A significant decrease of 37% in overdose fatalities involving opioids mixed with other stimulant drugs, excluding cocaine, is likely attributed to broader treatment access, enhanced naloxone distribution, and focused educational initiatives, as indicated by a comprehensive study funded by the federal government.
This conclusion is part of the planned examination of secondary results from the HEALing (Helping to End Addiction Long-Term) Communities Study (HCS), which focused on evidence-based strategies to lower overdose deaths in Kentucky, Massachusetts, New York, and Ohio.
The study found that death rates from specific opioid-stimulant combinations, particularly fentanyl paired with methamphetamine, were 8.9 per 100,000 adults in communities that received the intervention, contrasting with 14.1 per 100,000 adults in communities that did not participate in the program—a statistically meaningful difference.
The study results were published on October 21, 2024, in JAMA Network Open.
As prescription opioids became less accessible when the trial commenced, fentanyl rapidly infiltrated the illicit market intertwined with methamphetamine, cocaine, counterfeit medications, and other stimulants, explained Bridget Freisthler, the study’s lead author and professor at The Ohio State University.
“We are witnessing a new demographic of individuals developing opioid addiction,” Freisthler stated, serving also as Ohio’s principal investigator for the HEALing Communities Study. “It’s encouraging to see reductions in overdose deaths involving this opioid blend, primarily fentanyl and psychostimulants, excluding cocaine, as this represents the latest trend in the ongoing epidemic.”
The analysis of different drug combinations indicated that intervention communities also experienced a 6% lower rate of overdoses involving opioids mixed with cocaine and a 1% lower rate with benzodiazepines, though these differences were not statistically significant.
The HEALing Communities Study was initiated by the National Institutes of Health (NIH) in 2019. Community coalitions partaking in this study implemented 615 strategies aimed at tackling opioid overdose deaths within health care, justice, and behavioral health systems. These coalitions chose from three evidence-based “menus” based on data that indicated effective interventions targeted at overdose education, naloxone distribution, increased accessibility to medication for opioid use disorders, and safer opioid prescribing practices.
In June, researchers reported the primary outcome of the HCS, indicating no statistically significant decrease in opioid overdose death rates within the assessment duration. However, intervention communities showed an 8% reduction in overall drug overdose rates compared to control communities, equating to an estimated 525 fewer overdose deaths.
The new paper highlighted that over 40% of overdose fatalities in the study involved a combination of at least one opioid and a stimulant.
Due to the elevated presence of fentanyl in the illegal drug market, communication strategies were adapted, stated Freisthler, who also holds the Cooper-Herron Professorship in Mental Health at the University of Tennessee, Knoxville.
“Our messaging had to evolve to inform users of psychostimulants, who often identify simply as meth or cocaine users, about the potential presence of fentanyl in their substances,” she said. “This is a multi-drug dilemma, not just an issue of fentanyl or opioids alone.”
“Communities were deeply invested in this issue, which greatly influenced the focus of our study.”
Communication campaigns across all intervention communities also incorporated naloxone’s potential to avert overdose deaths in polydrug users, a factor that may have contributed to the prevention of fatalities, according to researchers.
Freisthler noted that participating agencies successfully advocated on their behalf, setting the stage for communities to be better equipped to handle overdose situations in the future.
“The HCS provided numerous benefits to Brown County,” remarked Deanna Vietze, executive director of the Brown County Board of Mental Health and Addiction Services in southwest Ohio. “It validated ongoing initiatives, allowed for amplification of best practices, engaged new partners, strengthened existing collaborations, and enabled innovative purchases that will continue to positively affect residents of Brown County for years ahead.”
Leaders of the Ohio study are committed to ensuring that insights and success narratives from the study are broadly disseminated through a dedicated website featuring a range of resources. They are also working with groups eager to implement evidence-based practices within their own communities.
“The overdose crisis spans our communities, compounded by generational and intergenerational trauma within families. This will not change immediately,” Freisthler noted. “Thus, we need to persist in enhancing our understanding of this crisis and strive to lower overdose fatalities to prevent another generation from enduring similar trauma.”
The HEALing Communities Study was supported by a joint effort from the National Institute on Drug Abuse and Substance Abuse and Mental Health Services Administration through the NIH HEAL Initiative.
A $65.9 million NIH grant enabled Ohio State to lead the Ohio segment of the study, which was managed within the university’s College of Medicine. Co-authors also included principal investigators from study sites: Sharon Walsh of the University of Kentucky, Nabila El-Bassel of Columbia University, T. John Winhusen from the University of Cincinnati, Jeffrey Samet from Boston Medical Center, and Emmanuel Oga from RTI International.
