A large, federally funded study focused on reducing opioid overdose deaths highlighted mixed results.
Community-focused interventions, including naloxone distribution and increased education, can be effective at reducing overdose deaths that involve an opioid and a psychostimulant other than cocaine, according to a study published in JAMA Network Open.
However, the same interventions were found to have a non-significant impact on opioid overdose deaths overall.
“These results suggest that community-focused, data-driven interventions that scale up evidence-based practices with a communications campaign may collectively contribute to successes in addressing the evolving nature of some opioid-involved polysubstance overdose deaths,” the study’s authors wrote.
The study, called the HEALing Communities Study, was funded by the National Institute on Drug Abuse (NIDA).
Researchers analyzed 67 communities that are highly impacted by the opioid crisis in Kentucky, Massachusetts, New York and Ohio, 34 of which received a community-engaged intervention designed to reduce opioid overdose deaths and stigma. The remaining 33 communities served as controls.
Interventions included tailored overdose education, naloxone distribution, medications for opioid use disorder (MOUD), safer opioid prescribing and communication campaigns to decrease stigma and increase demand for evidence-based treatments. These interventions were instituted from January 2020 through June 2022; researchers analyzed data linking to the period July 2021 through June 2022.
Among the communities that received the interventions, overall overdose death rates decreased by 8%, but this figure was not considered significant, researchers wrote.
A significant reduction in overdose deaths did occur for a specific population of opioid users, however.
Overdose death rates for deaths involving an opioid and psychostimulants other than cocaine – most likely methamphetamines – were reduced by an impressive 37%.
The use of more than one drug at a time, known as polysubstance use, is becoming increasingly common. Data published in 2023 found that as many as 61% of people with substance use disorder (SUD) need treatment for at least two different substances.
The HEALing Communities Study found that deaths involving at least one opioid and a psychostimulant other than cocaine made up more than 40% of all overdose deaths.
“We found high prevalence of polysubstance use, consistent with prior research on overdose deaths in the U.S.,” the study’s authors wrote. “Deaths from polysubstance use are likely more reflective of the current reality of the opioid crisis than deaths from opioids alone.”
While the interventions were largely impactful for overdose deaths involving a psychostimulant other than cocaine, the reduction in overdose deaths that involved an opioid and cocaine was only 6%.
The difference in reductions between cocaine and likely methamphetamine deaths, researchers wrote, may be partly attributed to the drugs’ popularity in different regions. Historically, methamphetamine is more common in rural areas while cocaine is more common in urban areas.
Overdose education, naloxone distribution and media messaging may therefore have had a larger reach in rural areas with smaller populations, researchers wrote.
The study was limited by several factors, including the impact of the COVID-19 pandemic and the expansion of fentanyl in the drug supply, which increased the risk of overdose deaths among people who did not intend to use an opioid. Additionally, some communities received “significant outside funding” during the course of the study, which could be a confounding variable.
Researchers concluded that population-level interventions practiced in the study could be effective at reducing polysubstance overdoses that include opioids and are worthy of funding. They also recommend further research on the intervention model designed for smaller reductions in overdose deaths.
