The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study

Theresa Winhusen, Alexander Walley, Laura C Fanucchi, Tim Hunt, Mike Lyons, Michelle Lofwall, Jennifer L Brown, Patricia R Freeman, Edward Nunes, Donna Beers, Richard Saitz, Leyla Stambaugh, Emmanuel A Oga, Nicole Herron, Trevor Baker, Christopher D Cook, Monica F Roberts, Daniel P Alford, Joanna L Starrels, Redonna K Chandler, Theresa Winhusen, Alexander Walley, Laura C Fanucchi, Tim Hunt, Mike Lyons, Michelle Lofwall, Jennifer L Brown, Patricia R Freeman, Edward Nunes, Donna Beers, Richard Saitz, Leyla Stambaugh, Emmanuel A Oga, Nicole Herron, Trevor Baker, Christopher D Cook, Monica F Roberts, Daniel P Alford, Joanna L Starrels, Redonna K Chandler

Abstract

Background: The number of opioid-involved overdose deaths in the United States remains a national crisis. The HEALing Communities Study (HCS) will test whether Communities That HEAL (CTH), a community-engaged intervention, can decrease opioid-involved deaths in intervention communities (n = 33), relative to wait-list communities (n = 34), from four states. The CTH intervention seeks to facilitate widespread implementation of three evidence-based practices (EBPs) with the potential to reduce opioid-involved overdose fatalities: overdose education and naloxone distribution (OEND), effective delivery of medication for opioid use disorder (MOUD), and safer opioid analgesic prescribing. A key challenge was delineating an EBP implementation approach useful for all HCS communities.

Methods: A workgroup composed of EBP experts from HCS research sites used literature reviews and expert consensus to: 1) compile strategies and associated resources for implementing EBPs primarily targeting individuals 18 and older; and 2) determine allowable community flexibility in EBP implementation. The workgroup developed the Opioid-overdose Reduction Continuum of Care Approach (ORCCA) to organize EBP strategies and resources to facilitate EBP implementation.

Conclusions: The ORCCA includes required and recommended EBP strategies, priority populations, and community settings. Each EBP has a "menu" of strategies from which communities can select and implement with a minimum of five strategies required: one for OEND, three for MOUD, and one for prescription opioid safety. Identification and engagement of high-risk populations in OEND and MOUD is an ORCCArequirement. To ensure CTH has community-wide impact, implementation of at least one EBP strategy is required in healthcare, behavioral health, and criminal justice settings, with communities identifying particular organizations to engage in HCS-facilitated EBP implementation.

Trial registration: ClinicalTrials.gov NCT04111939.

Keywords: Continuum of care; Evidence-based practice; HEALing communities study; Helping to end addiction long-term; Medication; Naloxone; Opioid use disorder; Overdose; Prescription opioid safety; Retention.

Conflict of interest statement

RS reports Alkermes provided injectable naltrexone to Boston University for an NIH-funded study of which he is principal investigator. JS reports receiving research support from the Opioid Post-marketing Requirement Consortiumand having served as a core expert on the 2016 CDC Guideline committee. The other authors declare no conflicts of interest.

Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
The HEALing Communities Study Opioid-overdose Reduction Continuum of Care Approach (ORCCA) with Sample strategies.

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