New England Journal of Medicine published an RCT of Communities That Heal (CTH), a data-driven program that engaged communities in 4 states to rapidly deploy evidence-based practices to reduce opioid overdose deaths. Quick take: High-quality RCT finds no discernible effect on overdose deaths over 1 year.

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Program:

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• Communities participating in CTH received federal grants averaging $1.25M to adopt and deploy evidence-based practices, including promotion of opioid overdose education and naloxone distribution, the use of medications for opioid use disorder, and media messages to reduce stigma.

Study Design:

• The study sample comprised 67 communities in NY, OH, KY, and MA with high rates of overdose deaths, randomized to CTH vs control (usual services). Based on careful review, this was a high-quality RCT (e.g., baseline balance, negligible attrition, prespecified analyses).

Findings:

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• The study found that CTH led to strong community uptake of evidence-based practices. But it had no discernible impact on opioid overdose deaths over 1 year: There were 47.2 such deaths/100k people in the CTH group vs 51.7 in the control group, a difference that wasn't statistically significant (p=.30).

Comment:

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• The researchers offer possible reasons for the null results (e.g., CTH may need more time to produce effects). One possibility I'd add is that most of CTH's "evidence-based practices" are backed by only preliminary studies that often don't hold up in more definitive evaluations.

• For example, the studies of naloxone distribution are observational (non-RCTs), and opioid medication RCTs are almost all short duration (typically several weeks). Policymakers have unfortunately not invested in the rigorous research needed to build a body of *proven* practices with meaningful impacts on opioid addiction and overdoses.

• As a result, we're more than a decade into the worst drug epidemic in US history and, as I believe the CTH study shows, largely flying blind on how to address it.