The HEALing Communities Study

The HEALing Communities Study (HCS) is a multi-site implementation research study which investigates how tools for preventing and treating opioid use disorder and overdose are most effective at the local level.

The study tests the impact of the Communities That HEAL (CTH) intervention, an integrated set of evidence-based practices across health care, behavioral health, criminal justice, and other community-based settings. The goal of the study is to reduce opioid-related overdose deaths by 40% over the course of three years. Funded by the National Institute on Drug Abuse (NIDA), research institutions are partnering with 67 communities highly affected by the opioid crisis in four states (New York, Kentucky, Massachusetts, Ohio) to measure the impact of these efforts. Cortland County is one of 16 communities in NYS. In New York, a research team from Columbia University is managing the research project.

Communities That HEAL Intervention

The HEALing Communities Study looks at how each county implements the Communities That HEAL intervention. The intervention seeks to promote a common vision, shared goals, and tailored strategies to mobilize communities to adopt evidence-based practices. The intervention will use a stepwise community change process with three components:

• Community-engaged data-driven decision making
• A “menu” of evidence-based strategies (called the Opioid Reduction Continuum of Care Approach (ORCCA))
• Three community-based communication campaigns

The evidence-based strategies on the ORCCA menu fall into three categories:

• Overdose prevention education and naloxone distribution
• Effective delivery of medication opioid use disorder (MOUD)
• Safer opioid prescribing and dispensing

Anticipated Outcomes

Again, the primary expected outcome from participation in the HEALing Communities Study is a 40% reduction of opioid overdose deaths over three years. However, the study also recognizes the importance of the social and material contexts in which overdoses happen, which means we can expect some other outcomes as well:

• Increased numbers of providers treating opioid use disorder with MOUD including buprenorphine, methadone and naltrexone
• Increased numbers of people accessing MOUD and other drug treatment
• Increased number of people and community-based organization trained to administer naloxone and provide overdose education
• Reduced number of non-fatal overdoses
• Increased identification of people with opioid use disorder
• Reduction in number of people progressing to opioid use disorder

In the last 20 years, the US opioid epidemic has claimed the lives of over half a million people and impacted countless others. Cortland County has not escaped these devastating effects. From 2015 to 2017, the number of Cortland County admissions to opioid treatment programs rose from 217 to 340. This figure declined to 131 by 2019, but the county’s annual admission rate (per 1000,000) has exceeded the New York State rate in every year since 2012 (excluding NYC). Of particular note, Cortland County had an overdose death rate of 29.3, nearly 10 points higher than the New York State rate (19.8 per 100,000). As the intensity of opioid related challenges grows, it has become increasingly apparent that no single entity or institution can address all the challenges this epidemic presents. Therefore, we need a community working together across multiple sectors and strategies to reduce the number of people exposed to opioid misuse.

In 2015, CACTC was awarded the Partnership for Success (PFS) Grant through the NY State Office of Alcohol and Substance Abuse (OASAS). CACTC received a total of $627,300 over 4 ½ years with the goal of reducing prescription drug, heroin and opiate use and misuse amongst 12-25 year olds in Cortland County. Cortland County was one of ten communities awarded the PFS grant in New York State. CACTC partners collaborated on addressing the growing opioid epidemic here in Cortland County by strengthening and enhancing existing efforts such as the annual medication disposal events, increasing access to naloxone, creating countywide awareness campaigns, and increased partnerships with physicians and local law enforcement agencies. 

Since 2015, the Cortland County Health Department has increased the distribution and training for naloxone kits to community members. Over 1,000 kits have been distributed since 2016. In addition, there has been an increase in the awareness of naloxone. In September 2020, Family & Children’s Counseling Services began a push to increase naloxone to clients and community members, especially those at highest risk of overdose. The Center of Treatment Innovation (COTI) Program which is expanding access to medication for Opioid Use Disorder, counseling, peer services and case management is also now taking a lead on naloxone outreach. By providing mobile outreach, they are also able to address transportation and other barriers. 

The Cortland County Drug Disposal program has increased capacity significantly since 2015, collecting more prescription drugs every year since the beginning of the PFS grant project. Five permanent Drug Take Back Kiosks have been installed at all police departments (Homer, City of Cortland, SUNY Cortland and Sheriff’s Office) as well as at Guthrie Cortland Medical Center. In 2020, two permanent Sharps Disposal Kiosks were installed outside of the Homer Police Department and City Hall in Cortland.

Guthrie Cortland Medical Center has taken an active role in reducing opioid prescribing and has increased opioid related services in the hospital. By 2018, they have cut ER opioid prescribing by almost half. Naloxone is being dispensed in the ER, as well as buprenorphine. Local primary care providers are also taking an increasingly active role in addressing the issue. Family Health Network is now offering buprenorphine and referrals to counseling through a partnership with Family & Children’s Counseling Services.

The Cortland County Community Services Board has made substance use treatment and prevention its number one priority outcome in the Cortland County comprehensive plan. The Cortland County Health Department has also made substance use a priority area in line with the NYS Prevention Agenda. 

In 2019, Cortland County was chosen to participate in the HEALing Communities Study. We are excited to continue enhancing the work being done in Cortland County and across the region. In July 2022, we officially entered the implementation phase of the HCS project. During this 18-month period, agencies from across the community will work together to select and implement evidence-based strategies to reduce overdose deaths.