Brown Jennifer L, Larochelle Marc R, Fanucchi Laura C, Calvert Deirdre C, Campbell Aimee N C, Chandler Redonna K, Feaster Daniel J, Glasgow LaShawn M, Gibson Erin B, Holloway JaNae, Lofwall Michelle R, Mack Aimee, Mack Nicole, Nunes Edward V, Talbert Jeffery C, Tan Sylvia, Vandergrift Nathan, Villani Jennifer, Asman Kat, Babakhanlou-Chase Hermik, Bagley Sarah M, Battaglia Tracy A, Blevins Derek, Bridden Carly, Cheng Debbie M, Christopher Mia, Cogan Lindsay W, Cunningham Chinazo O, Eggleston Barry, Fareed Naleef, Fernandez Soledad, Freedman Darcy A, Freiermuth Caroline E, Freisthler Bridget, Gilbert Louisa, Hammerslag Lindsey, Harris Daniel, Hunt Timothy, Hussain Shazia, Huynh Phuong, Jackson Rebecca D, Kauffman Emily B, Knott Charles, Knudsen Hannah K, Lefebvre R Craig, Levin Frances R, Massatti Rick, McAlearney Ann Scheck, Morgan Jake R, Lopez Rosie Munoz, Lounsbury David W, Newman Lisa, Nickels Katrina, Oga Emmanuel A, Oller Devin A, Parran Theodore V, Quinn Maria, Ramsey Kelly S, Rapkin Bruce D, Salsberry Pamela, Stein Michael, Taylor Jessica L, Teater Julie, Walters Scott T, Zarkin Gary A, El-Bassel Nabila, Winhusen T John, Samet Jeffrey H, Walsh Sharon L
Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA.
Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA.
Drug Alcohol Depend. 2025 Sep 1;274:112785. doi: 10.1016/j.drugalcdep.2025.112785. Epub 2025 Jul 9.
Medications for opioid use disorder (MOUD) can reduce opioid use and overdose deaths. This study examined whether the Communities That HEAL (CTH) intervention increased MOUD initiation, retention, and linkage. The HEALing Communities Study was a multi-site, 2-arm, parallel, community-level, cluster-randomized, unblinded, wait-list controlled trial conducted in 67 communities (n = 34 intervention, n = 33 control). Using Prescription Drug Monitoring Programs and Medicaid claims data, we compared mean community-level rates of MOUD outcomes during the 1-year comparison period (July 2021-June 2022) for: (a) MOUD receipt at least once; (b) continuous MOUD receipt for 180 days; and (c) MOUD linkage within 31 days following an opioid-related emergency department or hospital encounter. For intervention and control communities, adjusted rates of receiving MOUD at least once were 578 (95 % CI: 562, 594) and 596 (95 % CI: 572, 621) per 1000 Medicaid enrollees, respectively [adjusted Relative Rate (aRR)= 0.97 (95 % CI: 0.93, 1.01)]. Adjusted rates of receiving MOUD for 180 consecutive days (retention) were 614 (95 % CI: 595, 634) and 620 (95 % CI: 603, 638) per 1000 Medicaid enrollees receiving MOUD at least once for intervention and control communities, respectively [aRR= 0.99 (95 % CI: 0.95, 1.04)]. The adjusted rate of linkage was 280 (95 % CI: 254, 310) and 252 (95 % CI: 226, 281) per 1000 encounters for intervention and control communities, respectively [aRR= 1.11 (95 % CI: 0.96, 1.28). Compared to control communities, communities that received the CTH intervention did not demonstrate higher rates of MOUD use, retention, or linkage. Additional efforts are needed to improve uptake and sustained use of MOUD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04111939.
用于阿片类物质使用障碍（MOUD）的药物可以减少阿片类物质的使用和过量死亡。本研究调查了“治愈社区（CTH）”干预措施是否能提高MOUD的启动率、留存率以及衔接率。“治愈社区研究”是一项多中心、双臂、平行、社区层面、整群随机、非盲、等待列表对照试验，在67个社区开展（n = 34个干预社区，n = 33个对照社区）。利用处方药监测计划和医疗补助报销数据，我们比较了在1年比较期（2021年7月至2022年6月）内社区层面MOUD相关结果的平均发生率，这些结果包括：（a）至少接受过一次MOUD治疗；（b）连续180天接受MOUD治疗；（c）在与阿片类物质相关的急诊科或医院就诊后31天内接受MOUD治疗。对于干预社区和对照社区，每1000名医疗补助参保者中至少接受过一次MOUD治疗的调整发生率分别为578（95%CI：562，594）和596（95%CI：572，621）[调整相对率（aRR）= 0.97（95%CI：0.93，1.01）]。对于至少接受过一次MOUD治疗的干预社区和对照社区，每1000名医疗补助参保者中连续180天接受MOUD治疗（留存率）的调整发生率分别为614（95%CI：595，634）和620（95%CI：603，638）[aRR = 0.99（95%CI：0.95，1.04）]。干预社区和对照社区每1000次就诊中接受MOUD治疗的调整衔接率分别为280（95%CI：254，310）和252（95%CI：226，281）[aRR = 1.11（95%CI：0.96，1.28）]。与对照社区相比，接受CTH干预的社区在MOUD的使用、留存或衔接率方面并未表现出更高的水平。需要做出更多努力来提高MOUD的接受度和持续使用率。试验注册：ClinicalTrials.gov标识符：NCT04111939。
