overdose, but these strategies are severely underutilized due to a number of barriers.

As part of the intervention, researchers worked with community coalitions to implement evidence-based practices to reduce deaths from opioid overdose. Continuum of care approach. These evidence-based practices are aimed at increasing opioid education and naloxone distribution, improving access to medications for opioid use disorders, and safer prescribing and dispensing of opioids.

The intervention also included a series of communication campaigns to help reduce stigma and increase demand for evidence-based practices.

Communities were randomly assigned to the intervention group (between January 2020 and June 2022) or to the control group (which received the intervention between July 2022 and December 2023). To test the effectiveness of the intervention at reducing opioid-related overdose deaths, researchers compared the number of overdose deaths among communities that received the intervention immediately versus those that did not during the period July 2021 and June 2022.

Between January 2020 and June 2022, intervention communities successfully implemented 615 evidence-based practice strategies (254 related to overdose education and naloxone distribution, 256 related to medications for opioid use disorder, and 105 related to prescription opioid safety).

Despite success in deploying evidence-based interventions in participating communities, there was no statistically significant difference in the overall number of opioid overdose deaths between July 2021 and June 2022 between communities that received the intervention and those that did didn’t. 47.2 opioid-related deaths per 100,000 people in the intervention group, versus 51.7 in the control group).

The research team is also examining data on the impact of the intervention on overall overdose deaths, including examining specific drug combinations, such as stimulants and opioids, and on non-fatal opioid overdoses.

“Implementing evidence-based interventions is critical to addressing the evolving overdose crisis,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA.

“This study recognizes that there is no quick fix to reducing opioid overdose deaths. Saving lives requires a continued commitment to evidence-based strategies. The HEALing Communities Study facilitated the implementation of 615 evidence-based practice strategies, with the potential to deliver life-saving results in years to come.” years.”

The authors highlight three specific factors that likely weakened the intervention’s impact on reducing opioid-related overdose deaths. First, the intervention was launched two months before the COVID-19 shutdown, severely disrupting the ability to work with health care, behavioral health, and criminal justice systems to implement evidence-based practices. Largely due to the emergence of COVID-19, only 235 of 615 strategies (38%) were implemented before the comparison period began in July 2021.

Second, after communities selected which evidence-based practices they wanted to implement, they had only ten months to implement them before the comparison period began.

The authors note that this was not enough time to robustly recruit needed staff, change clinical practice workflows, or develop new collaborations between agencies and organizations. They note that more time is needed to implement these strategies, and that more time may be needed between implementation and measurement of results to see the full impact of the intervention.

Finally, significant changes in the illicit drug market could have influenced the effectiveness of the intervention. Fentanyl increasingly entered the illicit drug supply and was increasingly mixed or used in combination with stimulant drugs such as methamphetamine and cocaine, or in counterfeit pills that looked like prescription drugs.

The increasing use of fentanyl and xylazine during the study period posed new challenges for the treatment of opioid use disorders and opioid-related overdoses.

“Even in the face of a global pandemic and a worsening overdose crisis, the HEALing Communities Study was able to support the implementation of hundreds of strategies that we know save lives,” said Redonna Chandler, Ph.D., director of the HEALing Communities Study . at NIDA.

“This is an incredible achievement for implementation science and shows that when we provide communities with the infrastructure to make data-driven decisions, they are able to effectively implement evidence-based practices based on their unique needs.”