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. 2025 Aug:142:104851.
doi: 10.1016/j.drugpo.2025.104851. Epub 2025 May 22.

Identifying and responding to policy-related barriers, facilitators, and misunderstandings in the HEALing communities study: A community-driven approach

Anita Silwal  1 , Robert Bohler  2 , Timothy Hunt  3 , Ramona G Olvera  4 , Michelle R Lofwall  5 , Christopher D Cook  6 , Katherine R Marks  7 , Carly Bridden  8 , Patricia R Freeman  9 , Monica Nouvong  8 , Laura C Fanucchi  10 , Nabila El-Bassel  3 , Lisa A Frazier  11 , Sharon L Walsh  5 , Jeffery C Talbert  12
Affiliations

Identifying and responding to policy-related barriers, facilitators, and misunderstandings in the HEALing communities study: A community-driven approach

Anita Silwal et al. Int J Drug Policy. 2025 Aug.

Abstract

Introduction: The HEALing (Helping to End Addiction Long-Term®) Communities Study (HCS) aimed to reduce opioid-involved overdose deaths across four states (Kentucky, Massachusetts, New York, and Ohio) via community-engaged implementation of three evidence-based practices (EBPs): (1) opioid overdose education and naloxone distribution, (2) medication for opioid use disorder expansion/linkage/retention, and (3) safer opioid prescribing and dispensing practices. A policy workgroup (PWG) was convened and developed a procedure to identify and address policies potentially impacting EBP implementation.

Methods: A five-step method was developed to identify, track, and respond to relevant policies at three of the research sites (Kentucky, Massachusetts, and New York) in collaboration with community partners and stakeholders. Policies possibly impacting EBPs were reported, reviewed, and documented, including any actions taken to address the policy issue. Policies were discussed with local, state, and federal level stakeholders in attempts to resolve barriers, clarify misunderstandings, and disseminate facilitators.

Results: A total of 87 (Kentucky = 37; Massachusetts = 19; New York = 31) policies were identified and addressed; 42 were identified as barriers, 24 as facilitators, and 21 as misunderstandings. PWG efforts resolved over 73 % (n = 31) of policy barriers, clarified 90 % (n = 19) of policy misunderstandings, and disseminated 100 % (n = 24) of policy facilitators.

Conclusions: A community-driven approach in policy surveillance identified, addressed, and disseminated several different types of policy issues that could impact implementation of EBPs for opioid-involved overdose prevention. Many policy barriers persisted during the HCS study, which may have adversely affected study outcomes.

Keywords: HEALing communities study; Medication for opioid use disorder; Opioid education and naloxone distribution; Opioid use disorder; Policy.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michelle R. Lofwall reports research consulting in the last three years for Braeburn Pharmaceuticals, Journey Colab, and Berkshire Biomedical. Sharon Walsh reports scientific consulting in the last three years for Braeburn Pharmaceuticals, Titan, Cerevel Therapeutics, Astra Zeneca, Kinoxis, Lundbeck, Opiant, Pocket Naloxone, and Reacx. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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