In January 2019, the National Institutes of Health launched the HEALing (Helping to End Addiction Long-Term) Communities Study to bring evidence-based practices to specific communities in an effort to reduce opioid-related overdose deaths. The results, published in June 2024, concluded that the practices did not result in a statistically significant reduction in opioid-related overdose deaths during the evaluation period.
However, results published recently as part of a planned study of secondary outcomes of the HEALing Communities Study (HCS) show that the practices likely led to a 37% reduction in overdose deaths from opioids combined with stimulant drugs other than cocaine.
The original HCS
Launched in 2019, the HEALing Communities Study is the largest addiction prevention and treatment implementation study ever conducted. It took place in 67 communities in Kentucky, Massachusetts, New York, and Ohio—four states that have been hard hit by the opioid crisis.
As part of the intervention, researchers collaborated with community coalitions to implement three specific evidence-based practices for reducing opioid overdose deaths: increasing opioid education and naloxone distribution; enhancing access to medication for opioid use disorder; and safer opioid prescribing and dispensing.
Communities were randomly assigned to receive the intervention—between January 2020 and June 2022—or the control group, who received the intervention between July 2022 and December 2023. To test the effectiveness, researchers compared the rate of overdose deaths between the communities that received the intervention immediately with those that did not during the period of July 2021 and June 2022.
Despite the success in deploying the interventions in participating communities, there was not a statistically significant difference in the overall rate of opioid-involved overdose deaths between the communities receiving the intervention and those that did not—47.2 opioid-related overdose deaths per 100,000 people in the intervention group versus 51.7 in the control.
The authors of the June study highlighted a few unforeseen challenges that likely weakened the impact of the intervention. Most prominently: the timing—the study was launched two months before the COVID-19 shutdown, which severely disrupted the ability to work across teams within the study.
Second, significant changes in the illicit drug market occurred during the intervention period, especially the increased use of fentanyl in combination with stimulant drugs like methamphetamine and cocaine, or in counterfeit pills made to look like prescription medications. This led coalition agencies to adjust their communication efforts accordingly—and that’s what ended up making a difference.
“We were already shifting to where psychostimulants had fentanyl in them and messages weren’t reaching the right folks because people who use psychostimulants think of themselves as using meth or cocaine, not opioids,” she said. “So we had to make it clear that fentanyl could be in every drug and that nobody was really immune from the possibility of an overdose. Communities emphasized that this is a multiple-drug issue, not just a fentanyl issue or an opioid issue.
Secondary outcomes of the HCS
Focusing just on the combination of opioids with stimulants other than cocaine, the new study recorded death rates at 8.9 per 100,000 adults in the intervention communities compared with 14.1 per 100,000 adults in communities that did not receive the intervention. That is a 37% reduction in overdose deaths from opioids combined with stimulant drugs other than cocaine—a statistically significant difference.
Cases with at least one opioid and a psychostimulant represented more than 40% of opioid overdose fatalities in this study.
“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,” said NIDA director, Nora D. Volkow, M.D. “Ongoing analyses of the rich data from this study will be critical to guiding our efforts in the future.”
Analysis of other drug combinations showed that intervention communities had lower rates of overdose deaths from an opioid mixed with cocaine (6%) and an opioid mixed with benzodiazepine (1%), but the differences did not reach statistical significance. Overall, intervention communities had an 8% lower rate of all drug overdoses compared with communities with no intervention—which, again, is not statistically significant but is estimated to represent 525 lives saved.
“Even in the face of a global pandemic and worsening overdose crisis, the HEALing Communities Study was able to support the implementation of hundreds of strategies that we know save lives,” said Redonna Chandler, director of the HEALing Communities Study at NIDA. “This is an incredible feat for implementation science, and shows that when we provide communities with an infrastructure to make data-driven decisions, they are able to effectively implement evidence-based practices based on their unique needs.”