Large-scale community-wide interventions to address opioid overdose deaths can be difficult to implement and require sustained effort before positive results are seen.
That’s one of the lessons from a large National Institutes of Health (NIH) study that found no statistically significant difference in overdose death rates between communities that implemented system-wide evidence-based practices aimed at opioid overdose and communities that did not. But those results, published yesterday in the New England Journal of Medicine, may have been compromised by the COVID-19 pandemic, the growing fentanyl epidemic, and the time required for large-scale strategies to take effect.
“This study brought researchers, providers, and communities together to break down barriers and promote the use of evidence-based strategies that we know are effective, including medications for opioid use disorder and naloxone,” said National Institute on Drug Abuse director, Nora D. Volkow, M.D., in a press release. “Yet, particularly in the era of fentanyl and its increased mixture with psychostimulant drugs, it’s clear we need to continue developing new tools and approaches for addressing the overdose crisis. Ongoing analyses of the rich data from this study will be critical to guiding our efforts in the future.”
As part of the NIH HEALing (Helping to End Addiction Long-term) Communities Study, 67 rural and urban communities in Kentucky, Massachusetts, New York, and Ohio were randomly divided to the Communities That Heal (CTH) intervention or a wait-list control. All communities had a baseline opioid-related overdose death rate of at least 25 per 100,000 adults.
The CTH intervention used a phased-planning process wherein researchers worked with community coalitions to identify and implement evidence-based strategies to improve existing gaps in three areas of opioid management: overdose education and naloxone distribution, the use of medications for opioid use disorder, and prescription opioid safety. The CTH intervention began on January 2020, and overdose outcomes between the CTH and wait-list communities were compared between July 2021 and June 2022.
The rates of opioid-related overdose deaths were similar in the intervention group and the control group during the comparison year (47.2 deaths per 100,000 population vs. 51.7 per 100,000 population, respectively). The effect of the intervention on the rate of opioid-related overdose deaths did not differ appreciably according to state, urban or rural category, age, sex, or race or ethnic group.
Overall, 615 evidence-based practices were implemented by the 34 CTH communities, but only 235 (38%) had been initiated by July 2021. “After the strategy selection process, only 10 months preceded the comparison period to establish agency partnerships and implement evidence-based practices,” wrote Jeffrey H. Samet, M.D., M.P.H., at Boston University School of Medicine and colleagues. “The time frame was insufficient to initiate many strategies for evidence-based practices, which often required recruiting new staff from an increasingly scarce health care workforce, changing clinical practice workflows, or developing new interagency collaborations.”
Moreover, the onset of COVID-19 shutdowns just two months after the CTH intervention started severely disrupted the systems targeted by these new practices CTH intervention, the authors noted.
For related information see the Psychiatric News article “AMA Identifies Six State Strategies for Ending Opioid Epidemic.”
(Image: Tyler A. McNeil)
