Community Intervention Fails to Reduce Overdose Deaths
Conexiant
June 24, 2024
Despite implementing 615 evidence-based strategies, of which only 38% were operational by the comparison year, a large community-based trial found no significant difference in opioid overdose death rates between intervention and control groups.
A community-engaged intervention aimed at reducing opioid overdose deaths did not demonstrate a statistically significant impact. The HEALing Communities Study Consortium conducted a cluster-randomized trial involving 67 communities across Kentucky, Massachusetts, New York, and Ohio, with a total adult population of 8.2 million, to assess the efficacy of enhanced implementation of evidence-based practices, including overdose education, naloxone distribution, medication-assisted treatment, and prescription opioid safety.
The trial, funded by the National Institutes of Health and published in The New England Journal of Medicine, spanned January 2020 to June 2022, coinciding with the COVID-19 pandemic and an increase in fentanyl-related overdoses. Thirty-four communities received the intervention, while 33 communities served as controls. The primary outcome measured was the rate of opioid-related overdose deaths.
Results indicated no statistically significant difference in opioid-related overdose death rates between the intervention and control groups. The intervention communities reported 47.2 deaths per 100,000 population compared to 51.7 per 100,000 in the control communities, resulting in an adjusted rate ratio of 0.91 (95% confidence interval, 0.76 to 1.09; P=0.30). The intervention's effectiveness did not significantly vary by state, urban or rural status, age, sex, or race/ethnic group.
Of the 615 implemented strategies, 254 involved overdose education and naloxone distribution, 256 involved medications for opioid use disorder, and 105 involved prescription opioid safety. Most implementation occurred from September 2020 through June 2022, with the comparison period being July 2021 through June 2022.
Factors that may have tempered the intervention's effect include the limited time frame for implementation, disruptions caused by the COVID-19 pandemic, and changes in the illicit drug market, particularly the increased prevalence of fentanyl.
For full disclosures, readers are directed to the original study.