INTRODUCTION: Evidence-based practices (EBPs) tailored to reduce opioid-related fatalities among minoritized populations may help reduce inequities, but research elucidating the relationship between local-level inequities in social determinants of health (SDH) and selection and implementation of tailored EBPs.
METHODS: The HEALing Communities Study was a multisite, wait-listed, community-level cluster-randomized trial with the objective to reduce opioid overdose deaths. Community coalitions selected and partner organizations implemented EBP strategies to increase access to Overdose Education and Naloxone Distribution (OEND) and Medications for Opioid Use Disorder (MOUD). The research team utilized negative binomial and zero-inflated Poisson models to assess whether the relationship between (a) communities’ need for tailored OEND and MOUD strategies, as indicated by opioid overdose death rates among minoritized groups; and (b) the selection, implementation, and reach of those strategies was moderated by local-level inequities in SDH, quantified by the Local Social Inequity in Drug Overdoses (LSI-DO) index. The analysis included data from 33 communities across four states.
RESULTS: Eleven of 33 communities implemented tailored OEND and MOUD strategies. Adjusted analysis revealed that LSI-DO scores moderated the relationship between 2021 opioid overdose death rates among minoritized groups and the proportion of community-implemented tailored strategies (p = 0.015). The research team found no moderation for the number of strategies selected or number of individuals reached by EBPs.
CONCLUSION: Few communities selected EBPs tailored to minoritized populations. For those that did, higher local-level social inequity was associated with decreased implementation of tailored strategies. Continued research on how to address overdose inequities—and local-level social inequity—is vital. Findings highlight the need for policy approaches that pair overdose prevention strategies with investments to reduce local-level social inequities that impede equitable implementation.
Local level of social inequity moderates implementation of evidence-based practices tailored to minoritized populations to reduce opioid overdose deaths
180, 209828. doi: 10.1016/j.josat.2025.209828. PMCID: PMC12863292.