Effect of the communities that HEAL intervention on overdose education and naloxone distribution: A cluster-randomized, wait-list controlled trial

Gary A. Zarkin; Katherine Jackson Asman; LaShawn Marie Glasgow; Charles Edward Knott; Nathan Alexander Vandergrift; Emmanuel Aja Oga; Joella Wabine Irene Adams; Christian Douglas; JaNae Logan Holloway; Patricia R Freeman; Alexander Y Walley; T John Winhusen; Emmanuel Aja Oga; Jennifer Villani; Timothy Hunt; Redonna K. Chandler; Douglas R. Oyler, Pharmd; Brittni Reilly; Kitty H. Gelberg; Christian Douglas; Michael S Lyons; JaNae Logan Holloway; Nathan Alexander Vandergrift; Joella Wabine Irene Adams; Kat Asman; Trevor J. Baker; Candace J. Brancato; Debbie M. Cheng; Janet E. Childerhose; James L. David; Daniel J. Feaster; Louisa Gilbert; LaShawn Marie Glasgow; Dawn A Goddard-Eckrich; Charles Edward Knott; Hannah K. Knudsen; Michelle R Lofwall; Katherine R. Marks; Jason T. McMullan; Carrie B. Oser; Monica F Roberts; Abigail B. Shoben; Michael D Stein; Scott T Walters; Josie Watson; Gary A. Zarkin; Rebecca D. Jackson; Jeffrey H. Samet; Sharon L. Walsh; Nabila El-Bassel

Effect of the communities that HEAL intervention on overdose education and naloxone distribution

A cluster-randomized, wait-list controlled trial

Freeman, P. R., Walley, A. Y., Winhusen, T. J., Oga, E. A., Villani, J., Hunt, T., Chandler, R. K., Oyler, D. R., Reilly, B., Gelberg, K., Douglas, C., Lyons, M. S., Holloway, J., Vandergrift, N. A., Adams, J. W., Asman, K., Baker, T. J., Brancato, C. J., Cheng, D. M., ... Bassel, N. E. (2025). Effect of the communities that HEAL intervention on overdose education and naloxone distribution: A cluster-randomized, wait-list controlled trial. American journal of public health, 115(1), 83-94. Advance online publication. https://doi.org/10.2105/AJPH.2024.307845

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Abstract

Objectives. To determine whether the Communities That HEAL (CTH) intervention is effective in increasing naloxone distribution compared with usual care.

Methods. 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.

Results. 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; P = .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.

Conclusions. The CTH intervention increased naloxone distribution compared with usual care in communities highly impacted by the opioid crisis.