Community-based overdose interventions didn’t prevent opioid deaths

On June 16, 2024, NIH researchers published results from the Helping to End Addiction Long-Term (HEALing) Communities Study in the New England Journal of Medicine (NEJM), revealing that data-driven, community-based interventions for preventing opioid-related overdose deaths did not effectively reduce mortality rates. Researchers hypothesize that changes in the illicit drug supply, resulting in a greater prevalence of fentanyl, weakened efforts from the interventions.

“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 NIDA director Nora D. Volkow, MD, in the NIH 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.”

The study examined 67 communities across Kentucky, Massachusetts, New York, and Ohio, randomly assigning 34 communities to receive the evidence-based interventions and 33 communities to serve as wait-list control communities.

The interventions incorporated hundreds of evidence-based, community-level overdose prevention strategies, including increased opioid education, naloxone distribution, access to medications for opioid use disorder (OUD), and safe opioid prescribing and interventions.

Despite evidence showing that these strategies could reduce the rates of opioid overdose deaths, the data from this study showed otherwise. More specifically, the intervention group had an opioid overdose death rate of 47.2 deaths per 100,000 individuals. Comparatively, the rate in the control group was only slightly higher at 51.7 deaths per 100,000 individuals.

The data suggests that while community-based interventions can assist in minimizing overdose deaths, broader interventions that address the evolving illicit drug supply are necessary.

“The implementation of evidence-based interventions is critical to addressing the evolving overdose crisis,” added Miriam E. Delphin-Rittmon, PhD, HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “This study recognizes there is no quick fix to reduce opioid overdose deaths. Saving lives requires ongoing commitment to evidence-based strategies. The HEALing Communities Study facilitated the implementation of 615 evidence-based practice strategies, with the potential to yield lifesaving results in coming years.”