The Multi-Sector and Multi-Level Community-Driven Approaches to Remove Structural Racism and Overdose Deaths in Black Indianapolis Communities (MACRO-B).
The Why:
In Marion County, Indiana, opioid overdose deaths have increased significantly since 2020, and as of 2025, it is the county with the highest drug overdose death rate in the state. While opioid overdose deaths affect all residents, data show that Black residents in several zip codes in Marion County were experiencing alarming rates of opioid overdose deaths, nearly six times the national average. At the same time, these communities also showed disproportionately low requests for naloxone, the life-saving medication used to reverse overdose. This raised questions such as: why were Black residents in these neighborhoods dying at higher rates than other populations? And, what barriers were preventing the distribution and use of overdose prevention resources?
The What and The How:
To answer these questions, in 2022, the Indiana University School of Public Health Bloomington launched The Multi-Sector and Multi-Level Community-Driven Approaches to Remove Structural Racism and Overdose Deaths in Black Indianapolis Communities (MACRO-B). MACRO-B blended legal epidemiology, involving policy and environmental scans, data analysis, and evaluation, with deep community partnership to tackle this observed difference in rates. Throughout, they upheld community power-building principles by:
- Acting Collectively: MACRO-B established a coalition that included overdose survivors, family members, community-based organizations, Emergency Medical Services, law enforcement, and policymakers. The coalition met monthly and guided every stage of the project to ensure research was grounded in community needs. For example, the coalition members identified neighborhoods with limited naloxone access and co-designed the placement of publicly accessible naloxone boxes, ensuring locations were trusted, visible, and safe for residents.
- Shifting Narratives: By combining data on overdose disparities with testimonies and stories from Black residents, the project reframed overdose prevention from being an individual responsibility to a broader public health challenge. As one community partner noted, “People are not willing to call 911 for fear of harassment from law enforcement and the stigma of substance use disorder” indicating that this crisis was rooted in long standing policy and access barriers. Education workshops, storytelling events, and neighborhood conversations aimed to reduce stigma and normalize harm reduction practices.
- Enhancing authentic engagement: Community members and leaders most affected by overdose were at the center of decision-making. Their lived experiences shaped naloxone distribution strategies, targeted outreach campaigns, and informed training sessions for the program. Focus groups participants shared the need for people to be able to access naloxone outside of traditional healthcare or government facilities, and in response, naloxone was distributed through trusted community spaces such as barber shops, community centers, and faith-based institutions.
- Cultivating Ongoing Relationships: These partnerships extended beyond the project’s research phase to maintain collaboration between residents, researchers, and public agencies. A key part of trust-building between partners involved hosting overdose response trainings led by community members themselves, positioning residents as also leaders and teachers within the initiative.
Read more about this initiative here: https://macro-b.org/
The project described here was supported by the Office of Minority Health (OMH) of the Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, OMH/OASH/HHS, or the U.S. Government.
