Kentucky CAN HEAL (Communities and Networks Helping End Addiction Long-term)

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ABSTRACT The Kentucky CAN (Communities and Networks) HEAL (Helping End Addiction Long-term) [KCH] study is a large-scale, community intervention project submitted in response to the HEALing Communities request for proposals to “test the immediate impact of implementing an integrated set of evidence-based interventions” with the aim of reducing opioid overdose deaths by 40% in three years. KCH represents a partnership between the University of Kentucky, Kentucky State government officials and numerous community organizations. This project will employ an incomplete stepped-wedge, cluster randomized design to deploy an integrated set of evidence-based practices in 17 highly affected counties in Kentucky in two waves of assignment. Highly affected counties were identified through an empirical algorithm that incorporated the requisite epidemiological criteria for opioid overdose and structural systems in place to support the deployment of evidence-based interventions (EBIs). Prior to randomization, a systematic implementation science-based approach will be used to assess barriers, attitudes and assets and to enhance implementation of EBIs. Primary intervention aims are to improve and expand treatment with medications for opioid use disorder (MOUD) by increasing capacity, entry and retention, expand overdose prevention approaches in the community and reduce opioid supply by decreasing high risk prescribing and increasing safe drug disposal. Community partners include those representing behavioral health, healthcare, public health, criminal justice and community coalitions. Interventions will include those focused on 1) development of a Care Navigation network in MOUD treatment programs (FQHC’s, OTPs and OBOT providers), syringe service programs, jails and parole and probation offices to increase the number of individuals screened, referred to, initiating evidence-based care, retained in treatment and receiving ancillary recovery support services; 2) enhancing and expanding the treatment workforce through increased DATA 2000 waiver trainings and weekly support through expert telehealth guidance using the ECHO model; 3) increasing overdose education and naloxone distribution in treatment settings, syringe services programs, jails, parole and probation; and the community; 4) increasing access to syringe services programs; 5) reducing risky opioid prescribing and dispensing; and 6) enhancing drug disposal. By targeting individuals who are at highest risk (e.g., out of treatment, reentering the community) and deploying a community-wide health communication strategy to increase awareness and demand for EBIs, we hypothesize that KCH will reduce overdose deaths by 40% in three years. KCH will leverage existing funding and resources to enhance its effectiveness, and the health economics of these interventions will be evaluated in order to have meaningful and translatable impact on public policy.