The MACRO-B project based in Indianapolis achieved a remarkable 45% drop in overdose deaths among Black residents in just two years. The results offer a roadmap for how cities across Indiana can fight back against a crisis that has devastated families for more than a decade.
We’ve found that Indianapolis is home to a wide range of treatment programs, from inpatient facilities to secluded sober homes that allow residents to recover with privacy. The MACRO-B joins their ranks as a unique approach that situates opioid recovery within its underlying social roots.
Origins in Indianapolis
The Multi-Sector and Multi-Level Community-Driven Approaches to Remove Structural Racism and Overdose Deaths in Black Indianapolis Communities project, officially began operations in 2022. Armed with funding from the U.S. Department of Health and Human Services’ Minority Health Office and led by Indiana University Bloomington professor Dong-Chul Seo, MACRO-B focused on four zip codes in downtown and northeast Indianapolis.
Seo first set out to reduce overdose deaths by 25% over three years among African Americans in his selected zip codes. His team surpassed the goal within the first year and progress continued, achieving a 45% drop in mortalities within two years.
Charlotte Crabtree is director of community outreach at Overdose Lifeline and one of MACRO-B’s lead outreach workers. She pointed how a coalition of community members bonded together over shared experiences and backgrounds to lend each other formal and informal peer support. Indeed, the stats speak for themselves. “The 45% is unprecedented,” Crabtree noted.
Why Fentanyl Addiction Hit Indianapolis So Hard
MACRO-B’s achievement is even more remarkable given the severity of the opioid crisis. From 2016 to 2021, fentanyl overdose deaths in Indiana’s capital alone increased nearly 700%.
Fentanyl is a synthetic opioid roughly 50x more potent than heroin. The drug is often present in a wide range of street drugs, often without the user’s knowledge. Since fentanyl is so potent, the line between a typical dose and a fatal overdose is dangerously thin.
The African American population has especially been hit hard. Seo reported that many African Americans face deep-rooted stigmas surrounding overdoses and drugs. Race-based discrimination has also sewed distrust around government policies and initiatives.
What Made the Project Work
MACRO-B overcame these obstacles by centering the project in the community itself. The project’s success rested on three pillars: community trust, harm reduction tools, and education.
On the harm reduction side, the project distributed more than 100,000 naloxone doses, along with 80,000 fentanyl and xylazine test strips. Naloxone, popularly known as Narcan, is a medication that can reverse an opioid overdose within minutes when administered nasally or by injection.
Fentanyl and xylazine test strips allow people to check whether a substance contains these particularly dangerous compounds before using. The test strips were so central to the project that coalition members helped pass Indiana House Bill 1167 in 2025 to legalize and promote the detection of drugs or controlled substances.
Community trust was built through monthly coalition meetings involving Indianapolis first responders, police, health officials, politicians, overdose survivors and other professionals who deal with the effects of the opioid epidemic. Training focused on naloxone administration, reducing stigma around substance use disorders, and the science of addiction to reduce underlying stress and improve emotional health, all framed with cultural sensitivity to the Black community.
The Impact Spread Beyond the Target Area
While the project focused on reducing opioid addiction deaths in Black communities, the benefits reached other ethnic groups. Overall overdoses decreased by 18% across the project area, not just among Black residents.
After success in Marion County, Indiana officials awarded funding so MACRO-B can expand to additional surrounding counties. That means communities in Gary, Fort Wayne, Evansville, South Bend, and Muncie will soon have access to the same resources that transformed outcomes in Indianapolis.
Finding Addiction Treatment in Indianapolis and Indiana
The MACRO-B results show that recovery is possible, and that community-based addiction treatment options make a real difference. If you or someone you love is struggling with opioid addiction or showing signs of addiction such as changes in behavior, withdrawal from family, or inability to stop using despite wanting to, help is available now.
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