$86 Million Grant to Reduce Overdose Deaths in New York State Celebrates Accomplishments, Enters Second Phase

After the rate of opioid overdose deaths in New York State nearly tripled between 2010 and 2017, it was clear that innovative interventions were necessary to save lives. In April 2019, the Columbia School of Social Work received an $86 million grant from the National Institute on Drug Abuse (NIDA) to address this epidemic using community-based data-driven approaches. The HEALing Communities Study (HCS) was implemented the same year.

HCS is led by Principal Investigator Nabila El-Bassel, PhD, and by a large number of multidisciplinary scientists. Dr. El-Bassel is also the Director of the Social Intervention Group, part of the Columbia School of Social Work, and a University Professor at Columbia University.

A total of 64 communities are included in the HCS from four states (NY, MA, Ohio and Kentucky), where 50% of the counties (Wave 1) have received the “Communities that HEAL” intervention for over two-and-a-half years. Sixteen total NY State counties are participating in HCS. The first eight counties just completed Wave 1 on June 30, 2022.

The impact of HCS across New York’s initial eight county sites – Cayuga, Columbia, Erie, Greene, Lewis, Putnam, Suffolk, and Ulster – was measurably significant, thanks to partnerships with New York State Department of Health, and more than 100 agencies and community partners.

Each county has a coalition including collaborations with County Health and Mental Health commissioners, local law enforcement, healthcare providers, emergency departments, homeless assistance agencies, youth-serving organizations, and elected officials and policy makers. Critically, the Study includes people with lived experience, and family members who have lost loved ones because of drug overdose.

Dr. El-Bassel is committed to implementing community-based approaches, both throughout her thirty years as a research scientist and with HCS.

“I am convinced that our community engagement model, which was designed by the HCS study team and implemented with engagement of the counties’ community coalitions, including drug treatment and harm reduction programs, can be applied to addressing other health and social issues impacting our communities. Without true community engagement including people with lived experience and their families, the design and implementation of interventions to address the overdose crisis will not lead to lasting outcomes and good science,” said Dr. El-Bassel.

An important achievement of this community approach is the use of real time data by each county coalition to understand who is at risk for drug overdose, what types of services are available, who has access, and how to provide broader availability of evidence-based prevention and treatment interventions to all in need. The data identify gaps in services and use data visualization so evidence-based practices can be deployed to ameliorate the overdose crisis.

“Our data dashboards with interactive visualizations provide easily understood visuals to support the coalitions to quickly and accurately draw conclusions, make decisions, and take action to deploy evidence-based practices. The dashboard also includes visualizations on simulation and prediction of the level of interventions needed by the coalitions, such as opioid use disorder treatment, naloxone, or linkage to care,” said Dr. El-Bassel.

HCS applies harm reduction principles anchored in human rights and focused primarily on quality of life for affected individuals and communities rather than total drug use cessation, in order to create a safer environment for individuals with substance use disorders and prevent overdose. Harm reduction also affords people who use drugs the respect and voice necessary to help create effective policies for serving them.

The HCS coalitions implemented more than 177 evidence-based practices with partnering agencies. One example of harm reduction is the HCS campaign to increase access and use of life-saving Naloxone, an overdose reversal medication. Participating counties in Wave I dispensed over 16,000 units of Naloxone to local partner agencies, who distributed the Naloxone both to individuals in high-risk populations and their social networks. and provided over 2,300 linkages to this medication in criminal justice settings such as sheriff departments, pretrial services, home incarceration, drug courts, jails and probation and parole programs.

In addition, in Wave I, HCS placed over 600 “NaloxBoxes” (boxes containing Naloxone) in high-risk locations where overdoses have occurred such as motels, gas stations, bars and restaurants. The New York State Department of Health continues to refill the NaloxBoxes.

Communication campaigns are another important component of HCS, designed for several purposes including to reduce stigma against the use of medication for opioid use disorder (MOUD), reduce stigma towards people who use drugs, and improve access to MOUD, Naloxone and other harm reduction services.

The coalitions made a particular effort to reach out to diverse communities to ensure these practices reached communities of color and other marginalized groups.

The overdose epidemic has continued to evolve, particularly with overdoses involving fentanyl, which is 50 times more potent than heroin. The CDC reported that the majority of the 104,034 drug fatalities that occurred between February 2021-2022 involved illicitly manufactured fentanyl. Increasingly, communities of color are experiencing dramatic rise in overdoses. As governments continue to tackle the crisis, they must address the lack or delay of data by race and ethnicity, which is needed to develop culturally-congruent interventions to address specific community needs.

As HCS begins to implement Wave II, eight more highly-affected counties in NY State will benefit from the Study’s harm reduction-based campaigns, which will build upon the innovative strategies of Wave I and emphasize the importance of real-time data collection to rapidly respond to highly-impacted communities.

“Informed by wave I, the same model allows for innovation and improvements including engaging a greater number of individuals with lived experience and accelerating the use of rapid data, dashboards, to implement evidence-based practices to reduce drug overdose deaths,” Dr. El-Bassel said.

Acknowledging the role of community and academic partners, she concludes,

“HCS could not be successful without the true collaboration of the New York State Department of Health, county health and mental health commissioners, and a firm local commitment from each county collation. HCS also benefits from a multidisciplinary team of investigators from Columbia and other schools dedicated to making this type of intervention succeed and be sustained by the communities involved.”

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More about HCS:

Location: The Study includes 16 highly impacted counties in New York split into two waves. Each wave has a mix of both urban and rural communities. Wave 1 ended June 30th, 2022, and Wave 2 began July 1st.

Academic participants: Columbia University including the School of Social Work, the Department of Psychiatry, the Mailman School of Public Health, and the Data Science Institute. Researchers from Albert Einstein School of Medicine/Montefiore Health System, City University of New York, Weill Cornell Medical College, New York University School of Medicine, University of Miami, and Yale School of Medicine.