Table 1.

HEALing Communities Study primary and secondary outcome measures for hypothesis testing.

Hypothesis	Outcome measure name, description, and data source
H1	Opioid overdose deaths
	Number of opioid overdose deaths among HCS residents during the evaluation period as measured by deaths with an underlying cause-of-death being drug overdose (i.e. an underlying cause-of-death ICD-10 code in the range X40-X44, X60-X64, X85, Y10-Y14) where opioids, alone or in combination with other drugs (i.e. a multiple cause-of-death ICD-10 code in the range T40.0-T40.4, or T40.6), were determined to be contributing to the drug overdose death.
	Data source: Drug overdose deaths are captured by death certificate records; additional medicolegal death investigation records can be used (per established protocol) to determine opioid involvement when specific drugs contributing to the overdose deaths are not listed on the death certificate.
H2	Naloxone distribution
	Number of naloxone units distributed in an HCS community during the evaluation period as measured by the sum of (1) the naloxone units distributed to community residents by overdose education and naloxone distribution programs with support from state and federal funding, including dedicated HCS funding, and (2) the naloxone units dispensed by retail pharmacies located within HCS communities.
	Data source: Data are captured from state administrative records and supplemented by study records to include naloxone funded through HCS, as well as IQVIA Xponent® database.
H3	Individuals on medication for opioid use disorder (MOUD)
	Number of HCS residents receiving buprenorphine products approved by the Food and Drug Administration for treatment of OUD as measured by the number of unique individuals residing in an HCS community who had at least one dispensed prescription for these products during the evaluation period.
	Data source: State prescription drug monitoring program data.
H4	Measure for incidence of high-risk opioid prescribing
	Number of HCS residents with new incidents of high-risk opioid prescribing during the evaluation period as measured by the number of residents in an HCS community who met at least one of the following four criteria for a new high-risk opioid prescribing episode after a washout period of at least 45 days: (1) incident opioid prescribing episode greater than 30 days duration (continuous opioid receipt with no more than a 7-day gap); (2) starting an incident opioid prescribing episode with extended-release or long-acting opioid formulation; (3) incident high-dose opioid prescribing, defined as ≥90 mg morphine equivalent dose over 3 calendar months; or (4) incident overlapping opioid and benzodiazepine prescriptions greater than 30 days over 3 calendar months.
	Data source: State prescription drug monitoring program data.