According to a significant study funded by the government, the implementation of more treatment options, increased distribution of naloxone, and focused educational campaigns likely contributed to a 37% decrease in overdose fatalities involving a combination of opioids and stimulant drugs, except for cocaine.
This conclusion is part of the HEALing (Helping to End Addiction Long-Term) Communities Study (HCS), which was planned to assess various outcomes. The study mainly focused on evidence-based interventions aimed at reducing overdose deaths in Kentucky, Massachusetts, New York, and Ohio.
In areas that received the intervention, death rates from specific mixtures of opioids with other stimulants, such as fentanyl combined with methamphetamine, stood at 8.9 per 100,000 adults. In contrast, comparison areas without the intervention reported a rate of 14.1 per 100,000 adults, indicating a statistically significant difference.
The results, published today (Oct. 21, 2024) in JAMA Network Open, highlight the effectiveness of the strategies employed.
Bridget Freisthler, the lead author and a professor at The Ohio State University, noted that by the time of this study, the prescription opioid medications that instigated the crisis were becoming harder to access. Meanwhile, fentanyl was increasingly appearing in the illicit drug market, often mixed with methamphetamine, cocaine, counterfeit pills, and various other stimulants.
“We are now seeing a new group of individuals struggling with opioid addiction,” Freisthler explained, serving as Ohio’s primary investigator for the HEALing Communities Study. “It was encouraging to observe a reduction in overdose deaths related to this specific combination of opioids, chiefly fentanyl, and psychostimulants, excluding cocaine, as this marks a burgeoning trend in the ongoing epidemic.”
Further analysis showed that areas with interventions also experienced lower overdose death rates from opioids mixed with cocaine (by 6%) and those combined with benzodiazepines (by 1%), although these differences were not statistically significant.
The HEALing Communities Study was initiated by the National Institutes of Health (NIH) in 2019, with community coalitions implementing 615 strategies aimed at tackling opioid-related overdose deaths across healthcare, justice, and behavioral health sectors. Communities selected from three sets of evidence-based practices tailored to their specific needs, focusing on overdose education, naloxone distribution, enhancing access to medication for opioid use disorder, and promoting safer prescription practices.
In June, researchers disclosed the overall results, indicating that the intervention did not lead to a statistically significant reduction in opioid overdose death rates during the evaluation period. However, they revealed that intervention communities experienced an 8% lower rate of all drug overdoses compared to control communities, which equated to about 525 fewer overdose fatalities.
In the new findings, it was noted that more than 40% of overdose deaths during the study involved a blend of at least one opioid with a stimulant.
This rise in illicit fentanyl led coalition agencies to modify their communication strategies, Freisthler added, who is also the Cooper-Herron Professor in Mental Health at the University of Tennessee, Knoxville.
“We began to recognize that psychostimulants often contained fentanyl, and our messages weren’t reaching the right audience because users of psychostimulants tend to identify solely as users of meth or cocaine, ignoring the opioid category,” she stated. “We had to clarify that fentanyl could be present in any drug, making all users vulnerable to overdose. Communities stressed that this is a multi-drug problem, not just limited to fentanyl or opioids.”
“In many respects, the focus on these specific outcomes stemmed from the high level of concern and investment from the communities,” she noted.
Furthermore, communications about naloxone’s potential role in preventing overdose deaths among multi-drug users were included in the campaigns implemented across all intervention communities, which may have further contributed to the decrease in fatalities, according to researchers.
Freisthler remarked that participating agencies effectively advocated for themselves, setting a strong foundation for communities to better tackle overdose issues in the future.
“The HCS brought several benefits to Brown County,” said Deanna Vietze, the executive director of the Brown County Board of Mental Health and Addiction Services in southwest Ohio. “It validated ongoing efforts, allowed for the expansion of best practices, fostered new partnerships, bolstered existing collaborations, and facilitated innovative outreach initiatives that will continue to positively affect Brown County residents in the coming years.”
Ohio study leaders are dedicated to ensuring that the lessons and success stories from the study are widely shared through a website offering a variety of resources, and they are engaging with groups interested in adopting evidence-based practices in their local communities.
“The drug overdose crisis pervades our communities, deeply affected by multigenerational trauma. This is not a problem that will resolve quickly,” Freisthler explained. “Continuous efforts are necessary to enhance our understanding of this crisis and decrease overdose deaths to prevent future generations from enduring similar trauma.”
The HEALing Communities Study received support through a collaboration between the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration as part of the NIH HEAL Initiative.
A funding award of $65.9 million from the NIH supported Ohio State’s leadership role in the Ohio segment of the study, based in the university’s College of Medicine. Co-authors of the published paper include key investigators from various universities, reflecting the broad collaborative effort.
