Examining Changes in Coalition Dynamics to Support Opioid Fatality Reduction

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Introduction: The goal was to evaluate how changes in coalition capacity and leadership were related to adoption and reach of overdose education and naloxone distribution in communities participating in the HEALing Communities Study. Study Design: This was a multisite, cluster randomized waitlist-controlled trial; only analysis of Wave 1 data was performed. Setting/Participants: Longitudinal analysis of cross-sectional surveys completed by coalition members from 33 communities in 4 states based on data collected from January 2021 to June 2022. Intervention: =33) received the Communities That HEAL intervention to support expansion of evidence-based practices, including overdose education and naloxone distribution, to curtail opioid-related fatalities. Main Outcomes: Coalition capacity and leadership were measured at the midpoint and end of the intervention using validated scales averaged at the community level. Community adoption and reach of overdose education and naloxone distribution were assessed as changes in the rate of community partners implementing overdose education and naloxone distribution strategies and naloxone units distributed from midpoint to the end of the intervention. Negative binomial and linear models, adjusted for baseline characteristics, were conducted in 2024. Results: Increases in general coalition capacity, adjusted for changes in overdose education and naloxone distribution-specific coalition capacity, were significantly associated with higher rates of community partners engaged in overdose education and naloxone distribution implementation. There was a 56% increase over time in community partners engaged in overdose education and naloxone distribution implementation per unit increase in general capacity scores among coalitions receiving Communities That HEAL. Changes in coalition leadership and capacity did not significantly correlate with changes in naloxone being distributed. Conclusions: Strengthening general coalition capacity is vital for increasing community partner engagement to expand adoption of overdose education and naloxone distribution. Findings support ongoing investment in coalition capabilities to enhance the effectiveness of public health interventions seeking to reduce opioid-related fatalities. Efforts to strengthen general capacities of coalitions, such as data-informed decision making and collective goalsetting, may accelerate implementation and scaling of evidence-based practices such as overdose education and naloxone distribution.

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