Bright Spot Communities: Understanding Community-Level Protective Factors to Improve Opioid Outcomes in Virginia

Context: There were 50,000 U.S. opioid overdose deaths in 2019. Research on opioids often focuses on communities with poor opioid-related outcomes, while studies on community-level protective factors are limited. Objective: To identify "Bright spot" communities in Virginia with lower opioid mortality than predicted based on risk factors. Dataset: Virginia All Payer Claims Database (APCD), Virginia Department of Health (VDH) statewide medical examiner registry, and American Community Survey (ACS). Time period: 2019. Population: APCD includes VA residents with medical claims through commercial, Medicaid, and Medicare coverage. VDH data includes fatal drug overdoses. ACS surveys all VA residents. Study Design and Analysis: Ecologic study. We created a multivariate model to predict opioid mortality at the community level based on socioecological, workforce, and healthcare delivery data. A generalized linear mixed model was used to calculate the magnitude of difference between actual and predicted opioid mortality per 100,000 across all census tracks in VA and to identify communities with lower mortality than predicted. A qualitative analysis was performed, using thematic coding, to review key factors associated with Bright Spots. Outcome Measures: Primary outcome: fatal opioid overdoses. Secondary outcomes: emergency room visits for opioid-related diagnoses, outpatient diagnoses for opioid use disorder, opioid prescription rate, and buprenorphine prescription rate. Results: Opioid mortality is associated with higher community percent poverty (r=.38, p