Community Coalitions' Navigation of Policies to Address the Opioid Epidemic: Insights from Qualitative Interviews in Four States

Overview

Journal BMJ Public Health

Publisher BMJ Publishing Group

Date 2025 Mar 7

PMID 40051546

Authors

Ramona G Olvera

Allyson G Cogan

Mary Bartkus

Shoshana N Benjamin

Jill Davis

Lisa A Frazier

Brandy F Henry

Timothy Hunt

Elizabeth N Kinnard

Hallie Mattingly

Ann Scheck McAlearney

Dean Rivera

Mari-Lynn Drainoni

Daniel M Walker

Affiliations

Soon will be listed here.

Abstract

Introduction: The opioid epidemic in the USA presents a multifaceted challenge regulated by a patchwork of federal, state and local policies. In some communities, cross-sector coalitions navigate this complex policy environment to address the epidemic. However, limited research has explored these public health-oriented community coalitions and their interactions with the policy landscape. This study explores how cross-sector public health-oriented community coalition members perceive and navigate the multidimensional policy landscapes to address the opioid epidemic.

Methods: Using data from 304 semistructured HEALing Communities Study coalition member interviews conducted April-June 2021 in 67 communities in Kentucky, New York, Massachusetts and Ohio, we inductively analysed participants' discussions of opioid-related policies to characterise themes and subthemes.

Results: We describe two themes where coalitions and policy intersect: policy landscape barriers and navigation and mitigation strategies to address policy barriers. Participants revealed community misunderstandings and lack of knowledge of opioid-related policies. Furthermore, participants shared how these policies often hindered coalitions' initiatives to address substance use. Nevertheless, community coalitions functioned despite these policy challenges through knowledge sharing, innovation and policy advocacy.

Conclusions: Cross-sector public health-oriented community coalitions serve a vital role in navigating the complexities of the multidimensional policy landscape regulating substance use services. Insights from these findings may encourage policy-makers to support community coalitions in pursuing solutions to the opioid crisis and other public health crises.

Trial Registration Number: NCT04111939.

References

Krawczyk N, Rivera B, King C, Dooling B . Pandemic telehealth flexibilities for buprenorphine treatment: a synthesis of evidence and policy implications for expanding opioid use disorder care in the United States. Health Aff Sch. 2023; 1(1):qxad013. PMC: 10734906. DOI: 10.1093/haschl/qxad013. View

Kennedy-Hendricks A, Song M, McCourt A, Sharfstein J, Eisenberg M, Saloner B . Licensure Policies May Help States Ensure Access To Opioid Use Disorder Medication In Specialty Addiction Treatment. Health Aff (Millwood). 2024; 43(5):732-739. DOI: 10.1377/hlthaff.2023.01306. View

Goldsamt L, Rosenblum A, Appel P, Paris P, Nazia N . The impact of COVID-19 on opioid treatment programs in the United States. Drug Alcohol Depend. 2021; 228:109049. PMC: 8461004. DOI: 10.1016/j.drugalcdep.2021.109049. View

. The HEALing (Helping to End Addiction Long-term ) Communities Study: Protocol for a cluster randomized trial at the community level to reduce opioid overdose deaths through implementation of an integrated set of evidence-based practices. Drug Alcohol Depend. 2020; 217:108335. PMC: 7568493. DOI: 10.1016/j.drugalcdep.2020.108335. View

Schuler M, Heins S, Smart R, Griffin B, Powell D, Stuart E . The state of the science in opioid policy research. Drug Alcohol Depend. 2020; 214:108137. PMC: 7423757. DOI: 10.1016/j.drugalcdep.2020.108137. View

Drainoni M, Knudsen H, Adams K, Andrews-Higgins S, Auritt V, Back S . Community coalition and key stakeholder perceptions of the community opioid epidemic before an intensive community-level intervention. J Subst Abuse Treat. 2022; 138:108731. PMC: 9167242. DOI: 10.1016/j.jsat.2022.108731. View

