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The following is a summary of “Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths,” published in the June 2024 issue of Psychiatry by Samet et al.
Overdose deaths from opioids can be reduced with education about overdoses and naloxone, using medications to treat opioid addiction, and safer prescribing practices for opioids.
Researchers conducted a prospective study to see if involving communities can boost the adoption of the practices and cut down opioid-related overdose deaths.
They conducted a community-level cluster-RCTs with 67 communities in Kentucky, Massachusetts, New York, and Ohio, assigning 34 to an intervention group and 33 to a wait-list control. The groups were balanced by urban/rural classification, previous overdose rates, and community population within each state. The primary outcome was the number of opioid-related overdose deaths among adults in the communities.
The results showed that from July 2021 to June 2022, opioid-related overdose death rates were similar between the intervention and control groups (47.2 vs. 51.7 per 100,000; adjusted rate ratio of 0.91; 95% CI, 0.76-1.09; P=0.30). The intervention’s effect didn’t vary by state, urban/rural status, age, sex, or race/ethnicity. Intervention communities implemented 615 out of 806 selected evidence-based strategies (254 involving overdose education and naloxone, 256 involving medication use for opioid use disorder, and 105 involving prescription opioid safety), with only 235 (38%) started by the comparison year.
Investigators concluded that despite efforts, the 12-month trial showed similar opioid overdose death rates in both the intervention and control groups, likely influenced by the COVID-19 pandemic and the fentanyl-related overdose crisis.
Source: nejm.org/doi/full/10.1056/NEJMoa2401177
