An ambitious federal trial to curb opioid-related deaths by using community interventions came up short. 

Despite the implementation of public education campaigns, increased naloxone distribution and improved access to medications for opioid use disorder (MOUD), as well as many other interventions, the trial failed to demonstrate a statistically significant reduction in overdose deaths.

The large-scale federal trial sought to lower opioid-related overdose deaths in dozens of communities by 40%.

“In retrospect, the prespecified 40% reduction in opioid-related overdose deaths was clearly ambitious,” the study’s authors wrote. “The trial may have been underpowered to detect substantially smaller yet clinically meaningful differences.”

Several factors likely hindered the study’s ability to demonstrate a statistically significant reduction in overdose deaths, according to the authors. These limitations include the relatively short timeframe of the intervention, disruptions caused by the COVID-19 pandemic and the increased prevalence of fentanyl.

The study, called the HEALing Communities Study (HCS), randomly identified 34 communities in Kentucky, Massachusetts, New York and Ohio to implement a slew of evidence-based community-engaged interventions designed to reduce opioid overdose deaths. 

Over 600 evidence-based strategies were used by these communities, including some focused on overdose education and naloxone distribution, some focused on the use of MOUD and others involving prescription opioid safety.

Researchers compared these communities with a control group of 33 similar communities in the same states that did not receive these interventions.

The control communities experienced an opioid overdose death rate of approximately 51.7 per 100,000 population from July 2021 to June 2022. The communities that did receive the intervention experienced a death rate of 47.2 deaths per 100,000, a statistically insignificant decrease.

The communities chosen to implement interventions had only 10 months to establish agency partnerships and deploy the initiatives. By the time the study began collecting data on the number of overdose deaths, only 38% of these strategies had been initiated.

“The time frame was insufficient to initiate many strategies for evidence-based practices, which often required recruiting new staff from an increasingly scarce health care workforce, changing clinical practice workflows or developing new interagency collaborations to introduce services,” the study’s authors wrote. “Ultimately, 615 strategies were implemented, which suggests the effectiveness of the CTH intervention in mobilizing communities to pursue the adoption of evidence-based practices.

Eventually, communities involved in the study implemented 615 strategies, which the study’s authors said demonstrated that efforts to mobilize communities to adopt evidence-based practices were effective.

The COVID-19 pandemic also “severely disrupted” systems that were chosen for study involvement. This disruption reduced the capacity of communities to implement chosen interventions, and therefore, reduced the potential for these interventions to be effective.

Additionally, the increased prevalence of fentanyl and xylazine may have reduced the impact of the study’s interventions. The authors also note that spikes in fentanyl use may not have been uniform across the communities involved in the study.

The study did have several strengths, according to its authors, including the use of timely data to inform which interventions were utilized and the partnerships that were developed between community agencies, people with lived experience, public health practitioners and government officials.

“Although there were no significant between-group differences in the rate of opioid-related overdose deaths, the trial showed that the CTH community-engaged intervention, with its leveraging of community coalitions and a data-driven approach, can bring about meaningful progress in implementing evidence-based practices,” the study’s authors wrote.

Another federal study on opioid overdoses, this one focused on Medicare beneficiaries, was released the same day as the HEALing Communities Study.

The study, published in JAMA Internal Medicine, found that 17% of Medicare beneficiaries who experienced a nonfatal drug overdose experienced another nonfatal drug overdose within one year. Approximately 1% of those Medicare beneficiaries died as a result of a subsequent overdose within a year.

The study also found that opioid interventions, including receiving MOUDs, filling naloxone prescriptions and receiving behavioral health services, were all associated with reducing the risk of a subsequent fatal drug overdose.

“People who have experienced one overdose are more likely to experience another,” Miriam Delphin-Rittmon, assistant secretary for mental health and substance use at the Centers for Medicare & Medicaid Services and the leader of SAMHSA, said in a statement. “But we found that when survivors received gold-standard care such as medications for opioid use disorder and naloxone, the chances of dying from an overdose in the following year drop dramatically. In short, medications for opioid use disorder, opioid overdose reversal medications, and behavioral health supports save lives.”  

While measures including MOUDs and naloxone can decrease the risk of death, few Medicare beneficiaries receive these interventions.

Only 4.1% of Medicare beneficiaries who survived an opioid overdose received MOUD and only 6.2% filled a naloxone prescription in the next year, the study found.

“These findings underscore the need to increase the uptake of evidence-based care after a nonfatal drug overdose,” the study’s authors wrote.