Do Communities Implementing the Communities That HEAL Intervention Have Significantly Lower Rates of High-Risk Opioid Prescribing and Dispensing?

Introduction: Prescription opioids can contribute to risk for opioid use disorder and overdoses. Improving prescription opioid safety is a critical component in reducing opioid risks. This report aims to determine whether communities randomized to the Communities That HEAL (CTH) intervention have significantly different rates of prescription opioid safety measures. Study Design: A multisite, 2-arm, community-level, cluster randomized, unblinded, wait-list controlled comparison trial designed to assess the effectiveness of the CTH intervention in reducing opioid-related overdose deaths among community residents 18 years of age or older (adults). Setting/Participants: Sixty-seven (67) communities in Kentucky, Massachusetts, New York, and Ohio. "Participants" were communities in this study. Intervention: The Communities That Heal intervention consists of multiple dimensions: a coalition-driven community engagement process to select and support implementation of Evidence Based Practices; the Opioid-overdose Reduction Continuum of Care Approach, a compendium of Evidence Based Practices and technical assistance resources organized under overdose education and naloxone distribution, medication for Opioid Use Disorder, and prescription[DB1] opioid safety menus; and communication campaigns intended to reduce Opioid Use Disorder stigma and raise awareness and demand for naloxone and medication for Opioid Use Disorder [DB1] I pulled the intervention language from the body of the manuscript. Journal guidelines aske for no abbreviations in Abstract...so that is why everything is spelled out. Main Outcomes and Measures: The main outcome was the number of adults with new incident high-risk opioid prescribing episodes after at least a 45-day washout. Other outcomes included the number of opioid-naïve adults with new opioid prescriptions limited to a 7-day supply, number of adults who received opioid prescriptions from multiple prescribers or pharmacies, and number of locations providing drug take-back services. Outcomes were assessed from July 2021-June 2022. Results: There was no statistically significant difference in the adjusted rates for new incident high-risk opioid prescribing per 100,000 adults during the comparison period between intervention (1094.48 (95% CI: [1063.15, 1126.74])) and wait-list control communities (1121.90 (95% CI: [1079.62, 1165.84])). The adjusted relative rate comparing intervention to wait-list control communities was 0.98 (95% CI: [0.93, 1.02]; p-value=0.296). Similarly, there were no statistically significant differences between intervention and wait-list control communities for the other outcomes. Conclusions and Relevance: Although no statistically significant differences were found in prescription opioid safety measures between study arms, improvement in these measures during the comparison period for both study arms suggested that there may have events outside the trial, such as published revised Center for Disease Control and Prevention clinical practice guidelines for prescribing opioids, that may have impacted study outcomes.