Publications of the Week: The impact of evidence-based practices on opioid overdose mortality

Background: Evidence-based interventions to reduce opioid-related overdose deaths include overdose education and naloxone distribution, use of medications for the treatment of opioid use disorder (OUD), and prescription opioid safety. Studies are needed to assess the effectiveness of community-based, evidence-based interventions to reduce opioid-related overdose deaths.

Methods: It was a community-level, cluster randomized trial, in which 67 communities in the United States (Kentucky, Massachusetts, New York, Ohio) received the intervention (34 communities) or a wait-list control (33 communities), stratified by state. The trial was conducted during the coronavirus disease 2019 (COVID-19) pandemic and during a surge in the number of fentanyl-related overdose deaths. The primary outcome was the number of opioid-related overdose deaths among community adults.

Results: The trial groups were balanced within states by urban or rural classification, previous overdose rate, and community population. The interventions were implemented into the assigned communities between January 2020 and June 2022, followed by a 12-month comparison period from July 2021 until June 2022. During the comparison period, the population-averaged rates of opioid-related overdose deaths were similar in the intervention group and the control group (47.2 deaths vs 51.7/100,000 population), with the adjusted rate ratio of 0.91 (95% CI, 0.76-1.09). The effect of the intervention on the rate of opioid-related overdose deaths did not differ significantly according to subgroups (state, urban or rural category, age, sex, or race or ethnicity). Intervention communities implemented 615 evidence-based practice interventions from the 806 strategies selected by communities (254 pertaining to overdose education and naloxone distribution, 256 pertaining to medication use for OUD, and 105 for prescription opioid safety). Of these evidence-based interventions, 235 (38%) had been initiated by the start of the comparison year.

Conclusions: In this 12-month multimodal, community-based intervention trial assessing evidence-based practices to reduce opioid overdose deaths, death rates were similar in the intervention group and the control group.

McMaster editors’ commentary: This study is a major step forward to inform best practices related to opioid-related deaths. Factors that might have affected the results include impact of the pandemic to effectively implement preventative interventions and the effect of illicit drug use on death rates.