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Community strategy reduced opioid overdose deaths in Pennsylvania counties
The monthly opioid overdose death (ODD) rate fell by 30% in Pennsylvania counties that implemented a novel community-focused strategy developed by University of Pittsburgh researchers, according to a new study published today in the Journal of Studies on Alcohol and Drugs.
By analyzing counties that did or didn't implement the Pennsylvania Opioid Overdose Reduction Technical Assistance Center (ORTAC) strategy over time, the researchers estimate that this cost-effective, community-led approach prevented 1,818 opioid-related deaths over two years.
"I passionately believe that communities have to come together and be empowered to take control of their own public health to really make sea change on issues like ODD," said senior author Janice Pringle, Ph.D., professor of pharmacy and therapeutics and director of the Program Evaluation and Research Unit (PERU) at the Pitt School of Pharmacy. "Our study is one of the first to show that a community approach is how you move the needle on preventing ODD."
According to Pringle, public health issues such as the opioid crisis are usually tackled through dozens of disconnected initiatives led by organizations or systems that target specific populations. But this kind of approach can lead to certain groups of people falling through the cracks and perpetuating disparities in who is accessing care.
"ORTAC aims to bring efforts together, pool resources and integrate services to reduce opioid-related overdose deaths at a community level," said Pringle. "If the opioid crisis is a tree, one thousand steak knives is not going to chop it down. We need sixty-seven hands—one for each county in Pennsylvania—on the chainsaw."
Pringle and her team developed a systematic eight-step framework to build and support community coalitions and help them plan, implement and sustain efforts to decrease opioid supply and demand and reduce the risk of opioid overdose in their counties.
The first step involves gathering leadership from multiple sectors—including first responders, emergency departments, the drug and alcohol system, the mental health system and criminal justice—who have a shared goal of addressing the opioid crisis.
"The idea behind ORTAC is that community members and people on the front lines know what's best for their community," said lead author Renee Cloutier, Ph.D., research scientist in the Pitt School of Pharmacy's Department of Pharmacy and Therapeutics and scientific director of PERU. "The ORTAC team worked to develop and activate community coalitions to clarify the problems in their community, generate plans and act on them."
After assessing local data to understand overdose deaths and identify their community's unique needs, coalitions developed and enacted a strategic plan to reduce opioid deaths. Interventions included improving access to treatment programs, educating first responders in leave-behind practices for the opioid-reversing drug naloxone, implementing harm reduction strategies such as syringe service programs and drug disposal services, and developing messaging campaigns aimed at reducing stigma.
To understand the impact of ORTAC, the researchers used data from OverdoseFreePA to analyze ODDs from 2016 to 2019 in 29 counties where ORTAC was implemented and 19 comparison counties. While 67% of ORTAC counties had a reduction in ODD per 100,000 people, just 47% of the comparison counties had a reduction over the same period.
After accounting for factors that could affect opioid deaths, such as county distribution of naloxone beyond ORTAC efforts, illicit drug supply and opioid prescriptions, the researchers found that the ODD rate in ORTAC counties was consistently lower than comparison counties over time, a difference ranging from 1.5 to 3.8 deaths per 100,000 people in the first two years following ORTAC implementation.
"If you fund communities and provide structured support, you can make transformational change beyond what might be possible with a top-down approach," said Cloutier. "We hope to see more funding targeted toward supporting communities on the ground in this way."
The researchers calculated that it cost less than $6,000 to prevent each overdose death. For comparison, another analysis estimated the savings associated with avoiding a single ODD at $10.5 million.
"Our strategy had a meaningful impact on reducing ODD and is incredibly cost-effective," said Pringle. "With more funding and support, we can continue to guide communities to reduce the risk of ODD for everyone because this issue is in all our backyards. The opioid crisis affects us all, and there is so much more work to be done."
More information: Pennsylvania's Community Coordination Strategy to Reduce Opioid Overdose Deaths, Journal of Studies on Alcohol and Drugs (2023).