Evidence-based strategies and communication campaigns help communities reduce overdose deaths and addiction stigma

The HEALing Communities Study was the largest addiction prevention and treatment study ever conducted to date. A large, federally-funded intervention in four states — Ohio, New York, Kentucky and Massachusetts — its goal was to reduce deaths from opioid overdoses. While researchers are still looking at the data from the now-completed study, they have already found that the study prevented nearly 500 opioid overdose deaths in the participating communities.

Sixty-seven communities took part in Wave One (January 2020-June 2022) or Wave Two (July 2022-December 2023). To see how well the study intervention worked, researchers compared the Wave One group to the Wave Two group after the start of the intervention in Wave One and before Wave Two received the intervention.

All participating communities implemented evidence-based strategies selected from a menu of options provided by the study. At the same time, communities distributed a health communications campaign to increase awareness of the well-known antidote medication naloxone and other medications for opioid use disorder, and to reduce social stigma associated with addiction.

Some examples of strategies supported by the HEALing Communities Study were:

• Installing vending machines to dispense free naloxone (Narcan® ) in public locations
• Purchasing mobile medical units to reduce transportation barriers by offering naloxone distribution, harm reduction services and linkage to addiction treatment services
• Developing a patient navigation program for people with addiction who are released from jail that lets them obtain medications for opioid use disorder, such as buprenorphine (SUBOXONE®), naltrexone (VIVITROL®) and methadone

Bridget Freisthler, PhD, served as the principal investigator of the study at The Ohio State University. She commends communities for selecting innovative, effective strategies and says their local knowledge was key to their success.

“Communities are experts on what has and may work in their county,” Dr. Freisthler says. “Although the study provided some loose guardrails on what could be selected, the coalitions were essential in identifying strategies that would be most likely to be effective in their community and partner organizations that would be good agencies to implement those strategies.”

The Ohio State University received funding to conduct the study in Ohio and partnered with the University of Cincinnati and Case Western Reserve University. The universities hired three staff members in each of 18 participating counties in Ohio. The staff worked with local drug prevention coalitions and partner agencies to help select evidence-based strategies that were best for each community and shared messaging from the health communications campaign through local television, print and radio advertisements and social media. The study provided funding and technical assistance to the coalitions and local agencies to implement the strategies and campaigns.

The HEALing Communities Study has resulted in:

• Prevention of 483 overdose deaths from opioids. There was a 9% reduction in opioid overdoses in Wave One compared to Wave Two communities across all four states including Ohio. While the reduction was not statistically significant, it still led to hundreds of lives saved. The study also prevented 525 overdose deaths from all types of prescription and recreational drugs. Across the four states, there was an 8% reduction in all overdose deaths, but in Ohio, there was an 18% reduction
• 37% decrease in overdose deaths from an opioid combined with any type of psychostimulant besides cocaine across all Wave One compared to Wave Two communities. Psychostimulants include drugs such as Adderall®, Ritalin® and methamphetamines
• Implementation of evidence-based strategies in 618 categories across all Wave One communities, which included overdose education and naloxone distribution, increasing access to, linkage to, or retention on medications for opioid use disorder, safer prescribing or dispensing of opioid medications; or safer disposal of opioids. In Ohio, Wave One counties selected 112 strategy categories, which far exceeded the 45 required by the study
• Nearly 80% higher rate of naloxone distribution in Wave One compared to Wave Two communities. In Wave One communities, 3,378 units of naloxone were distributed, and 1,884 units were distributed in Wave Two communities
• Reduced stigma toward people who are in recovery. Leaders who were interviewed in Wave One communities said they saw less stigma toward people receiving treatment for opioid use disorder and toward the medications themselves, than leaders in Wave Two communities. Residents of Wave One communities also showed positive changes in stigma and willingness to carry naloxone compared to Wave Two communities

The long-term impact of the HEALing Communities Study is not yet known; however, signs are pointing in the right direction, toward positive outcomes. For the second year in a row, drug overdose deaths in Ohio have decreased.

“The communities have been leading this fight for decades, from hospitals to addiction specialists, to social workers, and criminal justice officials,” Dr. Freisthler says. “That work deserves to be recognized and celebrated. We hope these numbers continue to decrease."

Though the study has ended, communities throughout Ohio are still creating innovative, localized solutions to tackle the opioid epidemic and prevent deaths of family, friends and neighbors.

The Toledo Fire and Rescue Department in Lucas County is one study partner agency that implemented a strategy to leave naloxone with friends, family, and bystanders at the scene of an opioid overdose. Since the program started in 2020, they have given out 850 naloxone kits. The program has also expanded to include naloxone distribution using bicycles and ATVs during public events, an innovative way to reach many people in crowded places. Dr. Freisthler says they were fortunate to have a partners like Toledo Fire and Rescue Department and others who have sustained the practice of leaving naloxone after an overdose to save lives.

“The Ross County Hope Partnership Project found an innovative way to allow individuals to reach out to them via their harm reduction vending machine to speak with a person in recovery,” Dr. Freisthler says. “And Jefferson County TEMS Joint Ambulance District spearheaded a strategy to place Naloxboxes in rest areas that was ultimately implemented across the entire state.”

Dr. Freisthler says the fact that Toledo Fire and Rescue has sustained this program speaks volumes to the sound strategies implemented across the state.

“It’s a testament to commitment of their staff and Lucas County in reducing opioid overdose deaths,” Dr. Freisthler says.

Learn more about the impact of the HEALing Communities Study in Ohio.