How Community-Based Strategies Reduced Opioid Overdose Deaths

The University of Pittsburgh’s community-based strategy for reducing opioid deaths has helped counties across the state fortify public health, boost patient access to care, and ultimately, improve outcomes, according to a study in the Journal of Studies on Alcohol and Drugs.

The Pennsylvania Opioid Overdose Reduction Technical Assistance Center (ORTAC) prioritizes community-led strategies for addressing the opioid crisis. Instead of a piecemeal approach led by singular entities—public health agencies, community health groups, and medical groups—ORTAC provides a space for each of those stakeholders to convene and uses the expertise of the community-facing groups to address opioid overdose deaths (ODD).

“I passionately believe that communities have to come together and be empowered to take control of their own public health to really make sea change on issues like ODD,” Janice Pringle, PhD, the study’s senior author and professor of pharmacy and therapeutics and director of the Program Evaluation and Research Unit (PERU) at the Pitt School of Pharmacy, said in a statement. “Our study is one of the first to show that a community approach is how you move the needle on preventing ODD.”

ORTAC runs on the fundamental principle that some public health problems are better solved by a group of people working together on a single approach rather than by multiple, disparate interventions. In the case of the opioid crisis, multiple stakeholders often lead their own interventions with limited, disconnected impact. When each of those stakeholders works together, the impact is more pronounced, Pringle said.

“ORTAC aims to bring efforts together, pool resources and integrate services to reduce opioid-related overdose deaths at a community level,” said Pringle. “If the opioid crisis is a tree, 1,000 steak knives is not going to chop it down. We need 67 hands — one for each county in Pennsylvania — on the chainsaw.”

The ORTAC framework is eight steps and is tailored to help community organizations work with other experts to create a roadmap for intervention. Projects start with a planning phase that includes leaders from first responder groups, emergency departments, drug and alcohol systems, mental health systems, and the criminal justice system. The entities work together to determine how best to serve the unique needs of a community, informed by big data about the community.

“The idea behind ORTAC is that community members and people on the front lines know what’s best for their community,” lead author Renee Cloutier, PhD, a research scientist in the Pitt School of Pharmacy’s Department of Pharmacy and Therapeutics and scientific director of PERU, stated publicly. “The ORTAC team worked to develop and activate community coalitions to clarify the problems in their community, generate plans and act on them.”

Once community groups decide on a unified mission, they outline specific action items. Cloutier and Pringle said that interventions have ranged from improving access to addiction treatment care, educating first responders on naloxone use, carrying out harm-reduction strategies like syringe service programs, and creating messaging campaigns to reduce treatment stigma.

This approach worked better at reducing ODDs than the standard approach, the researchers reported. The team looked at ODD rates from between 2016 and 2019 in 29 counties where ORTAC was carried out and compared that data with 19 counties that used a standard approach to opioid intervention.

Two-thirds of the counties that used the ORTAC approach saw a reduction in ODDs per 100,000 people. That compares to just 47 percent of the counties using a standard approach who saw the same results.

Moreover, the researchers found that the ODD rate in ORTAC counties was lower than in control counties over time. In the first two years after ORTAC implementation, the difference in ODD rates ranged from 1.5 to 3.8 deaths per 100,000 people. Those figures account for factors like county distribution of naloxone, illicit drug supply, and opioid prescriptions.

“If you fund communities and provide structured support, you can make transformational change beyond what might be possible with a top-down approach,” said Cloutier. “We hope to see more funding targeted toward supporting communities on the ground in this way.”

Notably, this approach was cost-effective, the researchers added. It cost less than $6,000 to prevent each overdose death, they said. A separate analysis found that counties saw a savings of $10.5 million for avoiding a single ODD.

“Our strategy had a meaningful impact on reducing ODD and is incredibly cost-effective,” said Pringle. “With more funding and support, we can continue to guide communities to reduce the risk of ODD for everyone because this issue is in all our backyards. The opioid crisis affects us all, and there is so much more work to be done.”