Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths

被引：11

作者：

Samet, Jeffrey H. ^{[1
,2
,15
]}

El-Bassel, Nabila ^{[22
]}

Winhusen, T. John ^{[6
,32
]}

Jackson, Rebecca D. ^{[39
]}

Oga, Emmanuel A. ^{[53
]}

Chandler, Redonna K. ^{[54
]}

Villani, Jennifer ^{[54
]}

Freisthler, Bridget ^{[40
]}

Adams, Joella ^{[53
]}

Aldridge, Arnie ^{[53
]}

Angerame, Angelo ^{[23
]}

Babineau, Denise C. ^{[53
]}

Bagley, Sarah M. ^{[3
,4
,5
]}

Baker, Trevor J.

Balvanz, Peter ^{[6
]}

Barbosa, Carolina ^{[53
]}

Barocas, Joshua ^{[55
,56
]}

Battaglia, Tracy A. ^{[7
]}

Beard, Dacia D. ^{[8
]}

Beers, Donna ^{[6
,25
]}

Blevins, Derek ^{[24
]}

Bove, Nicholas ^{[25
]}

Bridden, Carly ^{[6
]}

Brown, Jennifer L. ^{[78
]}

Bush, Heather M. ^{[59
]}

Bush, Joshua L.

Caldwell, Ryan ^{[23
]}

Calver, Katherine ^{[6
]}

Calvert, Deirdre ^{[9
,10
]}

Campbell, Aimee N. C. ^{[24
]}

Carpenter, Jane ^{[6
]}

Caspar, Rachel ^{[53
]}

Chassler, Deborah

Chaya, Joan ^{[26
]}

Cheng, Debbie M. ^{[11
]}

Cunningham, Chinazo O. ^{[27
]}

Dasgupta, Anindita ^{[22
]}

David, James L. ^{[22
]}

Davis, Alissa ^{[22
]}

Dean, Tammy ^{[33
]}

Drainoni, Mari-Lynn ^{[8
,12
]}

Eggleston, Barry ^{[53
]}

Fanucchi, Laura C. ^{[61
]}

Feaster, Daniel J. ^{[79
]}

Fernandez, Soledad ^{[39
]}

Figueroa, Wilson ^{[41
]}

Freedman, Darcy A. ^{[50
]}

Freeman, Patricia R. ^{[62
]}

Freiermuth, Caroline E.

Friedlander, Eric ^{[63
]}

机构：

[1] Boston Univ, Boston Med Ctr, Dept Med, Sect Gen Internal Med,Chobanian & Avedisian Sch M, Boston, MA USA

[2] Boston Univ, Sch Publ Hlth, Boston, MA USA

[3] Boston Med Ctr Boston, Boston, MA USA

[4] Boston Univ, Dept Med, Chobanian & Avedisian Sch Med, Boston, MA USA

[5] Boston Univ, Dept Pediat, Chobanian & Avedisian Sch Med, Boston, MA USA

[6] Boston Med Ctr, Sect Gen Internal Med, Boston, MA USA

[7] Boston Univ, Chobanian & Avedisian Sch Med, Boston, MA USA

[8] Boston Univ, Dept Hlth Law Policy & Management, Sch Publ Hlth, Boston, MA USA

[9] Massachusetts Dept Publ Hlth, Bur Subst Addict Serv Calvert, Boston, MA USA

[10] Boston Univ, Sch Social Work, Boston, MA USA

[11] Boston Univ, Dept Biostat, Sch Publ Hlth, Boston, MA USA

[12] Boston Univ, Dept Med, Sect Infect Dis, Chobanian & Avedisian Sch Med, Boston, MA USA

[13] Massachusetts HCS Community Advisory Board, Boston, MA USA

[14] Boston Med Ctr, Sect Infect Dis, Boston, MA USA

[15] Boston Med Ctr, 801 Massachusetts Ave,2nd Fl, Boston, MA 02118 USA

[16] Boston Univ, Dept Med, Sect Gen Internal Med, Chobanian & Avedisian Sch Med, Boston, MA USA

