Long-Term Effects of Increasing Buprenorphine Treatment Seeking, Duration, and Capacity on Opioid Overdose Fatalities: A Model-based Analysis

Abstract

Objectives: Because buprenorphine treatment of opioid use disorder reduces opioid overdose deaths (OODs), expanding access to care is an important policy and clinical care goal. Policymakers must choose within capacity limitations whether to expand the number of people with opioid use disorder who are treated or extend duration for existing patients. This inherent tradeoff could be made less acute with expanded buprenorphine treatment capacity. Methods: To inform such decisions, we used a validated simulation model to project the effects of increasing buprenorphine treatmentseeking, average episode duration, and capacity (patients per provider) on OODs in the United States from 2023 to 2033, varying the start time to assess the effects of implementation delays. Results: Results show that increasing treatment duration alone could cost lives in the short term by reducing capacity for new admissions yet save more lives in the long term than accomplished by only increasing treatment seeking. Increasing provider capacity had negligible effects. The most effective 2-policy combination was increasing capacity and duration simultaneously, which would reduce OODs up to 18.6% over a decade. By 2033, the greatest reduction in OODs (≥20%) was achieved when capacity was doubled and average duration reached 2 years, but only if the policy changes started in 2023. Delaying even a year diminishes the benefits. Treatment-seeking increases were equally beneficial whether they began in 2023 or 2025 but of only marginal benefit beyond what capacity and duration achieved.Conclusions: If policymakers only target 2 policies to reduce OODs, they should be to increase capacity and duration, enacted quickly and aggressively.

Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis

“…Buprenorphine-waivered providers are estimated using a combination of peer-reviewed literature, governmental reports, and the Substance Abuse and Mental Health Services Administration's (SAMHSA) year-end website statistics (Table 2 ). See Stringfellow et al ( 59 ) for buprenorphine treatment analysis in SOURCE.…”

Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity Among Individuals Who Use Opioids

“…We reviewed the literature for estimates of the association of each intervention with duration, capacity, and initiation and the cost of each intervention (eMethods 2 and eTables 1-6 in Supplement 1). Based on previous analyses, the model assumed that lifting the X waiver was not associated with a change in initiation, capacity, or duration . We included the type of effect for each intervention (duration, capacity, and initiation) based on measured effects in the literature and excluded effects that we could not quantify.…”

“…Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity in the total number of people with OUD, 18,19 buprenorphine treatment demand will decrease 28 and no longer be capacity constrained as of 2024 (eFigure 2 in Supplement 1).…”

“…Until 2021, physicians and other eligible health care clinicians in the US were required to complete at least 8 hours of training to obtain a waiver allowing them to prescribe buprenorphine to 30 patients or fewer . This requirement was lifted in 2021 to allow prescribing to up to 30 patients per clinician without a waiver or additional training by notifying the federal government . The waiver requirement was lifted in December 2022, allowing clinicians to prescribe buprenorphine with a standard US Drug Enforcement Administration prescribing registration number .…”

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

“…While wide implementation of multiple evidence-based interventions is needed to reduce OODs, most studies support the implementation of interventions only for a limited period of time . For example, the HEALing Communities Study supports the implementation of interventions for approximately 2 years.…”