A federally funded study has found that expanded treatment options, increased distribution of naloxone, and targeted educational campaigns contributed to a significant 37% reduction in overdose deaths from opioids combined with stimulant drugs, excluding cocaine. The study, a secondary outcome of the HEALing Communities Study (HCS), tested a broad intervention aimed at curbing overdose fatalities in four U.S. states: Kentucky, Massachusetts, New York, and Ohio.
The research, published in JAMA Network Open on October 21, 2024, revealed that overdose death rates involving opioids and non-cocaine stimulants—most commonly fentanyl combined with methamphetamine—were significantly lower in communities that received the intervention. Death rates in these areas were recorded at 8.9 per 100,000 adults, compared to 14.1 per 100,000 in communities that did not participate in the intervention.
“The rise of fentanyl, often mixed with methamphetamine, cocaine, and other stimulants, has altered the landscape of drug overdose deaths,” said Bridget Freisthler, lead author of the study and a professor at The Ohio State University. “The intervention successfully addressed these specific drug combinations.”
While the intervention did not show a statistically significant reduction in overdose deaths from opioids mixed with cocaine (6% decrease) or opioids combined with benzodiazepines (1% decrease), it demonstrated meaningful progress in tackling the most dangerous combinations.
The National Institutes of Health (NIH) launched the HEALing Communities Study in 2019 to address the opioid epidemic. Community coalitions implemented 615 strategies to reduce opioid-related deaths across healthcare, justice, and behavioral health settings. These efforts included overdose education, naloxone distribution, access to medications for opioid use disorder, and safer prescribing practices.
Earlier findings from June showed that the intervention led to an 8% overall reduction in overdose deaths across all drug types, an impact estimated to have prevented 525 deaths. However, this latest analysis sheds light on the more significant impact on opioid-stimulant combinations, which are particularly deadly.
The study highlighted that over 40% of overdose deaths involved the use of both opioids and stimulants. As fentanyl’s presence in the illicit drug market increased, coalition agencies adapted their communication strategies to inform users of stimulants like methamphetamine that they were also at risk of opioid overdose.
“We had to make it clear that fentanyl could be in any drug, including stimulants, and that no one was immune to the risk of overdose,” Freisthler said. “Communities emphasized that this is a multi-drug issue, not just about fentanyl or opioids.”
The expanded use of naloxone, an overdose-reversal drug, played a crucial role in the success of the intervention. Education campaigns that highlighted the need for naloxone for people using multiple substances likely contributed to the reduction in deaths.
According to Deanna Vietze, executive director of the Brown County Board of Mental Health and Addiction Services in Ohio, the study provided significant benefits to the local community, affirming existing efforts and enabling further expansion of best practices. “It strengthened partnerships and created new opportunities for outreach, which will continue to benefit our citizens in the years to come,” she said.
Ohio researchers are now focused on making the lessons and success stories from the study accessible to other communities through a dedicated website and by collaborating with groups interested in adopting the evidence-based practices.
“The drug overdose crisis is deeply entrenched in our communities, with multigenerational trauma affecting families,” Freisthler said. “While change won’t happen overnight, we must continue to expand our understanding and find ways to reduce overdose deaths.”
The HEALing Communities Study is a collaboration between the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration, part of the NIH HEAL Initiative. Ohio State University led the Ohio portion of the study, supported by a $65.9 million NIH award. Co-authors of the study include researchers from the University of Kentucky, Columbia University, the University of Cincinnati, Boston Medical Center, and RTI International.
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