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Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths.

, Jeffrey H Samet1, Nabila El-Bassel1

  • 1The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Departments of Medicine and Pediatrics (S.M.B.), Boston Medical Center, Section of General Internal Medicine (T.J.B., P.B., D. Beers, C. Bridden, K.C., J. Carpenter, E.B.G., A. Harris, S.K., Nikki Lewis, R.M.L., M.R., M. Saucier, R.S.C.), Boston University Chobanian and Avedisian School of Medicine (T.A.B.), Boston University School of Public Health, Department of Health Law, Policy and Management (D.D.B., M.D. Stein), Massachusetts Department of Public Health, Bureau of Substance Addiction Services (D. Calvert), Boston University School of Social Work (D. Chassler), Boston University School of Public Health, Department of Biostatistics (D.M.C.), Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of Infectious Diseases, and Boston University School of Public Health, Department of Health Law, Policy and Management (M.-L.D.), Massachusetts HCS Community Advisory Board (J.L.K., K.P.), Boston Medical Center, Section of Infectious Diseases (E.N.K., C.S.), Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine (M.R. Larochelle, J.L.T., A.Y.W.), Boston Medical Center, Department of Medicine (H.M.L.), Massachusetts Department of Public Health, Registry of Vital Records and Statistics (S.P.), Tufts University School of Medicine, Department of Public Health and Community Medicine (T.J.S.), and McLean Hospital, Division of Alcohol, Drugs, and Addiction, and Harvard Medical School, Department of Psychiatry (R.W.) - all in Boston; the Social Intervention Group, School of Social Work, Columbia University (N.E.-B., A. Dasgupta, J.L.D., A. Davis, K.H.G., L. Gilbert, D.A.G.-E., D.E.G., J. Hotchkiss, T. Hunt, J.L.N., E.R., S. Rodriguez, E.W.), New York HCS Community Advisory Board (A. Angerame, R. Caldwell, S.M., K.M., J.P., K.R., W.R., M. Salvage), Columbia University Irving Medical Center, Department of Psychiatry (D. Blevins, A.N.C.C., F.R.L., E.V.N.), Albert Einstein College of Medicine, Department of Epidemiology and Population Health (N.B., D.G., D.W.L., B.D.R.), Montefiore Medical Center (J. Chaya), New York State Office of Addiction Services and Supports (C.O.C.), City University of New York (T. Huang, N.S.), Weill Cornell Medicine, Department of Population Health Sciences (B.S.), and the New York Office of Mental Health (A. Sullivan), New York, and the New York State Department of Health, Albany (T.Q.N., E.S.) - all in New York; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine (T.J.W.), University of Cincinnati Corrections Institute (T.D.), University of Cincinnati College of Medicine, Department of Emergency Medicine (C.E.F., J. McMullan), University of Cincinnati Medical Center, Emergency Medicine (N.H.D.), University of Cincinnati College of Medicine, Department of Environmental and Public Health Sciences (T.I.), Case Western Reserve University School of Medicine, Department of Family Medicine and Community Health (T.V.P.), Brightview Health (S. Ryan), and University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience (J.S.), Cincinnati, the College of Medicine (R.D.J., S.F., K.H., J.E.L., M.S.L.) and the College of Social Work (B.F.), Center of Health Outcomes and Policy Evaluation Studies (W.F.), Department of Family and Community Medicine (T.R.H., A.S.M., D.M.W.), College of Public Health and Translational Data Analytics Institute (A. Hyder), Department of Emergency Medicine (E.K.), Ohio Colleges of Medicine Government Resource Center (A.M., R.M.), One Ohio Foundation (A.N.), College of Public Health (P.S., E.E.S., A. Shoben), Recovery Ohio (A. Shadwick), and the School of Communication (M.D. Slater), Ohio State University, Columbus, Case Western Reserve University School of Medicine, Department of Population and Quantitative Health Sciences (D.A.F.), and Case Western Reserve University School of Medicine, Clinical and Translational Science Institute (M.W.K.), Cleveland, and Brown County Mental Health and Addiction Services, Georgetown (D.J.V.) - all in Ohio; RTI International, Research Triangle Park, NC (E.A.O., J.A., A. Aldridge, D. Babineau, C. Barbosa, R. Caspar, B.E., L. Glasgow, S.G., M.E.H., J. Holloway, C.K., P.A.L., R.C.L., L.N., N.V., G.A.Z.); the National Institute on Drug Abuse, Bethesda, MD (R.K.C., J.V.); University of Colorado School of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Aurora (J.B.); University of North Texas Health Science Center, Fort Worth (S.T.W.); Kentucky Office of Drug Control Policy, Frankfort (V.L.I.), University of Kentucky, College of Public Health (H.M.B.), University of Kentucky, Kentucky Injury Prevention Research Center (J.L. Bush, S.L.H ), University of Kentucky College of Medicine, Department of Medicine, Division of Infectious Diseases, Center on Drug and Alcohol Research (L.C.F.), University of Kentucky, Department of Pharmacy Practice and Science (P.R.F., D.H., D.R.O.), Commonwealth of Kentucky, Cabinet for Health and Family Services (E.F., K.R.M.), University of Kentucky, Department of Communication (D.W.H., Nicky Lewis), University of Kentucky, Department of Behavioral Science (H.K.K.), University of Kentucky College of Medicine, Center on Drug and Alcohol Research (M.R. Lofwall, S.L.W.), University of Kentucky, Department of Health Management and Policy and Center for Innovation in Population Health (M.L.M.), University of Kentucky, Substance Use Research Priority Area (J. Miles, M.F.R., P.R., D.S.), University of Kentucky College of Medicine, Internal Medicine (D.A.O.), University of Kentucky, Department of Sociology (C.B.O.), University of Kentucky (B.D.R.), University of Kentucky, Department of Biostatistics (S.S., P.M.W.), University of Kentucky, Dr. Bing Zhang Department of Statistics (K.L.T.), University of Kentucky, Department of Behavioral Science (M. Staton, H.L.S.), University of Kentucky, Center for Health Equity Transformation (D.J.S.-W.), University of Kentucky College of Medicine, Institute for Biomedical Informatics (J.C.T.), and University of Kentucky, Department of Epidemiology and Environmental Health (R.A.V.-S., A.M.Y.), Lexington, and the Commonwealth of Kentucky, Clark County Health Department, Winchester (J.G.) - all in Kentucky; Purdue University, Department of Psychological Sciences, Lafayette, IN (J.L. Brown); University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami (D.J.F.); Oak Ridge Associated Universities (ORAU), Health Communications, Marketing, and Promotion Program, Oak Ridge, TN (J.G.R.); and University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia (L.E.S.).