[17] Boston Med Ctr, Dept Med, Boston, MA USA

[18] Massachusetts Dept Publ Hlth, Registry Vital Records & Stat, Boston, MA USA

[19] Tufts Univ, Dept Publ Hlth & Community Med, Sch Med, Boston, MA USA

[20] McLean Hosp, Div Alcohol Drugs & Addict, Boston, MA USA

[21] Harvard Med Sch, Dept Psychiat, Boston, MA USA

[22] Columbia Univ, Sch Social Work, New York, NY USA

[23] New York HCS Community Advisory Board, New York, NY USA

[24] Columbia Univ, Dept Psychiat, Irving Med Ctr, New York, NY USA

[25] Albert Einstein Coll Med, Dept Epidemiol & Populat Hlth, New York, NY USA

[26] Montefiore Med Ctr, New York, NY USA

[27] New York State Off Addict Serv & Supports, New York, NY USA

[28] CUNY, New York, NY USA

[29] Weill Cornell Med, Dept Populat Hlth Sci, New York, NY USA

[30] New York Off Mental Hlth, New York, NY USA

[31] New York State Dept Hlth, New York, NY USA

[32] Univ Cincinnati, Dept Psychiat & Behav Neurosci, Coll Med, Cincinnati, OH USA

[33] Univ Cincinnati, Correct Inst, Cincinnati, OH USA

[34] Univ Cincinnati, Dept Emergency Med, Coll Med, Cincinnati, OH USA

[35] Univ Cincinnati, Emergency Med, Med Ctr, Cincinnati, OH USA

[36] Univ Cincinnati, Dept Environm & Publ Hlth Sci, Coll Med, Cincinnati, OH USA

[37] Case Western Reserve Univ, Dept Family Med & Community Hlth, Sch Med, Cincinnati, OH USA

[38] Brightview Hlth, Cincinnati, OH USA

[39] Ohio State Univ, Coll Med, Columbus, OH USA

[40] Ohio State Univ, Coll Social Work, Columbus, OH USA

[41] Ohio State Univ, Ctr Hlth Outcomes & Policy Evaluat Studies, Columbus, OH USA

[42] Ohio State Univ, Dept Family & Community Med, Columbus, OH USA

[43] Ohio State Univ, Coll Publ Hlth, Columbus, OH USA

[44] Ohio State Univ, Translat Data Analyt Inst, Columbus, OH USA

[45] Ohio State Univ, Dept Emergency Med, Columbus, OH USA

[46] Ohio State Univ, Ohio Coll Med, Govt Resource Ctr, Columbus, OH USA

[47] Ohio State Univ, One Ohio Fdn, Columbus, OH USA

[48] Ohio State Univ, Recovery Ohio, Columbus, OH USA

[49] Ohio State Univ, Sch Commun, Columbus, OH USA

[50] Case Western Reserve Univ, Dept Populat & Quantitat Hlth Sci, Sch Med, Cleveland, OH USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2024年 / 391卷 / 11期

关键词：

UNITED-STATES;

D O I：

10.1056/NEJMoa2401177

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Evidence-based practices for reducing opioid-related overdose deaths include overdose education and naloxone distribution, the use of medications for the treatment of opioid use disorder, and prescription opioid safety. Data are needed on the effectiveness of a community-engaged intervention to reduce opioid-related overdose deaths through enhanced uptake of these practices. METHODS In this community-level, cluster-randomized trial, we randomly assigned 67 communities in Kentucky, Massachusetts, New York, and Ohio to receive the intervention (34 communities) or a wait-list control (33 communities), stratified according to state. The trial was conducted within the context of both the coronavirus disease 2019 (Covid-19) pandemic and a national surge in the number of fentanyl-related overdose deaths. The trial groups were balanced within states according to urban or rural classification, previous overdose rate, and community population. The primary outcome was the number of opioid-related overdose deaths among community adults. RESULTS During the comparison period from July 2021 through June 2022, the population-averaged rates of opioid-related overdose deaths were similar in the intervention group and the control group (47.2 deaths per 100,000 population vs. 51.7 per 100,000 population), for an adjusted rate ratio of 0.91 (95% confidence interval, 0.76 to 1.09; P=0.30). The effect of the intervention on the rate of opioid-related overdose deaths did not differ appreciably according to state, urban or rural category, age, sex, or race or ethnic group. Intervention communities implemented 615 evidence-based practice strategies from the 806 strategies selected by communities (254 involving overdose education and naloxone distribution, 256 involving the use of medications for opioid use disorder, and 105 involving prescription opioid safety). Of these evidence-based practice strategies, only 235 (38%) had been initiated by the start of the comparison year. CONCLUSIONS In this 12-month multimodal intervention trial involving community coalitions in the deployment of evidence-based practices to reduce opioid overdose deaths, death rates were similar in the intervention group and the control group in the context of the Covid-19 pandemic and the fentanyl-related overdose epidemic.

引用

页码：989 / 1001

页数：13

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