Effect of the Communities That HEAL Intervention on Overdose Education and Naloxone Distribution: A Cluster-Randomized, Wait-List Controlled Trial
<b>Objectives.</b> To determine whether the Communities That HEAL (CTH) intervention is effective in increasing naloxone distribution compared with usual care. <b>Methods.</b> The HEALing (Helping to End Addiction Long-Term) Communities Study (HCS) is a cluster-randomized, parallel-arm, wait-list controlled implementation science trial testing the impact of the CTH intervention on increasing the use of evidence-based practices to lower opioid-related overdose deaths. Communities (n = 67) highly impacted by opioid overdose in Kentucky, Massachusetts, New York, and Ohio were allocated to CTH intervention (n = 34) or wait-list comparison (usual care; n = 33) arms. The primary outcome for this study was the number of naloxone units distributed in HCS communities during the comparison period (July 1, 2021‒June 30, 2022), examined using an intent-to-treat negative binomial regression model. <b>Results.</b> Naloxone distribution was 79% higher in the CTH intervention versus usual care arm (adjusted relative rate = 1.79; 95% confidence interval = 1.28, 2.51; <i>P</i> = .001; adjusted rates of naloxone distribution 3378 vs 1884 naloxone units per 100 000 residents), when controlling for urban‒rural status, state, baseline opioid-related overdose death rate, and baseline naloxone distribution rate. <b>Conclusions.</b> The CTH intervention increased naloxone distribution compared with usual care in communities highly impacted by the opioid crisis. <b>Trial Registration.</b> ClinicalTrials.gov identifier: NCT04111939. (<i>Am J Public Health</i>. 2025;115(1):83-94. https://doi.org/10.2105/AJPH.2024.307845).
Authors
- Trevor Baker (ORCID: https://orcid.org/0000-0003-4346-2435)
- Christian Douglas (ORCID: https://orcid.org/0000-0001-8902-0531)
- Katherine R. Marks (ORCID: https://orcid.org/0000-0001-5936-7497)
- JaNae Holloway (ORCID: https://orcid.org/0009-0009-1609-8237)
- Emmanuel Oga
- Dawn Goddard‐Eckrich (ORCID: https://orcid.org/0000-0002-3456-2322)
- Michael D. Stein (ORCID: https://orcid.org/0000-0002-2466-5192)
- Charles Knott (ORCID: https://orcid.org/0000-0002-3340-1850)
- Candace J. Brancato
- Kitty H. Gelberg (ORCID: https://orcid.org/0000-0002-3734-3280)
- SHARON L. WALSH (ORCID: https://orcid.org/0000-0002-9722-5681)
- Carrie B. Oser (ORCID: https://orcid.org/0000-0001-8658-9335)
- Daniel J. Feaster (ORCID: https://orcid.org/0000-0002-6172-7460)
- Jennifer Villani (ORCID: https://orcid.org/0000-0003-2337-2504)
- Hannah K. Knudsen (ORCID: https://orcid.org/0000-0002-0137-9337)
- Kat Asman (ORCID: https://orcid.org/0000-0001-6728-4990)
- Louisa Gilbert (ORCID: https://orcid.org/0000-0003-2715-8310)
- Patricia Rippetoe Freeman (ORCID: https://orcid.org/0000-0002-4749-6563)
- Jason T. McMullan (ORCID: https://orcid.org/0000-0002-7656-7447)
- Nathan Vandergrift (ORCID: https://orcid.org/0000-0001-9994-5466)
- Janet E. Childerhose (ORCID: https://orcid.org/0000-0003-0985-1306)
- Jeffrey H. Samet (ORCID: https://orcid.org/0000-0002-0897-3400)
- Alexander Yale Walley (ORCID: https://orcid.org/0000-0002-8158-4882)
- Scott T. Walters (ORCID: https://orcid.org/0000-0003-4074-6141)
- Gary A. Zarkin (ORCID: https://orcid.org/0000-0003-3331-0788)
- Debbie M. Cheng (ORCID: https://orcid.org/0000-0002-2206-3059)
- J. Watson
- Michelle R. Lofwall (ORCID: https://orcid.org/0000-0002-5911-0752)
- Douglas R. Oyler (ORCID: https://orcid.org/0000-0002-6153-831X)
- James L. David (ORCID: https://orcid.org/0009-0009-6738-8031)
- Joëlla W. Adams (ORCID: https://orcid.org/0000-0002-7703-5944)
- LaShawn Glasgow (ORCID: https://orcid.org/0000-0003-3336-7039)
- Theresa Winhusen (ORCID: https://orcid.org/0000-0002-3364-0739)
- Abigail B. Shoben (ORCID: https://orcid.org/0000-0001-9347-4755)
- Brittni Reilly (ORCID: https://orcid.org/0000-0002-4980-8938)
- Monica Roberts
- Timothy Hunt
- Rebecca D. Jackson (ORCID: https://orcid.org/0000-0003-1682-5544)
- Michael S. Lyons (ORCID: https://orcid.org/0000-0002-4774-1899)
- Nabila El Bassel
- Redonna K. Chandler
Institutions
- University of Cincinnati Medical Center (US)
Publication Details
- Journal
- American Journal of Public Health
- Published
- 2024-10-10
- DOI
- https://doi.org/10.2105/ajph.2024.307845
- Citations
- 10
- Primary Topic
- Opioid Use Disorder Treatment
- Type
- article
- Field-Weighted Citation Impact
- 5.43
Funders
- New York State Department of Health
- Ohio State University
- University of Cincinnati
- RTI International
- Ohio Department of Health
- Bureau of Substance Addiction Services
- National Institutes of Health
- Goddard Space Flight Center
- College of Pharmacy, University of Kentucky