Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths.
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HEALing Communities Study Consortium, Samet Jeffrey H, El-Bassel Nabila, Winhusen T John, Jackson Rebecca D, Oga Emmanuel A, Chandler Redonna K, Villani Jennifer, Freisthler Bridget, Adams Joella, Aldridge Arnie, Angerame Angelo, Babineau Denise C, Bagley Sarah M, Baker Trevor J, Balvanz Peter, Barbosa Carolina, Barocas Joshua, Battaglia Tracy A, Beard Dacia D, Beers Donna, Blevins Derek, Bove Nicholas, Bridden Carly, Brown Jennifer L, Bush Heather M, Bush Joshua L, Caldwell Ryan, Calver Katherine, Calvert Deirdre, Campbell Aimee N C, Carpenter Jane, Caspar Rachel, Chassler Deborah, Chaya Joan, Cheng Debbie M, Cunningham Chinazo O, Dasgupta Anindita, David James L, Davis Alissa, Dean Tammy, Drainoni Mari-Lynn, Eggleston Barry, Fanucchi Laura C, Feaster Daniel J, Fernandez Soledad, Figueroa Wilson, Freedman Darcy A, Freeman Patricia R, Freiermuth Caroline E, Friedlander Eric, Gelberg Kitty H, Gibson Erin B, Gilbert Louisa, Glasgow LaShawn, Goddard-Eckrich Dawn A, Gomori Stephen, Gruss Dawn E, Gulley Jennifer, Gutnick Damara, Hall Megan E, Harger Dykes Nicole, Hargrove Sarah L, Harlow Kristin, Harris Aumani, Harris Daniel, Helme Donald W, Holloway JaNae, Hotchkiss Juanita, Huang Terry, Huerta Timothy R, Hunt Timothy, Hyder Ayaz, Ingram Van L, Ingram Tim, Kauffman Emily, Kimball Jennifer L, Kinnard Elizabeth N, Knott Charles, Knudsen Hannah K, Konstan Michael W, Kosakowski Sarah, Larochelle Marc R, Leaver Hannah M, LeBaron Patricia A, Lefebvre R Craig, Levin Frances R, Lewis Nikki, Lewis Nicky, Lofwall Michelle R, Lounsbury David W, Luster Jamie E, Lyons Michael S, Mack Aimee, Marks Katherine R, Marquesano Stephanie, Mauk Rachel, McAlearney Ann Scheck, McConnell Kristin, McGladrey Margaret L, McMullan Jason, Miles Jennifer, Munoz Lopez Rosie, Nelson Alisha, Neufeld Jessica L, Newman Lisa, Nguyen Trang Q, Nunes Edward V, Oller Devin A, Oser Carrie B, Oyler Douglas R, Pagnano Sharon, Parran Theodore V, Powell Joshua, Powers Kim, Ralston William, Ramsey Kelly, Rapkin Bruce D, Reynolds Jennifer G, Roberts Monica F, Robertson Will, Rock Peter, Rodgers Emma, Rodriguez Sandra, Rudorf Maria, Ryan Shawn, Salsberry Pamela, Salvage Monika, Sabounchi Nasim, Saucier Merielle, Savitzky Caroline, Schackman Bruce, Schady Elizabeth, Seiber Eric E, Shadwick Aimee, Shoben Abigail, Slater Michael D, Slavova Svetla, Speer Drew, Sprunger Joel, Starbird Laura E, Staton Michele, Stein Michael D, Stevens-Watkins Danelle J, Stopka Thomas J, Sullivan Ann, Surratt Hilary L, Sword Cruz Rachel, Talbert Jeffery C, Taylor Jessica L, Thompson Katherine L, Vandergrift Nathan, Vickers-Smith Rachel A, Vietze Deanna J, Walker Daniel M, Walley Alexander Y, Walters Scott T, Weiss Roger, Westgate Philip M, Wu Elwin, Young April M, Zarkin Gary A, Walsh Sharon L
Аннотация
METHODS: In this community-level, cluster-randomized trial, we randomly assigned 67 communities in Kentucky, Massachusetts, New York, and Ohio to receive the intervention (34 communities) or a wait-list control (33 communities), stratified according to state. The trial was conducted within the context of both the coronavirus disease 2019 (Covid-19) pandemic and a national surge in the number of fentanyl-related overdose deaths. The trial groups were balanced within states according to urban or rural classification, previous overdose rate, and community population. The primary outcome was the number of opioid-related overdose deaths among community adults.
RESULTS: During the comparison period from July 2021 through June 2022, the population-averaged rates of opioid-related overdose deaths were similar in the intervention group and the control group (47.2 deaths per 100,000 population vs. 51.7 per 100,000 population), for an adjusted rate ratio of 0.91 (95% confidence interval, 0.76 to 1.09; P = 0.30). 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. Intervention communities implemented 615 evidence-based practice strategies from the 806 strategies selected by communities (254 involving overdose education and naloxone distribution, 256 involving the use of medications for opioid use disorder, and 105 involving prescription opioid safety). Of these evidence-based practice strategies, only 235 (38%) had been initiated by the start of the comparison year.
CONCLUSIONS: In this 12-month multimodal intervention trial involving community coalitions in the deployment of evidence-based practices to reduce opioid overdose deaths, death rates were similar in the intervention group and the control group in the context of the Covid-19 pandemic and the fentanyl-related overdose epidemic. (Funded by the National Institutes of Health; HCS ClinicalTrials.gov number, NCT04111939.).