Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio

Young, April M.; Brown, Jennifer L.; Hunt, Timothy; Martínez, Linda Sprague; Chandler, Redonna K.; Oga, Emmanuel; Winhusen, Theresa; Baker, Trevor; Battaglia, Tracy A.; Bowers-Sword, Rachel; Button, Amy; Fallin‐Bennett, Amanda; Fanucchi, Laura; Freeman, Patricia R.; Glasgow, LaShawn; Gulley, Jennifer; Kendell, Charles; Lofwall, Michelle R.; Lyons, Michael S.; Quinn, Maria; Rapkin, Bruce D.; Surratt, Hilary L.; Walsh, Sharon

doi:10.1136/bmjopen-2021-059328

Cited by 16 publications

(3 citation statements)

References 56 publications

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“…When the early response to the pandemic amplified risks related to opioid overdoses, the HCS developed a “fast-track” protocol allowing for expedited implementation of OEND to high-risk populations through direct financial support for OEND and technical assistance for agencies implementing OEND. HCS community coalitions were presented with the option to approve the expedited launch of OEND efforts in jails (Young et al, 2022 ). Kentucky was the only one of the four participating HCS research sites to directly partner with jails to provide and track no-cost naloxone for distribution at release, so this study focuses on the implementation of the OEND fast-track protocol in HCS-Kentucky Wave 1 regional/county jails.…”

Section: Methodsmentioning

confidence: 99%

Rapid jail-based implementation of overdose education and naloxone distribution in response to the COVID-19 pandemic

Oser,

McGladrey,

Booty

et al. 2024

Health Justice

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Background People incarcerated in jails are highly impacted by the opioid epidemic, and overdose education and naloxone distribution (OEND) is an effective strategy to reduce opioid overdose deaths. This study examines barriers and facilitators of fast-track OEND implementation within the jails in the Wave 1 Kentucky counties of the HEALing Communities Study during the COVID-19 pandemic. Methods Meeting minutes with jail stakeholders were qualitatively coded using the Practical, Robust Implementation and Sustainability Model (PRISM) as the coding framework. The analysis highlighted the top barriers and facilitators to fast-track OEND implementation within the PRISM framework. Results Space and staffing shortages related to the COVID-19 pandemic, disruptions in interorganizational programming from pandemic-related service suspensions, and a lack of technological solutions (e.g., reliable Internet access) for socially distanced delivery were the top barriers to fast-track OEND implementation. In addition, there were limitations on non-jail staff access to jails during COVID-19. Top facilitators included jail leadership support, the option to prioritize high-risk groups, and the incorporation of OEND processes into existing communications and management software. While the COVID-19 pandemic strained jail infrastructure, jail and partner agency collaboration led to creative implementation strategies for the successful integration of OEND into jail operations. Urban jails were more likely than rural jails to be early adopters of OEND during the public health emergency. Conclusions Understanding the barriers to and facilitators of OEND within jails will improve implementation efforts seeking to curb opioid overdose deaths. Jail leadership support and interorganizational efforts were key facilitators to implementation; therefore, it is recommended to increase buy-in with multiple agencies to promote success. Challenges brought on by COVID-19 have resulted in a need for innovative solutions for implementation. Clinical trial information ClinicalTrials.gov, NCT04111939, Submitted 30 September 2019, https://clinicaltrials.gov/study/NCT04111939?titles=HEALing%20Communities%20Study&rank=1.

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Section: Methodsmentioning

confidence: 99%

Rapid jail-based implementation of overdose education and naloxone distribution in response to the COVID-19 pandemic

Oser,

McGladrey,

Booty

et al. 2024

Health Justice

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“…The HEALing Communities Study (HCS) 20 is a randomized community-based trial evaluating the impact of implementing an integrated set of evidence-based practices from the Communities That HEAL (CTH) intervention framework delivered across health care, behavioral health, criminal legal system, and other community-based settings. The goal of HCS is to reduce opioid-related overdose deaths in highly affected communities in Kentucky, Massachusetts, New York, and Ohio.…”

Section: Introductionmentioning

confidence: 99%

Impact of the Communities That HEAL Intervention on Buprenorphine-Waivered Practitioners and Buprenorphine Prescribing

