Communities that HEAL intervention and mortality including polysubstance overdose deaths: A randomized clinical trial

Gary A. Zarkin; Arnie P. Aldridge; Sylvia Margaret Tan; Carolina Pinto Pereira Barbosa; Emmanuel Aja Oga; Megan Elizabeth Hall; Aaron J. Macoubray; Rouba A. Chahine; Mia-Cara Christopher; Lauren D'Costa; Bridget Freisthler; Rouba A. Chahine; Jennifer Villani; Redonna Chandler; Daniel J. Feaster; Svetla Slavova; Jolene DeFiore-Hyrmer; Alexander Y Walley; Sarah Kosakowski; Arnie P. Aldridge; Carolina Barbosa; Sabana Bhatta; Candace J. Brancato; Carly Bridden; Mia-Cara Christopher; Tom Clarke; James L. David; Lauren D'Costa; Irene Ewing; Soledad Fernandez; Erin Gibson; Louisa Gilbert; Megan Hall; Sarah Hargrove; Timothy Hunt; Elizabeth N Kinnard; Lauren Larochelle; Aaron Macoubray; Shawn Nigam; Edward V Nunes; Carrie B. Oser; Sharon Pagnano; Peter Rock; Pamela J. Salsberry; Aimee Shadwick; Thomas J Stopka; Sylvia Margaret Tan; Jessica L Taylor; Philip M. Westgate; Elwin Wu; Gary A. Zarkin; Sharon L. Walsh; Nabila El-Bassel; T John Winhusen; Jeffrey H. Samet; Emmanuel Aja Oga

Communities that HEAL intervention and mortality including polysubstance overdose deaths

A randomized clinical trial

Freisthler, B., Chahine, R. A., Villani, J., Chandler, R., Feaster, D. J., Slavova, S., Defiore-Hyrmer, J., Walley, A. Y., Kosakowski, S., Aldridge, A., Barbosa, C., Bhatta, S., Brancato, C., Bridden, C., Christopher, M., Clarke, T., David, J., D'Costa, L., Ewing, I., ... Oga, E. A. (2024). Communities that HEAL intervention and mortality including polysubstance overdose deaths: A randomized clinical trial. JAMA network open, 7(10), e2440006. https://doi.org/10.1001/jamanetworkopen.2024.40006

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Abstract

IMPORTANCE: The HEALing Communities Study (HCS) evaluated the effectiveness of the Communities That HEAL (CTH) intervention in preventing fatal overdoses amidst the US opioid epidemic.

OBJECTIVE: To evaluate the impact of the CTH intervention on total drug overdose deaths and overdose deaths involving combinations of opioids with psychostimulants or benzodiazepines.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was a parallel-arm, multisite, community-randomized, open, and waitlisted controlled comparison trial of communities in 4 US states between 2020 and 2023. Eligible communities were those reporting high opioid overdose fatality rates in Kentucky, Massachusetts, New York, and Ohio. Covariate constrained randomization stratified by state allocated communities to the intervention or control group. Trial groups were balanced by urban or rural classification, 2016-2017 fatal opioid overdose rate, and community population. Data analysis was completed by December 2023.

INTERVENTION: Increased overdose education and naloxone distribution, treatment with medications for opioid use disorder, safer opioid prescribing practices, and communication campaigns to mitigate stigma and drive demand for evidence-based interventions.

MAIN OUTCOMES AND MEASURES: The primary outcome was the number of drug overdose deaths among adults (aged 18 years or older), with secondary outcomes of overdose deaths involving specific opioid-involved drug combinations from death certificates. Rates of overdose deaths per 100 000 adult community residents in intervention and control communities from July 2021 to June 2022 were compared with analyses performed in 2023.

RESULTS: In 67 participating communities (34 in the intervention group, 33 in the control group) and including 8 211 506 participants (4 251 903 female [51.8%]; 1 273 394 Black [15.5%], 603 983 Hispanic [7.4%], 5 979 602 White [72.8%], 354 527 other [4.3%]), the average rate of overdose deaths involving all substances was 57.6 per 100 000 population in the intervention group and 61.2 per 100 000 population in the control group. This was not a statistically significant difference (adjusted rate ratio [aRR], 0.92; 95% CI, 0.78-1.07; P = .26). There was a statistically significant 37% reduction (aRR, 0.63; 95% CI, 0.44-0.91; P = .02) in death rates involving an opioid and psychostimulants (other than cocaine), and nonsignificant reductions in overdose deaths for an opioid with cocaine (6%) and an opioid with benzodiazepine (1%).

CONCLUSION AND RELEVANCE: In this clinical trial of the CTH intervention, death rates involving an opioid and noncocaine psychostimulant were reduced; total deaths did not differ statistically. Community-focused data-driven interventions that scale up evidence-based practices with communications campaigns may effectively reduce some opioid-involved polysubstance overdose deaths.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04111939.