Indianapolis Project Cuts Black Overdose Deaths by 45 Percent Through Community-Driven Approach

When Charlotte Crabtree first started calling Indianapolis residents in 2022, she was met with suspicion. As director of community outreach at Overdose Lifeline, Crabtree cold-called people in predominantly Black neighborhoods to talk about opioid overdose prevention—a hard sell in communities where government initiatives and health interventions often arrived with strings attached or disappeared without follow-through.

Three years later, Crabtree doesn't need to make those calls anymore. People call her.

"The 45 percent is unprecedented," Crabtree said of the drop in overdose deaths among Black residents in targeted Indianapolis zip codes. "We have solidified our image and our presence in the community."

The MACRO-B project—Multi-Sector And Multi-Level Community-Driven Approaches to Remove Structural Racism and Overdose Deaths in Black Indianapolis Communities—focused on four zip codes in downtown and Northeast Indianapolis where opioid overdose deaths among Black residents had climbed alongside a 700 percent increase in fentanyl-related deaths citywide between 2016 and 2021. Funded by the U.S. Department of Health and Human Services Minority Health Office in 2022, the initiative set out to reduce overdose deaths by 25 percent over three years. It surpassed that goal within a year and ultimately achieved a 45 percent reduction in mortality within two years.

Dong-Chul Seo, the MACRO-B lead and an Indiana University Bloomington professor, credits the success to something most public health programs struggle to secure: trust.

The Trust Problem

Drug overdoses are the third leading cause of death for 18- to 24-year-olds in Indiana as of February 2026, according to the state Department of Public Health. But for Black communities, the opioid crisis has carried a different weight—layered on top of decades of race-based discrimination, over-policing, and medical mistrust rooted in histories of exploitation and neglect.

A 2025 MACRO-B priority problems assessment identified deep-rooted stigmas around overdoses and drug use within Black communities, compounded by distrust of government policies and public health initiatives. When opioid overdoses surged nationwide in the late 2010s, Black Americans were simultaneously more likely to be criminalized for drug use and less likely to receive access to life-saving medications like buprenorphine.

Seo understood that traditional top-down public health interventions wouldn't work. MACRO-B needed representatives who looked like the people they were trying to reach, who spoke the same cultural language, and—most importantly—who had lived experience with substance use disorder.

"Having people who have the same cultural background, especially with the lived experience of drug users, we were able to frame the message appropriately to reach out to those who are in need of such services," Seo said. "It was also very helpful to reach out to those Black people with lived experiences by having representatives from their communities on board."

The coalition—MACRO-B's "crown jewel," according to Crabtree—brought together about two dozen members who met monthly: first responders, police, health officials, politicians, overdose survivors, and community leaders. The meetings were deliberately inclusive.

"These are white people and Black people, and everyone is welcome," Crabtree said. "Our community is strong. There are people that care. There are people that are out here looking out for each other to make sure that this substance use disorder problem is minimized, that we can save our children from this vicious cycle."

Naloxone, Test Strips, and Legislative Wins

MACRO-B distributed more than 100,000 naloxone doses—the overdose-reversing medication commonly known as Narcan—into the targeted zip codes over three years, along with more than 50,000 fentanyl test strips and 30,000 xylazine test strips. These tools addressed the most immediate threats: fentanyl-contaminated drugs and xylazine (a veterinary sedative increasingly found in street opioids that complicates overdose response).

But distribution alone wasn't enough. The coalition worked to change policy. In 2025, MACRO-B members helped pass Indiana House Bill 1167, which legalized possession and distribution of drug-checking equipment like fentanyl test strips. Before the bill passed, carrying a test strip in Indiana could result in criminal charges for drug paraphernalia.

"Before the passage, possession and distribution of fentanyl test strips was illegal," Seo said. "The availability of drug-checking equipment is essential to reducing those deaths."

Clarie Wright, overdose prevention and community engagement manager at Overdose Lifeline, said MACRO-B's education efforts were tailored to be culturally sensitive. Training sessions focused on proper naloxone administration, destigmatizing substance use disorder, and explaining the neuroscience of addiction—information many participants had never received.

"Most importantly, it focuses on the Black community, and the public health crisis, and ways that we can decrease the overdose death rates," Wright said.

