In 2019, amid an ever-worsening drug crisis, the federal government launched a research study with an ambitious goal: to lower opioid overdoses in participating communities by 40% using evidence-based interventions like distributing naloxone and providing access to addiction medications.
But communities that implemented the public health strategies did not see a statistically significant reduction in opioid overdose deaths, according to data published Sunday in the New England Journal of Medicine.
Given the study’s simple premise — that helping communities use proven strategies could help prevent deaths — the results came as a surprise. But its leaders warn against making too much of the disappointing data, citing the fast-changing drug supply and, critically, the backdrop of the Covid-19 pandemic.
“We started this study in January of 2020, and guess what happened in March of 2020?” Redonna Chandler, the National Institute on Drug Abuse official who directed the research project. “And while our communities continued working in the background, we weren’t able to get into hospitals. We weren’t able to get into jails. We weren’t able to get into a lot of the places and spaces where we wanted to implement our evidence-based practices.”
In fact, of the hundreds of individual interventions that communities had planned to use as part of the study, just 38% had been implemented by the start of the year that data was analyzed, according to the NEJM analysis.
The National Institutes of Health launched the initiative, known as the HEALing Communities Study — short for Helping End Addiction Long-term — in April 2018. It awarded $344 million to participating communities, using funds that Congress had appropriated for substance use research the previous year.
“Now is the time to channel the efforts of the scientific community to deliver effective — and sustainable — solutions to this formidable public health challenge,” several top NIH officials, including then-director Francis Collins and NIDA director Nora Volkow, wrote in 2018 when the project kicked off.
The study focused on 67 communities across Massachusetts, New York, Kentucky, and Ohio. Roughly half were picked to implement their overdose-prevention strategies beginning in 2020; the rest put their strategies into place beginning in 2022, following the comparison period between the two groups.
Interventions included increasing access to medications like methadone and buprenorphine by reducing restrictions, supporting health care providers, and working with jails and prisons. It also included education surrounding opioid prescribing, and bolstering the distribution of naloxone, a medication used to reverse opioid overdoses.
During the comparison period, the communities that put their strategies into place sooner experienced 47.2 opioid-related overdose deaths per 100,000 people; the communities that hadn’t begun experienced 51.7. Despite a nearly 10% lower death rate in communities that had implemented their strategies, however, the results fell short of statistical significance.
In statements, federal health officials cast the study as at least a partial victory. While the interventions did not meaningfully reduce overdose deaths, the officials argued, they set the stage for future action and created a framework to help hard-hit communities choose new policy approaches and begin to implement them, with the hope that with more time and without Covid-19, deaths would fall.
Nora Volkow, the NIDA director, said that increasing use of stimulants like methamphetamine and cocaine, and the proliferation of fentanyl, mean society must “continue developing new tools and approaches” for preventing overdose deaths. Miriam Delphin-Rittmon, the director of the Substance Abuse and Mental Health Services Administration, said the study “recognizes there is no quick fix.”
And in an interview, Chandler, the director of the study, stressed that the results should not challenge what research has long demonstrated: There is a “mountain of evidence,” she said, supporting the belief that tools like naloxone, medications for opioid use disorder, and safer prescribing techniques, save lives. The challenge, Chandler said, lies in implementation — not the strategies themselves.
The study released Sunday, she said, “doesn’t negate, in any way, the evidence that suggests the strengths of those interventions.”
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