Projected Estimates of Opioid Mortality After Community-Level Interventions

Abstract

IMPORTANCE The United States is experiencing a crisis of opioid overdose. In response, the US Department of Health and Human Services has defined a goal to reduce overdose mortality by 40% by 2022. OBJECTIVE To identify specific combinations of 3 interventions (initiating more people to medications for opioid use disorder [MOUD], increasing 6-month retention with MOUD, and increasing naloxone distribution) associated with at least a 40% reduction in opioid overdose in simulated populations. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model used a dynamic populationlevel state-transition model to project outcomes over a 2-year horizon. Each intervention scenario was compared with the counterfactual of no intervention in simulated urban and rural communities in Massachusetts. Simulation modeling was used to determine the associations of community-level interventions with opioid overdose rates. The 3 examined interventions were initiation of more people to MOUD, increasing individuals' retention with MOUD, and increasing distribution of naloxone. Data were analyzed from July to November 2020. MAIN OUTCOMES AND MEASURES Reduction in overdose mortality, medication treatment capacity needs, and naloxone needs. RESULTS No single intervention was associated with a 40% reduction in overdose mortality in the simulated communities. Reaching this goal required use of MOUD and naloxone. Achieving a 40% reduction required that 10% to 15% of the estimated OUD population not already receiving MOUD initiate MOUD every month, with 45% to 60%% retention for at least 6 months, and increased naloxone distribution. In all feasible settings and scenarios, attaining a 40% reduction in overdose mortality required that in every month, at least 10% of the population with OUD who were not currently receiving treatment initiate an MOUD. CONCLUSIONS AND RELEVANCE In this modeling study, only communities with increased capacity for treating with MOUD and increased MOUD retention experienced a 40% decrease in overdose mortality. These findings could provide a framework for developing community-level interventions to reduce opioid overdose death.

Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis

“…In our analysis, increased naloxone distribution (which SOURCE assumes goes primarily to people who use opioids) reduced fatal opioid overdoses. This finding is consistent with other models ( 13 – 17 ) and empirical evidence that naloxone saves lives when made widely and freely available to people who use opioids ( 19 ). Our analysis points additionally to the importance of addressing naloxone distribution inefficiencies.…”

“…SOURCE is a compartmental feedback model that simulates the movement of the U.S. opioid-using population through opioid misuse, OUD, and remission; treatment with medications for OUD (MOUD); and nonfatal and fatal opioid overdose. SOURCE builds on other opioidfocused models (13)(14)(15)(16)(17). It endogenously reproduces historical trends from 1999 to 2020 and, where the data support it, includes the operational detail necessary to compare specific mechanisms.…”

Modeling the evolution of the US opioid crisis for national policy development

“…The one published model that incorporates key feedbacks driving the crisis ( 16 ) lacks SOURCE’s level of operational and input detail. A few models examine policy-relevant aspects of the crisis in more detail, like treatment ( 17 ) or fatal overdose prevention ( 18 ), but do not integrate these details into the complexities of the broader opioid crisis. By incorporating these feedbacks and details, SOURCE’s estimates shed new light not only on the historical trajectory of the crisis, but also trends and developments still unfolding, to better inform policy decisions and anticipate unintended consequences.…”

Assessment of Same-Day Naloxone Availability in New Mexico Pharmacies

“…Increased access to naloxone at the state and community level is associated with reduced risk for death from overdose, and, consequently, widespread availability is recommended. [14][15][16][17] Statewide real-time pharmacy availability of naloxone-as patients would experience availability-has not been previously reported. These findings suggest unpredictable same-day availability that may affect experience and care outcomes.…”