Opioid Use Disorder

Corey Whetzel, PharmD, JD

In 2023, there were 81,083 opioid-related overdose deaths in the United States, according to CDC. Many practitioners believe that community-based interventions can aid in reducing the number of deaths, but data related to the effectiveness of such interventions are lacking.

A study published June 16, 2024, in NEJM attempts to shed light on the value of certain interventions to reduce OUD deaths. Researchers looked at overdose education, naloxone distribution, the use of medications for treatment of OUD, and prescription opioid safety. After analyzing 615 interventions in 67 communities in Kentucky, Massachusetts, New York, and Ohio to determine if a reduction in opioid-related overdose deaths would occur, the researchers found that there was no significant difference between the intervention group and the control group with respect to opioid-related overdose deaths.

Context of findings

In the cluster-randomized trial, called the Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths, researchers also examined the state the intervention was conducted in, the classification of that area as rural or urban, and the sex, age, and race or ethnic group of the research participant. They found similar results between the two groups. Overall, findings of the study appear puzzling given that all three of the interventions are known evidence-based practices for reducing opioid-related overdose deaths.

So, what could have caused these results and what can practitioners and others still learn from this study?

The study’s interventions were imple-mented in January of 2020—just 2 months before the COVID-19 lockdowns in the United States. Those individuals tasked with putting the interventions in place were operating at a reduced capacity, which likely led to an inability to carry out the interventions. 

The COVID-19 pandemic also presented additional challenges for the research. The rise in opioid-related overdose deaths was not consistent among states, which led to difficulties determining the number of individuals who could benefit from interventions as a part of resource allocation. Additionally, once a community experienced a spike in opioid-related overdose deaths, they likely received additional resources and funds to combat the increase, which could have affected control communities resulting in a masking of an intervention effect.

Patients may benefit from a state- or community-specific approach as each community’s needs and available resources are likely to be different. A community having ample resources available to those struggling with OUD likely has different needs than a community where there are limited resources. While there may be similarities in the needs of communities across the nation, additional research should be conducted to see how their differences impact the rate of opioid-related overdose deaths.

The design of the study may have contributed to the lack of positive results, too. The study was powered to detect a prespecified 40% reduction in the rate of opioid-related overdose deaths, which even the authors admit was “clearly ambitious.” If the study had been powered differently, there may have been a chance to observe smaller yet still clinically meaningful differences between the intervention and control groups.

The illicit drug market may have also had an influence on the study results. Fentanyl has contributed significantly to OUD deaths. Further, there may be extrapolation problems because whether fentanyl is used at the same rates within communities and states is unknown.

Takeaways

Pharmacists, health care providers, and community groups should be aware of trends within the illicit drug market.

Being able to educate patients and the community at-large about changes within this market, especially the use of fentanyl in stimulants and counterfeit pills, may change the community’s rate of opioid-related overdose deaths. Additionally, having this knowledge allows those working within the space to adjust their community interventions to account for these changes and prevent more deaths.

Community-based interventions take time to put into practice and they involve forming collaborations between health care professionals and non–health care professionals. ■