Stopka,

Babineau,

Gibson

et al. 2024

JAMA Netw Open

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ImportanceBuprenorphine significantly reduces opioid-related overdose mortality. From 2002 to 2022, the Drug Addiction Treatment Act of 2000 (DATA 2000) required qualified practitioners to receive a waiver from the Drug Enforcement Agency to prescribe buprenorphine for treatment of opioid use disorder. During this period, waiver uptake among practitioners was modest; subsequent changes need to be examined.ObjectiveTo determine whether the Communities That HEAL (CTH) intervention increased the rate of practitioners with DATA 2000 waivers and buprenorphine prescribing.Design, Setting, and ParticipantsThis prespecified secondary analysis of the HEALing Communities Study, a multisite, 2-arm, parallel, community-level, cluster randomized, open, wait-list–controlled comparison clinical trial was designed to assess the effectiveness of the CTH intervention and was conducted between January 1, 2020, to December 31, 2023, in 67 communities in Kentucky, Massachusetts, New York, and Ohio, accounting for approximately 8.2 million adults. The participants in this trial were communities consisting of counties (n = 48) and municipalities (n = 19). Trial arm randomization was conducted using a covariate constrained randomization procedure stratified by state. Each state was balanced by community characteristics including urban/rural classification, fatal opioid overdose rate, and community population. Thirty-four communities were randomized to the intervention and 33 to wait-list control arms. Data analysis was conducted between March 20 and September 29, 2023, with a focus on the comparison period from July 1, 2021, to June 30, 2022.InterventionWaiver trainings and other educational trainings were offered or supported by the HEALing Communities Study research sites in each state to help build practitioner capacity.Main Outcomes and MeasuresThe rate of practitioners with a DATA 2000 waiver (overall, and stratified by 30-, 100-, and 275-patient limits) per 100 000 adult residents aged 18 years or older during July 1, 2021, to June 30, 2022, were compared between the intervention and wait-list control communities. The rate of buprenorphine prescribing among those waivered practitioners was also compared between the intervention and wait-list control communities. Intention-to-treat and per-protocol analyses were performed.ResultsA total of 8 166 963 individuals aged 18 years or older were residents of the 67 communities studied. There was no evidence of an effect of the CTH intervention on the adjusted rate of practitioners with a DATA 2000 waiver (adjusted relative rate [ARR], 1.04; 95% CI, 0.94-1.14) or the adjusted rate of practitioners with a DATA 2000 waiver who actively prescribed buprenorphine (ARR, 0.97; 95% CI, 0.86-1.10).Conclusions and RelevanceIn this randomized clinical trial, the CTH intervention was not associated with increases in the rate of practitioners with a DATA 2000 waiver or buprenorphine prescribing among those waivered practitioners. Supporting practitioners to prescribe buprenorphine remains a critical yet challenging step in the continuum of care to treat opioid use disorder.Trial RegistrationClinicalTrials.gov Identifier: NCT04111939

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“…The HCS provides support for 67 community coalitions in Massachusetts (MA), New York (NY), Kentucky (KY), and Ohio (OH). The study focuses on a community coalition intervention called Communities that HEAL (CTH) (Oesterle et al, 2018; Young et al, 2022). This intervention involves a community-engaged approach to selecting and implementing EBPs from a menu called the Opioid-overdose Reduction Continuum of Care Approach (ORCCA; Sprague Martinez et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study of Health Equity’s Role in Community Coalition Development

et al. 2023

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Opioid overdose deaths are dramatically increasing in the United States and disproportionately affecting minority communities, with the increasing presence of fentanyl exacerbating this crisis. Developing community coalitions is a long-standing strategy used to address public health issues. However, there is a limited understanding of how coalitions operate amid a serious public health crisis. To address this gap, we leveraged data from the HEALing Communities Study (HCS)—a multisite implementation study aiming to reduce opioid overdose deaths in 67 communities. Researchers analyzed transcripts of 321 qualitative interviews conducted with members of 56 coalitions in the four states participating in the HCS. There were no a priori interests in themes, and emergent themes were identified through inductive thematic analysis and then mapped to the constructs of the Community Coalition Action Theory (CCAT). Themes emerged related to coalition development and highlighted the role of health equity in the inner workings of coalitions addressing the opioid epidemic. Coalition members reported seeing the lack of racial and ethnic diversity within their coalitions as a barrier to their work. However, when coalitions focused on health equity, they noted that their effectiveness and ability to tailor their initiatives to their communities’ needs were strengthened. Based on our findings, we suggest two additions to enhance the CCAT: (a) incorporating health equity as an overarching construct that affects all stages of development, and (b) ensuring that data about individuals served are included within the pooled resource construct to enable monitoring of health equity.

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Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio

Cited by 16 publications

References 56 publications

Rapid jail-based implementation of overdose education and naloxone distribution in response to the COVID-19 pandemic

Rapid jail-based implementation of overdose education and naloxone distribution in response to the COVID-19 pandemic

Impact of the Communities That HEAL Intervention on Buprenorphine-Waivered Practitioners and Buprenorphine Prescribing

A Qualitative Study of Health Equity’s Role in Community Coalition Development

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