Community coalition’s diversity and targeted overdose prevention strategies designed to reach special populations

BACKGROUND: Despite significant efforts to address the opioid crisis, there are critical inequities among populations disproportionately burdened by overdose deaths. Community-level adoption of evidence-based practices (EBPs), including opioid education, naloxone distribution (OEND) and medication treatment for opioid use disorder (MOUD), hold promise for addressing the opioid crisis. Community coalitions are key agents for increasing community-level adoption of EBPs, and diversity and cultural sensitivity among coalition members are essential for advancing work that reaches populations experiencing inequities. METHODS: This analysis leverages data from 445 community coalition members from 33 communities across four states participating in the HEALing Communities Study (HCS). We explore associations between HCS community coalition members' perceived need for tailored OEND and MOUD strategies and the coalitions' selection and implementation of strategies explicitly designed to reach special populations, defined in HCS as people experiencing homelessness, people who are non-English speakers or immigrants, people involved in transactional sex, women who are pregnant and post-partum, racial and ethnic minoritized people, and veterans. We also explore the association between the proportion of coalition members identifying as racially and ethnically minoritized and the selection and implementation of OEND and MOUD strategies designed to reach racial and ethnic minoritized people. RESULTS: We found a significant association between the proportion of coalition members identifying as racially or ethnically minoritized and the number of selected OEND strategies explicitly designed to reach racial and ethnic minoritized people (Adjusted Change [AC] = 1.88, CI:1.37, 2.59, p < 0.001). A similar significant association was found between the proportion of coalition members identifying as racially and ethnically minoritized and the number of implemented OEND strategies designed to reach racial and ethnic minoritized people (AC = 1.76, CI: 1.27, 2.44, p < 0.001). No significant association was found between coalition diversity and the selection or implementation of MOUD strategies designed to reach racial and ethnic minoritized people. We also did not find a significant association between coalition members' perceived need for tailored strategies and selection or implementation of OEND and MOUD strategies designed to reach special populations. CONCLUSIONS: Our study underscores the importance of community coalitions in addressing the opioid crisis through EBPs that are tailored to reach special populations. Enhancing coalition diversity and providing adequate support for community coalitions can help improve community-level adoption of EBPs and promote tailoring of OEND and MOUD strategies to reach special populations. TRIAL REGISTRATION: (ClinicalTrials.gov Identifier: NCT04111939).