Press release
Sunday June 16, 2024
A data-driven intervention that engaged communities to rapidly deploy evidence-based practices to reduce opioid-related overdose deaths – such as increasing naloxone distribution and improving access to medication for opioid use disorder – did not result in a statistically significant reduction in opioid use-related deaths. overdose mortality rate during the evaluation period, according to results from the National Institutes of Health’s HEALing (Helping to End Addiction Long-Term) Communities Study. Researchers identified the COVID-19 pandemic and the increased prevalence of fentanyl in the illicit drug market – including mixed with cocaine and methamphetamine – as factors that could weaken the impact of the intervention on reducing opioid-related overdose deaths.
The results were published in the New England Journal of Medicine and presented at the College on Problems of Drug Dependence (CPDD) meeting on Sunday, June 16, 2024. Launched in 2019, the HEALing Communities Study is the largest drug prevention and treatment implementation study ever conducted and took place in 67 communities in Kentucky, Massachusetts, New York and Ohio – four states hit hard by the opioid crisis.
Despite unforeseen challenges, the HEALing Communities study was successful in engaging communities to select and implement hundreds of evidence-based strategies during the intervention, demonstrating how to leverage community partnerships and use data to inform public health decisions can effectively support the uptake of evidence. strategies based on the local level.
“This study brought together researchers, providers, and communities to remove barriers and promote the use of evidence-based strategies that we know are effective, including medications for substance use disorder. opioids and naloxone,” said NIDA Director Nora D. Volkow, MD. “Yet, particularly in the era of fentanyl and its increasing mix with psychostimulant medications, it is clear that we must continue to develop new tools and approaches to address the overdose crisis. Continued analyzes of the rich data from this study will be essential to guide our efforts in the future.
The NIH launched the HEALing Communities Study, a four-year, multi-site research study to test a set of evidence-based interventions to reduce overdose deaths in health care, justice, and healthcare settings behavioral. More than 100,000 people die each year from drug overdoses, more than 75% of which are opioid-related. Many evidence-based practices have been proven to prevent or reverse opioid overdoses, but these strategies are severely underutilized due to a number of barriers.
As part of the intervention, researchers collaborated with community coalitions to implement evidence-based practices to reduce opioid overdose deaths through the Continuum of Care approach to drug overdose reduction. ‘opioids. These evidence-based practices focus on increasing opioid education and naloxone distribution, improving access to medications for opioid use disorder, and safer prescribing and dispensing of opioids. The intervention also included a series of communication campaigns aimed at reducing stigma and increasing demand for evidence-based practices.
Communities were randomly assigned to either receive the intervention (between January 2020 and June 2022) or to be part of the control group (which received the intervention between July 2022 and December 2023). To test the intervention’s effectiveness in reducing opioid-related overdose deaths, researchers compared the rate of overdose deaths between communities that received the intervention immediately with those that did not at first. during the period of July 2021 and June 2022.
Between January 2020 and June 2022, response communities successfully implemented 615 evidence-based practice strategies (254 related to overdose education and naloxone distribution, 256 related to overdose medications opioid use disorders and 105 related to prescription opioid safety).
Despite the successful deployment of evidence-based interventions in participating communities, between July 2021 and June 2022, there was no statistically significant difference in the overall rate of opioid-related overdose deaths between communities receiving intervention and those who did not (47.2 opioid-related overdose deaths per 100,000 people in the intervention group, compared to 51.7 in the control group). The study team is also reviewing data on the impact of the intervention on total overdose deaths and examining specific drug combinations, such as stimulants and opioids, and on non-opioid overdoses. fatalities, among other results of the study.
“Implementing evidence-based interventions is critical to addressing the evolving overdose crisis,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and substance use and leader of SAMHSA. “This study recognizes that there is no silver bullet for reducing opioid overdose deaths. Saving lives requires continued commitment to evidence-based strategies. The HEALing Communities study facilitated the implementation of 615 evidence-based practice strategies, with the potential to produce life-saving results in the years to come.
The authors highlight three specific factors that likely weakened the intervention’s impact on reducing opioid-related overdose deaths. First, the intervention was launched two months before the COVID-19 shutdown, which severely disrupted the ability to work with health care, behavioral health, and criminal justice systems to implement evidence-based practices on evidence. Indeed, largely due to the emergence of COVID-19, only 235 of 615 strategies (38%) were implemented before the start of the comparison period in July 2021.
Second, after communities selected the evidence-based practices they wanted to implement, they had only 10 months to implement them before the comparison period began. The authors note that this has not been enough to recruit necessary staff, change clinical practice workflows, or develop new collaborations between agencies and organizations. They note that it may take more time to implement these strategies, and more time between implementation and measuring results, to observe the full impact of the intervention.
Finally, significant changes in the illicit drug market could have impacted the effectiveness of the intervention. Fentanyl is increasingly permeating the illicit drug supply and is increasingly mixed or used in combination with stimulant drugs like methamphetamine and cocaine, or in counterfeit pills designed to look like prescription drugs. The increasing use of fentanyl, as well as xylazine, during the study period posed new challenges for the treatment of opioid use disorder and opioid-related overdose.
“Even in the face of a global pandemic and a worsening overdose crisis, the HEALing Communities study has been able to support the implementation of hundreds of strategies that we know save lives,” said Redonna Chandler, Ph. .D., director of the HEALing Communities study. at NIDA. “This is an incredible feat for implementation science and shows that when we provide communities with infrastructure to make data-driven decisions, they are able to effectively implement data-driven practices. evidence based on their unique needs. »
The HEALing Communities study was supported and carried out in partnership between the National Institute on Drug Abuse (NIDA) of the National Institute of Health and the Substance Abuse and Mental Health Services Administration (SAMHSA) through the initiative NIH HEAL.
Helping End Long-Term Addiction®, NIH HEAL Initiative® and HEALing Communities Study® are registered service marks of the Department of Health and Human Services.
If you or someone you know is struggling or in crisis, help is available. Call or text 988or chat on988lifeline.org. To find out how to get help for mental health, drug or alcohol problems, visitFindSupport.gov. If you are ready to locate a treatment facility or provider, you can reach out directly toFindTreatment.gov or call800-662-HELP (4357).
About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2022, nearly 49 million people in the United States suffered from at least one substance use disorder. Substance use disorders are defined in part by continued substance use despite negative consequences. These are also recurring conditions, in which periods of abstinence (not using substances) may be followed by a return to use. Stigma can make people with substance use disorders less likely to seek treatment. Using preferred language can help accurately report substance use and dependence. Check out the NIDA online guide.
About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports much of the world’s research into the health aspects of drug use and dependence. The Institute conducts a wide variety of programs to inform policy, improve practice, and advance the science of addiction. For more information about NIDA and its programs, visit www.nida.nih.gov.
About the National Institutes of Health (NIH):
The NIH, the nation’s medical research agency, is comprised of 27 institutes and centers and is part of the U.S. Department of Health and Human Services. The NIH is the primary federal agency that conducts and supports basic, clinical, and translational medical research, and studies the causes, treatments, and cures for common and rare diseases. For more information about the NIH and its programs, visit www.nih.gov.
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