HCS
Trial question
What is the role of Communities That HEAL intervention in communities reporting high opioid overdose fatality rates?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
52.0% female
48.0% male
N = 8211506
8211506 patients (4251903 female, 3959603 male).
Inclusion criteria: communities reporting high opioid overdose fatality rates.
Key exclusion criteria: at least 30% rural classification within the communities; willingness in the community to address in the response strategy the implementation of MOUD, overdose prevention training, and naloxone distribution across their community.
Interventions
N=4439170 Communities That HEAL intervention (34 communities with a community-engaged approach with local coalitions to employ data-driven decision-making using community-level data to select and guide the implementation of evidence-based practices, coupled with communication campaigns).
N=3772336 wait list control communities (33 communities with usual care during the first 30 months of the trial).
Primary outcome
Drug overdose deaths
55.99
61.11
61.1 per 10...
45.8 per 10...
30.6 per 10...
15.3 per 10...
0.0 per 10...
Communities That HEAL
intervention
Wait list control
communities
No significant
difference ↔
No significant difference in drug overdose deaths (55.99 per 100,000 population vs. 61.11 per 100,000 population; RR 0.92, 95% CI 0.78 to 1.07).
Secondary outcomes
Significant decrease in overdose deaths involving any opioid and any psychostimulant other than cocaine (6.68 per 100,000 population vs. 10.55 per 100,000 population; RR 0.63, 95% CI 0.44 to 0.91).
No significant difference in overdose deaths involving any opioid and cocaine (10.32 per 100,000 population vs. 10.94 per 100,000 population; RR 0.94, 95% CI 0.69 to 1.3).
No significant difference in overdose deaths involving any opioid and any benzodiazepine (6.59 per 100,000 population vs. 6.64 per 100,000 population; RR 0.99, 99% CI 0.73 to 1.35).
Conclusion
In communities reporting high opioid overdose fatality rates, Communities That HEAL intervention was not superior to wait list control communities with respect to drug overdose deaths.
Reference
Bridget Freisthler, Rouba A Chahine, Jennifer Villani et al. Communities That HEAL Intervention and Mortality Including Polysubstance Overdose Deaths: A Randomized Clinical Trial. JAMA Netw Open. 2024 Oct 1;7(10):e2440006.
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