Estimated Reductions in Opioid Overdose Deaths With Sustainment of Public Health Interventions in 4 US States

Abstract

ImportanceIn 2021, more than 80 000 US residents died from an opioid overdose. Public health intervention initiatives, such as the Helping to End Addiction Long-term (HEALing) Communities Study (HCS), are being launched with the goal of reducing opioid-related overdose deaths (OODs).ObjectiveTo estimate the change in the projected number of OODs under different scenarios of the duration of sustainment of interventions, compared with the status quo.Design, Setting, and ParticipantsThis decision analytical model simulated the opioid epidemic in the 4 states participating in the HCS (ie, Kentucky, Massachusetts, New York, and Ohio) from 2020 to 2026. Participants were a simulated population transitioning from opioid misuse to opioid use disorder (OUD), overdose, treatment, and relapse. The model was calibrated using 2015 to 2020 data from the National Survey on Drug Use and Health, the US Centers for Disease Control and Prevention, and other sources for each state. The model accounts for reduced initiation of medications for OUD (MOUDs) and increased OODs during the COVID-19 pandemic.ExposureIncreasing MOUD initiation by 2- or 5-fold, improving MOUD retention to the rates achieved in clinical trial settings, increasing naloxone distribution efforts, and furthering safe opioid prescribing. An initial 2-year duration of interventions was simulated, with potential sustainment for up to 3 additional years.Main Outcomes and MeasuresProjected reduction in number of OODs under different combinations and durations of sustainment of interventions.ResultsCompared with the status quo, the estimated annual reduction in OODs at the end of the second year of interventions was 13% to 17% in Kentucky, 17% to 27% in Massachusetts, 15% to 22% in New York, and 15% to 22% in Ohio. Sustaining all interventions for an additional 3 years was estimated to reduce the annual number of OODs at the end of the fifth year by 18% to 27% in Kentucky, 28% to 46% in Massachusetts, 22% to 34% in New York, and 25% to 41% in Ohio. The longer the interventions were sustained, the better the outcomes; however, these positive gains would be washed out if interventions were not sustained.Conclusions and RelevanceIn this decision analytical model study of the opioid epidemic in 4 US states, sustained implementation of interventions, including increased delivery of MOUDs and naloxone supply, was found to be needed to reduce OODs and prevent deaths from increasing again.

Public Health Interventions and Overdose-Related Outcomes Among Persons With Opioid Use Disorder

“…Evidence from previous models highlights the importance of combining interventions to achieve reductions in opioid overdose-related outcomes. 12 , 15 As in previous studies, we simulated hypothetical improvements 13 , 17 directly in the rates of transitions in the OUD disease model (eg, increase in initiation of treatment with MOUD, reduction in recurrence of OUD [ie, discontinuation of MOUD combined with past 90-day opioid use], and reduction of nonfatal and fatal opioid overdose rates) resulting from combinations of unspecified public health interventions. We chose this approach because limited data exist to precisely estimate the impact of evidence-based interventions when scaled at a national level.…”

“…Evidence from previous models highlights the importance of combining interventions to achieve reductions in opioid overdose-related outcomes. 12,15 As in previous studies, we simulated hypothetical improvements 13,17…”

“…Given the complexity of OUD and the epidemic of opioid-involved overdose deaths, systems models have utility as a tool to understand the potential impact of and opportunities for evidence-based interventions to prevent overdose . Several systems models examining opioid use, misuse, OUD, and resulting overdose have been recently developed . While these models differ in scope, they highlight the need to combine interventions to achieve considerable reductions in opioid-involved overdose deaths.…”

“… 10 Several systems models examining opioid use, misuse, OUD, and resulting overdose have been recently developed. 11 , 12 , 13 , 14 , 15 , 16 , 17 While these models differ in scope, they highlight the need to combine interventions to achieve considerable reductions in opioid-involved overdose deaths. However, only a few state-specific models exist that focus on the population with OUD, 12 and previous models incorporate limited information on MOUD treatment duration.…”

Naltrexone Compared With Buprenorphine or Methadone in Pregnancy

“…3 Medication for opioid use disorder (MOUD) is the gold standard for treatment of OUD, and its use reduces the risk of opioid-related harms including fatal overdose. 4,5 Three medications are approved by the U.S. Food and Drug Administration as MOUD: methadone, buprenorphine, and naltrexone. For pregnant individuals with OUD, the American College of Obstetricians and Gynecologists recommends the use of opioid agonist pharmacotherapy (methadone or buprenorphine) over medically supervised withdrawal, which is associated with higher return to use and subsequent worse outcomes.…”