Author of Editorial Suggests That Disappointing Results of Largest Implementation Study on Addiction Should Prompt Reflection

The HEALing Communities Study was a $350 million research trial that evaluated best practices for reducing opioid overdose deaths. In a new editorial in Addiction, a researcher at Carnegie Mellon University notes that the study did not lower deaths, increase treatment, or boost the delivery of behavioral health services by statistically significant amounts, although it did reduce stigma appreciably.

“This disappointing result should prompt serious reflection among researchers, practitioners and policy makers working to reduce overdose deaths,” says Jonathan P. Caulkins, professor of operations research and public policy at Carnegie Mellon’s Heinz College, who wrote the editorial.

The HEALing Communities Study was a four-year community-level trial of evidence-based practices for reducing opioid overdose deaths. The largest ever implementation study on addiction, it included 67 communities in four states that were randomly assigned to a treatment group or a control group. Based on the belief that opioid overdose deaths are largely preventable, the study hoped to reduce such deaths by 40% in three years.

The study’s interventions embodied the field’s best wisdom by featuring community engagement, as well as communication campaigns to boost awareness of and demand for evidence-based practices and reduce stigma for people with opioid use disorder and the medications to treat them.

Surprisingly, the reductions in the opioid overdose death rate and the overall overdose death rate were far smaller than expected (8% not 40%). Indeed, they were so small that researchers could not rule out the possibility that they arose from chance fluctuations, according to the standard definition of statistical significance. Those results are difficult to reconcile with prior confidence in the power of these approaches, Caulkins notes, suggesting that researchers, policymakers, and others should consider adjusting their beliefs in light of this new evidence.

Caulkins notes that various arguments have been made for why the study could have failed to demonstrate the expected benefits, even if its approach remains sound, and that some are not particularly persuasive. For example, while it is true that fentanyl spread rapidly during the trial, that spread appeared to affect treatment sites no more than control sites, according to new data Caulkins presents.

Also, although the study began shortly before the start of the COVID-19 pandemic, which likely hampered effectiveness, many evidence-based practices were implemented before the evaluation period began and the interventions had enough time to reduce stigma. However, the problem may have been excessive optimism about the scale of investment needed or the speed with which these interventions could begin to appreciably bend the curve on death rates.

Caulkins also notes two puzzles that merit further research. First, if reducing stigma is the key to improving health outcomes, how did the study find strong reductions in stigma but not in corresponding health harms? Second, if the approaches embodied in the study’s interventions did not appreciably reduce overdose deaths, what else has succeeded in lowering the number of deaths so much since late 2023?

The writing of the editorial was funded in part by the National Science Foundation.

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Summarized from an article in Addiction, "HEALing Communities Study Results, Questions, and Implications," by Caulkins, JP (Carnegie Mellon University). Copyright 2025. All rights reserved.

About Carnegie Mellon University's Heinz College of Information Systems and Public Policy
The Heinz College of Information Systems and Public Policy is home to two internationally recognized schools: the School of Information Systems and Management and the School of Public Policy and Management. Heinz College leads at the intersection of people, policy, and technology, with expertise in analytics, artificial intelligence, arts & entertainment, cybersecurity, health care, and public policy. The college offers top-ranked undergraduate, graduate, and executive education certificates in these areas. Our programs are ranked #1 in Information Systems, #1 in Information and Technology Management, #8 in Public Policy Analysis, and #1 in Cybersecurity by U.S. News & World Report. For more information, visit www.heinz.cmu.edu.