MACRO-B also raised awareness about Indiana's Good Samaritan Law, which protects people who call 911 during an overdose from prosecution for drug possession. The law made naloxone available without a prescription statewide, but many community members didn't know it existed.

Though MACRO-B targeted Black residents, the program's impact rippled outward. Overall overdose deaths in Marion County (which includes Indianapolis) decreased by 18 percent during the same period.

"It's a community problem," Wright said. "As we aim to reach the Black community, we're also reaching all communities."

What the Data Didn't Capture

A 2025 American College Health Association survey found that 4 percent of college students reported using cocaine at least once and 8 percent used hallucinogens, but only 2.3 percent said they were actively in recovery—suggesting that many young people with substance use issues navigate the crisis alone, without formal support systems. MACRO-B recognized that reaching people before they hit bottom required meeting them in their own neighborhoods, not waiting for them to seek help at clinics or emergency rooms.

Crabtree recalled the early resistance she faced. People didn't trust outsiders showing up with promises of help. When she mentioned overdose prevention, doors closed. The opioid epidemic had been declared a public health emergency years earlier, but many Black communities had seen little benefit from that designation—only more policing, more incarceration, and more funerals.

What changed wasn't the message. It was the messenger.

When community health workers who grew up in those neighborhoods, who knew what it felt like to lose friends to overdoses, who understood the specific pressures of navigating substance use in a community where calling 911 could mean inviting police into your home—when those people started showing up, doors opened.

"There are people that are out here looking out for each other," Crabtree said.

Scaling Success, Confronting Limits

After MACRO-B's success in Marion County, the State of Indiana awarded funding to expand the model to Allen County, Lake County, Vanderburgh County, St. Joseph/Elkhart County, and Delaware County. Lake County and Vanderburgh are off to a strong start, training over 100 individuals with a focus on the Black community. The remaining counties are in setup phases.

But replication isn't guaranteed. MACRO-B succeeded because it invested in relationships, not just interventions. The coalition meetings, the culturally tailored education, the trust-building—those things take time and resources. Scaling a model built on trust requires more than funding; it requires sustained commitment from institutions that have historically failed the communities they now claim to serve.

The 45 percent reduction in overdose deaths among Black residents in MACRO-B's targeted zip codes is unprecedented, but it's also fragile. Fentanyl hasn't disappeared from Indianapolis streets. Economic instability, housing insecurity, and lack of access to long-term treatment remain barriers. And while naloxone can reverse an overdose, it doesn't address the underlying conditions that drive people toward substance use in the first place: trauma, poverty, systemic racism, lack of opportunity.

Saanvi Arora, a UC Berkeley student who helped draft California's AB 602 (which requires colleges to offer rehabilitation before disciplining students who overdose), testified that young people would "much rather just see what happens and hope that they're OK. Leave it up to fate honestly, than call or go downstairs and bring an RA or bring a trusted campus official." That calculation—whether asking for help is worth the risk—is one that people in MACRO-B's target communities have been making for years.

MACRO-B didn't eliminate that calculus, but it shifted the odds. When people know that calling for help won't result in arrest, that naloxone will be available, that the person showing up actually cares whether they live or die—they're more likely to make the call.

What Comes Next

Charlotte Crabtree doesn't have to cold-call anymore. People reach out when they need naloxone, when a friend overdoses, when they're ready to try treatment. That shift—from suspicion to trust—might be MACRO-B's most important outcome, even more than the 45 percent reduction in deaths.

Because trust is what allows public health interventions to work in the first place. Without it, naloxone sits unused in cupboards. Fentanyl test strips stay in packaging. People die alone because they're afraid of what will happen if they call for help.

Whether MACRO-B's model can sustain its success as it scales to other Indiana counties will depend on whether those communities receive the same investment in relationship-building, cultural sensitivity, and lived-experience leadership that made the Indianapolis project work. Funding can distribute naloxone. Only trust can make sure it gets used.

For now, in four Indianapolis zip codes, more people are surviving overdoses than three years ago. More people are carrying naloxone. More people know that if they call for help, someone will answer.

"We have solidified our image and our presence in the community," Crabtree said.

In a crisis where so many interventions fail, where so many promises go unmet, presence matters. Showing up matters. And in Indianapolis, it's saving lives.