MassHEAL - Reducing overdose deaths by 40% (2019-2023)

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Project Summary/Abstract This supplement aims to explore the impact of the infusion of health equity principles on overdose prevention strategies during implementation of the Communities That Heal (CTH) intervention as part of the HEALing Communities Study (HCS). The HCS is a multi-site, parallel arm, cluster randomized, wait-list controlled trial evaluating the impact of the CTH intervention compared with usual care in wait-list communities, on overdose deaths. The overall goal of the HCS is to reduce opioid overdose deaths by 40% in 67 HCS communities across four states. Communities form coalitions to make shared decisions about what overdose prevention strategies to implement and how best to implement them, particularly strategies that promote Overdose Prevention Education and Naloxone Distribution (OEND) and Medications for Opioid Use Disorder (MOUD). While it is known that minoritized communities (whether due to race, ethnicity, gender, or LGBTQIA+ status) have less and poorer access to treatment for Opioid Use Disorder (OUD) and associated disparities in outcomes, at its outset, HCS did not explicitly aim to reduce disparities or measure the effect of centering equity on overdose prevention. This approach changed in 2020 with acute awareness of the racial and ethnic disparities within the COVID epidemic and the racial awakening in response to the George Floyd killing. This supplement will leverage the existing infrastructure and study stuff of its parent study to analyze survey and other qualitative data already collected. The primary data sources will include surveys of coalition members, completed at four time points during the study period; the Opioid-Overdose Reduction Continuum of Care Approach Tracker (ORCCAT), completed monthly by study staff, that includes overdose prevention information by strategy, sector, venue, population served, coalition approval date, implementation plan developed, date started, number of partners/practices associated with strategy, and mode of delivery; and REACH data, completed by study staff monthly once each strategy is implemented that includes information on number of persons reached and demographics of those reached (e.g., race, ethnicity, sex, age). Data analysis will include both quantitative analysis looking at associations between survey answers regarding health equity topics and incorporation of equity into strategies, as well as qualitative analysis examining how coalitions discussed and prioritized equity topics. This study will be guided by the parent study’s PRISM/RE-AIM(S) conceptual framework with a novel health equity lens to examine how diversifying coalitions and infusing opioid overdose prevention strategies with health equity principles may help reach minoritized communities and how these contextual factors and processes may interact to promote or impede health equity. Results from this study may be used to inform policies, strategies, and practices for incorporating health equity principles when implementing overdose prevention strategies.