{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:25:32Z","timestamp":1787120732679,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000058","name":"Substance Abuse and Mental Health Services Administration","doi-asserted-by":"publisher","award":["UM1DA049394"],"award-info":[{"award-number":["UM1DA049394"]}],"id":[{"id":"10.13039\/100000058","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000058","name":"Substance Abuse and Mental Health Services Administration","doi-asserted-by":"publisher","award":["UM1DA049406"],"award-info":[{"award-number":["UM1DA049406"]}],"id":[{"id":"10.13039\/100000058","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000058","name":"Substance Abuse and Mental Health Services Administration","doi-asserted-by":"publisher","award":["UM1DA049412"],"award-info":[{"award-number":["UM1DA049412"]}],"id":[{"id":"10.13039\/100000058","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000058","name":"Substance Abuse and Mental Health Services Administration","doi-asserted-by":"publisher","award":["UM1DA049415"],"award-info":[{"award-number":["UM1DA049415"]}],"id":[{"id":"10.13039\/100000058","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000058","name":"Substance Abuse and Mental Health Services Administration","doi-asserted-by":"publisher","award":["UM1DA049417"],"award-info":[{"award-number":["UM1DA049417"]}],"id":[{"id":"10.13039\/100000058","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We evaluated whether community\u2010level naloxone distribution, medication for opioid use disorder treatment and retention and incident high\u2010risk opioid prescribing rates were associated with opioid overdose death rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational cohort conducted using 2019 to 2023 community\u2010level data as an exploratory analysis of the HEALing (Helping to End Addiction Long\u2010term\u00ae) Communities Study (HCS). Exposures included: (1) community\u2010level naloxone distribution, past 12\u2010months, categorized as \u22641000\u2009units per 100\u2009000 population vs. 1001\u20133000\u2009units per 100\u2009000 population vs. &gt;3000\u2009units per 100\u2009000 population; (2) individuals treated with buprenorphine per 100\u2009000 adult population in the current quarter; (3) individuals retained on buprenorphine for \u2265 180\u2009days per 100\u2009000 adult population in the current quarter; and (4) incident high\u2010risk opioid prescribing per 100\u2009000 adult population in the current quarter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>Population\u2010based study of 67 communities with 8.2 million adults in Kentucky, Massachusetts, New York and Ohio, USA, with required annual opioid overdose death rates of &gt; 25 per 100\u2009000 adult population and at least 30% rural. Across the 67 communities participating in the HCS, the adult population was 31% 18\u201334\u2009years, 31% 35\u201354\u2009years, 38% 55\u2009years and over, 52% female, 73% non\u2010Hispanic White, 15% non\u2010Hispanic Black and 7.4% Hispanic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Quarterly community\u2010level opioid overdose death rates from 2020 through 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The 2019 annual rates were 40.4 opioid overdose deaths, 1287 naloxone rescue units distributed, 977.7 people received buprenorphine treatment, 546.3 people retained for more than 180\u2009days on buprenorphine and 1266.7 high\u2010risk opioid prescribing incidents per 100\u2009000 population. In models adjusted for state, community age, sex, race\/ethnicity, rurality, HCS intervention group assignment, 2019 rates of opioid overdose death, naloxone distribution, buprenorphine and high\u2010risk opioid prescribing, and the ratio of opioid overdose deaths involving fentanyl, an increase in 100 people treated with buprenorphine per 100\u2009000 population was associated with a decrease of 0.92 [95% confidence interval (CI) = \u22121.30 to \u22120.55] in the quarterly opioid overdose death rate, while an increase of 100 people retained on buprenorphine for more than 180\u2009days per 100\u2009000 population was associated with a decrease of 1.3 (95% CI = \u22121.8 to \u22120. 76). There were no statistically significant associations between naloxone distribution or incident high\u2010risk opioid prescribing with change in quarterly opioid overdose death rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this exploratory analysis, increases in both buprenorphine treatment and retention were statistically significantly associated with decreases in opioid overdose death rates, after adjusting for baseline rates of buprenorphine treatment and retention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70478","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:00:38Z","timestamp":1781265638000},"page":"2482-2493","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The association between naloxone distribution, buprenorphine treatment and retention and incident high\u2010risk opioid prescribing with opioid overdose death in Kentucky, Massachusetts, New York and Ohio, United States: An exploratory community\u2010level cohort study of data from the HEALing Communities Study"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8158-4882","authenticated-orcid":false,"given":"Alexander Y.","family":"Walley","sequence":"first","affiliation":[{"name":"Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine Boston Medical Center\/Boston University School of Medicine  Boston MA USA"},{"name":"Massachusetts Department of Public Health Bureau of Substance Addiction Services  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie M.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Boston University School of Public Health  Boston MA USA"},{"name":"Center for Health Data Science (CHDS) Boston University School of Public Health  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Vandergrift","sequence":"additional","affiliation":[{"name":"RTI International  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Larochelle","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine Boston Medical Center\/Boston University School of Medicine  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JaNae","family":"Holloway","sequence":"additional","affiliation":[{"name":"RTI International  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Psychological Sciences Purdue University  West Lafayette IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Redonna","family":"Chandler","sequence":"additional","affiliation":[{"name":"Addiction Policy Forum  Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C.","family":"Fanucchi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Center on Drug and Alcohol Research University of Kentucky College of Medicine  Lexington KY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Feaster","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics Division, Department of Public Health Sciences University of Miami Miller School of Medicine  Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia R.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Science and Center on Drug and Alcohol Research University of Kentucky College of Medicine  Lexington KY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Hunt","sequence":"additional","affiliation":[{"name":"Social Intervention Group, School of Social Work Columbia University  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle R.","family":"Lofwall","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science and Center on Drug and Alcohol Research University of Kentucky College of Medicine  Lexington KY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah K.","family":"Knudsen","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science and Center on Drug and Alcohol Research University of Kentucky College of Medicine  Lexington KY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2055-3425","authenticated-orcid":false,"given":"Edward 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