Community-engaged intervention reduces polysubstance overdose deaths by 37%
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Key takeaways:
- The intervention group had a 37% reduction in opioid-involved polysubstance overdose deaths compared with the control group.
- They also had an 8% lower rate of overdose deaths.
A community coalition-engaged intervention led to a statistically significant reduction in overdose deaths involving any opioid and psychostimulants other than cocaine, according to a study published in JAMA Network Open.
By the time the study started, fentanyl had rapidly entered the illicit drug market in the U.S. in combination with methamphetamine, cocaine, counterfeit pills and other stimulants,
Bridget Freisthler, PhD, professor and associate dean for research and faculty development at The Ohio State University and lead author of the study, said in an Ohio State News press release related to the study. “Now we have a whole new group of people developing addiction to opioids,” she said.
As part of the HEALing Communities Study, a multisite, parallel-group, cluster randomized, unmasked, waitlist-controlled trial of 67 communities in Kentucky, Massachusetts, New York and Ohio that reported high opioid overdose fatality rates between 2020 and 2023, Freisthler and colleagues evaluated the impact of a community coalition-engaged intervention on total drug overdose deaths and opioid-involved polysubstance overdose deaths.
The researchers used covariate constrained randomization stratified by state to assign the communities to the Communities that HEAL intervention group (n = 34) or a wait-list control group (n = 33).
The researchers balanced the trial groups according to rural classification, community population and 2016 to 2017 opioid overdose death rate data.
The Communities that HEAL intervention targeted reducing opioid overdose deaths by implementing evidence-based practices, including overdose education and naloxone distribution, treatment with FDA-approved medications for opioid use disorder, and safer opioid prescribing and disposal practices. They also launched communication campaigns to increase demand for evidence-based practices and reduce stigma surrounding opioid use disorder.
The primary outcome of the study was the number of drug overdose deaths among community residents aged 18 years or older. Secondary outcomes assessed the number of opioid-involved overdose deaths that co-occurred with cocaine, benzodiazepine or a psychostimulant other than cocaine.
The researchers compared rates of overdose deaths per 100,000 adult residents in both the intervention and control groups from July 2021 to June 2022.
Across the communities’ 8,211,506 adult residents (51.8% women; 72.8% white), the overall raw rate of drug overdose deaths was 58.2 per 100,000 adults in the intervention group and 70 per 100,000 adults in the control group, according to the researchers.
Compared with the control group, they found that the intervention group had a nonsignificant 8% lower rate of overdose deaths (adjusted rate ratio [aRR] = 0.92; 95% CI, 0.78-1.07) and a statistically significant 37% reduction in overdose deaths involving any opioid and any psychostimulant other than cocaine (aRR = 0.63; 95% CI, 0.44-0.91). The researchers noted that state or urban or rural status did not modify these effects.
Additionally, they observed nonsignificant reductions in overdose deaths involving opioid and cocaine (aRR = 0.94; 95% CI, 0.69-1.3) and those involving opioid and benzodiazepines (aRR = 0.99; 95% CI, 0.73-1.35) among the intervention group compared with the control group.
“These results suggest that community-focused, data-driven interventions that scale up evidence-based practices with a communications campaign may collectively contribute to successes in addressing the evolving nature of some opioid-involved polysubstance overdose deaths,” Freisthler and colleagues wrote in the study.
The researchers acknowledged several study limitations, including the fact that overdose-related death rates across all communities increased at the beginning of the COVID-19 pandemic and did not return to baseline levels during the study period.
“The drug overdose crisis is pervasive in our communities, and we’ve got multigenerational and intergenerational trauma affecting families; that’s not going to change overnight,” Freisthler said in the press release. “That means we need to continue to improve understanding of this crisis and reduce overdose deaths so we don’t have another generation experiencing the same sort of trauma.”
Reference:
- A 37% drop in overdose deaths from drugs mixed with opioids – fentanyl included. https://news.osu.edu/a-37-drop-in-overdose-deaths-from-drugs-mixed-with-opioids--fentanyl-included/. Published Oct. 21, 2024. Accessed Oct. 25, 2024.
Perspective
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Anita Gupta, DO, PharmD, MPP, GMP, FASA
The most recent JAMA Network Open study puts into light a revolutionary community coalition intervention that reduced opioid overdose deaths by 37%. This finding is a game-changer in the fight against the opioid crisis, suggesting that community engagement is not just beneficial but essential. Previously, we knew that individual treatments could help, but this study demonstrates the power of collective action, showing that when communities unite, they can achieve remarkable outcomes.
Although this study outlines effective intervention strategies, further research is needed to show how long-term sustainability and adaptability to diverse communities are feasible, especially in other areas with different socioeconomic challenges. Further research into integrating mental health support and addressing polysubstance use could provide a more comprehensive approach to understanding the challenges. As communities come together to heal, the implications for policy and public health could be profound.
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