Jagpreet Chhatwal, PhD, and Mert Sahinkoc, PhD, of the Center for Health Technology Assessment (CHTA) within Mass General Brigham, are the co-lead authors of a paper published in The Lancet Regional Health - Americas, " Cost-effectiveness of community-based interventions for reducing opioid overdose and non-overdose deaths: simulation modeling of HEALing Communities Study ." Amy Knudsen, PhD, also of the CHTA, is a co-senior author, along with Carolina Barbosa, PhD, of RTI International.
Q: What challenges or unmet needs make this study important?
The opioid overdose crisis remains a public health emergency in the United States. While treatments that use medications for opioid use disorder (MOUD) such as buprenorphine, methadone and naloxone (the overdose-reversing medication) are lifesaving, communities have lacked clear evidence on which combinations of proven opioid interventions deliver the best health outcomes for the money invested.
Q: What central question(s) were you investigating?
We wanted to answer a straightforward but critical question for communities on the front lines of the opioid crisis: if you dedicate resources to getting more people into addiction treatment, keeping them in treatment longer and making naloxone more widely available, how do the benefits in lives saved compare to the investment required? We examined these strategies individually and in combination across 26 diverse communities in Massachusetts, New York and Ohio to understand what works best and where.
Q: What methods or approach did you use?
We built on data from the HEALing Communities Study (HCS), one of the largest and most ambitious research efforts ever undertaken to address the opioid crisis. The HCS was conducted across 67 communities in four states and collected detailed, multi-year, community-level data on how evidence-based practices are actually being used on the ground—an unparalleled resource for understanding what is happening in the real world.
Leveraging these data, we calibrated a validated computer simulation model—the Opioid Policy Simulation Model (OPSiM)—separately for 26 highly impacted communities (8 rural, 18 urban) in Massachusetts, New York and Ohio. The model tracked individuals with opioid use disorder from 2025 to 2030 under six different scenarios: maintaining current practice levels (the status quo), improving naloxone distribution alone, improving treatment initiation alone, improving treatment retention alone, combining better initiation and retention, and combining all three improvements together. We then compared the costs and health benefits of each strategy from both a healthcare and a broader societal perspective.
Q: What did you find?
The results were striking. A combined strategy of improving treatment initiation, treatment retention and naloxone distribution could reduce opioid overdose deaths by 15-40% and non-overdose opioid-related deaths by 7-24% across the 26 communities. This approach produced the largest gains in quality-adjusted life years (a measure of added years of life in good health) ranging from 1,006-38,292.
From a healthcare perspective, improving treatment initiation and retention was cost-effective in every single community we studied, costing between $12,000-91,000 for every quality-adjusted life year gained. These costs fall well below the $100,000 threshold commonly used in the United States for determining whether a health intervention provides reasonable value relative to other healthcare spending.
From a societal perspective, the picture was even more compelling: every strategy except maintaining the status quo was cost-saving, generating net savings of $121 million to $4.74 billion over six years when accounting for reduced productivity losses and criminal legal costs.
To put this in concrete terms, in one community, healthcare spending rose by $416 million to fund expanded treatment, but total societal costs fell by $2.39 billion—a return of nearly six dollars for every dollar invested.
Perhaps most importantly, we uncovered a finding that deserves far greater attention: non-overdose opioid-related deaths (roughly 240-3,000 per 100,000) substantially outnumbered overdose deaths (roughly 40-470 per 100,000) in nearly every community. This tells us that the true death toll of the opioid crisis is much larger than the overdose numbers alone suggest.
Q: What are the real-world implications, particularly for patients?
Expanding access to proven treatments and naloxone does not just save lives—it makes strong economic sense. Every community we studied benefited, regardless of whether it was rural or urban or how severe the local crisis was.
For policymakers and community leaders, this study provides a practical, evidence-based framework for deciding where to direct limited resources. Rather than a one-size-fits-all national approach, our community-level analysis shows which strategies deliver the greatest value in specific local contexts.
The findings also challenge us to think beyond overdose deaths. The substantially higher burden of non-overdose opioid-related mortality highlights the need for comprehensive strategies that address the full spectrum of harms associated with opioid use disorder. By investing in treatment and harm reduction, we can reduce not just overdoses, but the many other ways this crisis is cutting lives short.
Authorship: Additional study authors include Qiushi Chen, William Dowd, Jade Xiao, Gary A. Zarkin, Arnie Aldridge, Joshua A. Barocas, Magdalena Cerdá, Naleef Fareed, Lisa A. Frazier, Ayaz Hyder, Katherine M. Keyes, Charles E. Knott, Marc LaRochelle, Benjamin P. Linas, Emmanuel Oga, Sara M. Roberts, Jeffrey H. Samet, Bruce R. Schackman, Eric E. Seiber, Laura E. Starbird, Jennifer Villani, and Carolina Barbosa.
Paper cited: Chhatwal, J., et al. "Cost-effectiveness of community-based interventions for reducing opioid overdose and non-overdose deaths: simulation modeling of HEALing Communities Study." The Lancet Regional Health - Americas. DOI: https://doi.org/10.1016/j.lana.2026.101480
Funding: This research was supported by the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration through the HEAL (Helping to End Addiction Long-term®) Initiative under award numbers (UM1DA049394), (UM1DA049406), (UM1DA049412), (UM1DA049415) and (UM1DA049417).
Disclosures: Cerdá and Keyes have received personal fees for consulting in opioid litigations.