The New England Journal of Medicine
|June 17, 2024
PubMed
Summary
This summary is machine-generated.

A community-engaged intervention did not significantly reduce opioid overdose deaths. The study found similar death rates between intervention and control groups, highlighting challenges in implementing evidence-based practices during the COVID-19 pandemic and fentanyl crisis.

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Area of Science:

  • Public Health
  • Epidemiology
  • Intervention Science

Background:

  • Opioid overdose deaths remain a critical public health issue.
  • Evidence-based practices (EBPs) like naloxone distribution and medication for opioid use disorder (MOUD) are proven interventions.
  • Community-engaged approaches are needed to increase uptake of these EBPs.

Purpose of the Study:

  • To evaluate a community-engaged intervention aimed at reducing opioid overdose deaths.
  • To assess the impact of enhanced uptake of EBPs on overdose mortality.
  • To examine intervention effectiveness across diverse community settings.

Main Methods:

  • A community-level, cluster-randomized trial involving 67 communities across four states.
  • Communities were assigned to either an intervention or a wait-list control group.
  • The primary outcome was the rate of opioid-related overdose deaths over a 12-month period.

Main Results:

  • No significant difference in opioid-related overdose death rates was observed between the intervention and control groups (rate ratio: 0.91).
  • The intervention's effect did not vary by state, urban/rural classification, or demographic factors.
  • Despite selecting numerous EBPs, only 38% were initiated by the comparison year's start.

Conclusions:

  • A 12-month multimodal intervention did not reduce opioid overdose death rates.
  • Implementation challenges and the concurrent COVID-19 pandemic and fentanyl epidemic may have impacted outcomes.
  • Further research is needed to optimize community-level strategies for reducing opioid overdose deaths.