Massive Study Will Reduce Opioid Overdose Deaths.

There are proven, effective prevention methods and treatments for opioid use disorder and overdose, but only 20 percent of people with opioid use disorder are receiving treatment and prevention strategies are not widely or well-implemented. To close the gap, the National Institute on Drug Abuse (NIDA), as part of the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative, has awarded a team of Boston Medical Center/Boston University researchers $89 million as one of four sites in a $350 million national study called HEALing Communities. The study will test and develop effective strategies for getting proven prevention and treatment methods to the people who need them.

The BMC part of the study, called MassHEAL, aims to reduce Massachusetts opioid overdose deaths by 40 percent over the next three years. SPH researchers are working with colleagues at BMC, the School of Medicine, and the School of Social Work on the project, and leading efforts in data management and methodology, communication strategy, and prevention-based interventions.

“Having worked on addiction for 25 years, the idea that an addiction study would even get close to what a heart study would get almost brings tears to your eyes,” says Richard Saitz, professor of community health sciences, who is leading the SPH side of the project.

“I never thought that our society would devote resources like this to this health condition,” he says. “Awarding these grants at this level is a statement from Congress, and I hope that that indicates some change in how we relate to what are some of the most important health problems of our time.”

Based at BMC’s Grayken Center for Addiction, MassHEAL is led by Jeffrey Samet, the chief of general internal medicine at BMC and a professor of medicine at MED and of community health sciences at the SPH. MassHEAL will evaluate interventions in 16 communities that have been hit hard by the opioid crisis. All 16 will receive support for implementing office-based medication treatment under a model developed at BMC and now disseminated nationally as the “Massachusetts model.” Eight of the communities will also receive more intensive support: they will be able to pick from a “menu” of additional interventions that the researchers will help them implement and evaluate.

“Some of these interventions are admittedly a few steps upstream from overdoses—like public health often is,” Saitz says. “It’s the common public health adage that you can’t just keep pulling people out of the river without seeing where they’re coming from.”

One of these “upstream” interventions will train healthcare providers to improve safer opioid prescribing, co-led by Saitz. Another intervention will build off of ongoing work by the Activist Lab under Beverly Heinze-Lacey in school-based prevention programs. Michael Stein, professor and chair of health law, policy & management, will co-lead a set of public health messaging interventions. Patricia Elliott, clinical assistant professor of community health sciences, will lead an intervention for justice-involved youth. Traci Green, associate professor of community health sciences, will co-lead an intervention providing overdose response training and naloxone to people with opioid use disorder, and she will lead another intervention at the pharmacy level. An outreach intervention to high-risk individuals and their families will be co-led by Angela Bazzi, assistant professor of community health sciences. Megan Sandel, associate professor of environmental health, will lead an intervention addressing housing, transportation, childcare, employment, and food security concerns among people with opioid use disorder. And Edward Bernstein, professor of community health sciences, will serve as a mentor for faculty leading several other interventions.

Beyond the intervention “menu,” the Biostatistics & Epidemiology Data Analytics Center (BEDAC) will provide data management and methodology for the entire MassHEAL study, and Stein will lead overall communication strategy. The Schools of Medicine, Public Health, and Social Work will all be involved in the project’s extensive collaboration with community members; Mari-Lynn Drainoni, associate professor of health law, policy & management, will lead that effort from the SPH side, and Traci Battaglia, who is both associate professor medicine at MED and of epidemiology at SPH, will lead it from the MED side.

“A lot of research is incremental, and you don’t know what you’re going to find, but this one is different,” Saitz says. “Because of the magnitude of it, and the fact that there are so many services that people right now just aren’t getting, and because people will be receiving treatments that have known efficacy, I’m 99 percent sure that we will reduce opioid overdose mortality substantially—we will save lives.”

—Michelle Samuels