Overdose deaths among Black residents in Indianapolis decreased with IU project

Charlotte Crabtree said her work with the MACRO-B project began with cold-calling Indianapolis residents. As director of community outreach at Overdose Lifeline, she tried to get her foot in the door to share more about free and potentially life-saving services.  
 
In 2022, Crabtree and others on the MACRO-B project set out to reduce opioid overdose deaths in Black Indianapolis communities. Those community members, along with education and harm reduction tools, shaped the project's work over the next three years.  
 
Crabtree said overdose deaths among Black people in target areas decreased by 45 percent by the end of the project.  
 
Now, Crabtree said, people call her. 
 
"The 45 percent is unprecedented," Crabtree said. "We have solidified our image and our presence in the community." 
 
The MACRO-B project focused on four zip codes in downtown and Northeast Indianapolis. After its success, the program is expanding.  
 
"We are so happy and excited about the outcomes of this project," said Dong-Chul Seo, the MACRO-B lead, and an Indiana University Bloomington professor.  
 
MACRO-B stands for Multi-Sector And Multi-Level Community-Driven Approaches to Remove Structural Racism and Overdose Deaths in Black Indianapolis Communities.  
 
Seo set out to reduce overdose deaths by 25 percent over three years among Black people in targeted zip codes, Seo said. The goal was surpassed within one year and progress continued. 
 
"We already achieved a 45 percent decrease in mortalities within two years of the project," Seo said.  
 
The U.S. Department of Health of Human Services Minority Health Office awarded Seo funding for MACRO-B in 2022. At the time, overdoses spiked across the U.S. Seo said fentanyl overdose deaths in Indianapolis increased by about 700 percent from 2016 to 2021.  
 
There were a number of issues that Seo and other project members set out to address over the three-year project. 
 
Black people have deep-rooted stigmas around overdoses and drug use, Seo said. On top of that, race-based discrimination has caused more distrust around government policies and initiatives similar to MACRO-B.  
 
But Seo said community connections made the project successful.  
 
"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." 
 
In addition to interviewing locals, creating town halls and hosting focus groups, about two dozen coalition members met each month.  
 
"The coalition is just our crown jewel," Crabtree said. "These are white people and Black people, and everyone is welcome." 
 
The coalition includes first responders, police, health officials, politicians, overdose survivors and other professionals that deal with the effects of the opioid epidemic in Indianapolis.  
 
"Our community is strong," Crabtree said. "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." 
 
Seo said the project's success is also linked to the distribution of tens of thousands of naloxone doses, sometimes known as Narcan. The medicine can reverse opioid overdoses.  
 
"We distributed more than 100,000 naloxone doses to the target population area, along with more than 50,000 fentanyl test strips and more than 30,000 xylazine test strips," Seo said.  
 
Those test strips were important to the project's policy goals. Seo said coalition members helped pass Indiana House Bill 1167 in 2025 to allow paraphernalia that detects the presence of drugs or controlled substances.  
 
"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." 
 
Education is another key component of MACRO-B, and Crabtree said the information was tweaked to be culturally sensitive to the Black community.  
 
Training focused on proper naloxone administration, stigma around substance use disorders and the science of addiction, said Clarie Wright, the overdose prevention and community engagement manager at Overdose Lifeline.  
 
"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. 
 
The project also worked to spread awareness about the state's Good Samaritan Law, which made naloxone available without a prescription.  
 
Though the project focused on Black residents, overall overdoses decreased by 18 percent, Wright said. 
 
"It's a community problem," Wright said. "As we aim to reach the Black community, we're also reaching all communities." 
 
After success in Marion County, the State of Indiana awarded the project funding to expand to Allen County, Lake County, Vanderburgh County, St. Joseph/Elkhart County and Delaware County. 
 
"Lake County and Vanderburgh are off to a great start," Wright said. "They've already trained over 100 individuals in their communities with a focus on the Black community. And then the other remaining counties, we're getting them set up and prepared."