Davis C, Samuels E . Opioid Policy Changes During the COVID-19 Pandemic - and Beyond. J Addict Med. 2020; 14(4):e4-e5. PMC: 7273953. DOI: 10.1097/ADM.0000000000000679. View

Lefebvre R, Chandler R, Helme D, Kerner R, Mann S, Stein M . Health communication campaigns to drive demand for evidence-based practices and reduce stigma in the HEALing communities study. Drug Alcohol Depend. 2020; 217:108338. PMC: 7534788. DOI: 10.1016/j.drugalcdep.2020.108338. View

Knudsen H, Drainoni M, Gilbert L, Huerta T, Oser C, Aldrich A . Model and approach for assessing implementation context and fidelity in the HEALing Communities Study. Drug Alcohol Depend. 2020; 217:108330. PMC: 7531282. DOI: 10.1016/j.drugalcdep.2020.108330. View

10.

Mandavia A, Campbell A, Henry B, Chaple M, Hunt T, Arout C . Support for COVID-19-Related Substance Use Services Policy Changes: a New York State-Wide Survey. J Behav Health Serv Res. 2022; 49(3):262-281. PMC: 8810146. DOI: 10.1007/s11414-021-09784-y. View

11.

Gibbons J, Harris S, Solomon K, Sugarman O, Hardy C, Saloner B . Increasing overdose deaths among Black Americans: a review of the literature. Lancet Psychiatry. 2023; 10(9):719-726. DOI: 10.1016/S2215-0366(23)00119-0. View

12.

Nagorcka-Smith P, Bolton K, Dam J, Nichols M, Alston L, Johnstone M . The impact of coalition characteristics on outcomes in community-based initiatives targeting the social determinants of health: a systematic review. BMC Public Health. 2022; 22(1):1358. PMC: 9288063. DOI: 10.1186/s12889-022-13678-9. View

13.

Felmingham T, Backholer K, Hoban E, Brown A, Nagorcka-Smith P, Allender S . Success of community-based system dynamics in prevention interventions: A systematic review of the literature. Front Public Health. 2023; 11:1103834. PMC: 10080052. DOI: 10.3389/fpubh.2023.1103834. View

14.

Puro N, Joseph Kelly R . Community social capital or health needs: What is driving hospital-community partnerships to address social determinants of health?. SSM Popul Health. 2022; 18:101129. PMC: 9136097. DOI: 10.1016/j.ssmph.2022.101129. View

15.

McAlearney A, Walker D, Shiu-Yee K, Crable E, Auritt V, Barkowski L . Embedding Big Qual and Team Science into Qualitative Research: Lessons from a Large-scale, Cross-site Research Study. Int J Qual Methods. 2024; 22. PMC: 11044892. DOI: 10.1177/16094069231165933. View

16.

Zakocs R, Edwards E . What explains community coalition effectiveness?: a review of the literature. Am J Prev Med. 2006; 30(4):351-61. DOI: 10.1016/j.amepre.2005.12.004. View

17.

Varda D, Chandra A, Stern S, Lurie N . Core dimensions of connectivity in public health collaboratives. J Public Health Manag Pract. 2008; 14(5):E1-7. DOI: 10.1097/01.PHH.0000333889.60517.46. View

18.

Madden E, Christian B, Lagisetty P, Ray B, Sulzer S . Treatment provider perceptions of take-home methadone regulation before and during COVID-19. Drug Alcohol Depend. 2021; 228:109100. PMC: 8459541. DOI: 10.1016/j.drugalcdep.2021.109100. View

19.

Pitt A, Humphreys K, Brandeau M . Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic. Am J Public Health. 2018; 108(10):1394-1400. PMC: 6137764. DOI: 10.2105/AJPH.2018.304590. View

20.

Levander X, Pytell J, Stoller K, Korthuis P, Chander G . COVID-19-related policy changes for methadone take-home dosing: A multistate survey of opioid treatment program leadership. Subst Abus. 2021; 43(1):633-639. PMC: 8810732. DOI: 10.1080/08897077.2021.1986768. View