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

Lim, Tse Yang; Stringfellow, Erin; Stafford, Celia; DiGennaro, Catherine; Homer, Jack; Wakeland, Wayne W.; Eggers, Sara; Kazemi, Reza; Glos, Lukas; Ewing, Emily G; Bannister, Calvin B.; Humphreys, Keith; Throckmorton, Douglas C.; Jalali, Mohammad S.

doi:10.1073/pnas.2115714119

Cited by 45 publications

(53 citation statements)

References 31 publications

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“…The study results rely on the projections of SOURCE, which predicts changes in opioid use patterns and treatment demand . If the national demand for buprenorphine treatment decreases over time, as SOURCE predicts, interventions to expand capacity may only be needed in the next 4 to 6 years.…”

Section: Discussionsupporting

confidence: 90%

“…This study was subject to limitations, including the limitations of the SOURCE model . We only included interventions associated with buprenorphine duration, capacity, and initiation based on quantitative evidence in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…We projected the effectiveness of each intervention during a 12-year horizon (2021-2032) with lifetime follow-up, which includes average lifetime QALYs and costs expected for each person remaining in the model after 2032 as based on the age-weighted quality-adjusted life expectancy (Table 1; eMethods 4 in Supplement 1). We estimated total nonfatal opioid overdoses, OODs, and QALYs and compared these health outcomes with the status quo of no additional interventions …”

Section: Methodsmentioning

confidence: 99%

“…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).…”

Section: Jama Health Forum | Original Investigationmentioning

confidence: 98%

“…We estimated total nonfatal opioid overdoses, OODs, and QALYs and compared these health outcomes with the status quo of no additional interventions. 18,19 Cost-effectiveness Analysis…”

Section: Jama Health Forum | Original Investigationmentioning

confidence: 99%

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

Claypool,

DiGennaro,

Russell

et al. 2023

JAMA Health Forum

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ImportanceBuprenorphine is an effective and cost-effective medication to treat opioid use disorder (OUD), but is not readily available to many people with OUD in the US. The current cost-effectiveness literature does not consider interventions that concurrently increase buprenorphine initiation, duration, and capacity.ObjectiveTo conduct a cost-effectiveness analysis and compare interventions associated with increased buprenorphine treatment initiation, duration, and capacity.Design and SettingThis study modeled the effects of 5 interventions individually and in combination using SOURCE, a recent system dynamics model of prescription opioid and illicit opioid use, treatment, and remission, calibrated to US data from 1999 to 2020. The analysis was run during a 12-year time horizon from 2021 to 2032, with lifetime follow-up. A probabilistic sensitivity analysis on intervention effectiveness and costs was conducted. Analyses were performed from April 2021 through March 2023. Modeled participants included people with opioid misuse and OUD in the US.InterventionsInterventions included emergency department buprenorphine initiation, contingency management, psychotherapy, telehealth, and expansion of hub-and-spoke narcotic treatment programs, individually and in combination.Main Outcomes and MeasuresTotal national opioid overdose deaths, quality-adjusted life years (QALYs) gained, and costs from the societal and health care perspective.ResultsProjections showed that contingency management expansion would avert 3530 opioid overdose deaths over 12 years, more than any other single-intervention strategy. Interventions that increased buprenorphine treatment duration initially were associated with an increased number of opioid overdose deaths in the absence of expanded treatment capacity. With an incremental cost- effectiveness ratio of $19 381 per QALY gained (2021 USD), the strategy that expanded contingency management, hub-and-spoke training, emergency department initiation, and telehealth was the preferred strategy for any willingness-to-pay threshold from $20 000 to $200 000/QALY gained, as it was associated with increased treatment duration and capacity simultaneously.Conclusion and RelevanceThis modeling analysis simulated the effects of implementing several intervention strategies across the buprenorphine cascade of care and found that strategies that were concurrently associated with increased buprenorphine treatment initiation, duration, and capacity were cost-effective.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Jama Health Forum | Original Investigationmentioning

confidence: 98%

“…We estimated total nonfatal opioid overdoses, OODs, and QALYs and compared these health outcomes with the status quo of no additional interventions. 18,19 Cost-effectiveness Analysis…”

Section: Jama Health Forum | Original Investigationmentioning

confidence: 99%

See 3 more Smart Citations

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

Claypool,

DiGennaro,

Russell

et al. 2023

JAMA Health Forum

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

et al. 2023

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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.

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Development of Photoswitchable Tethered Ligands that Target the μ‐Opioid Receptor

Lahmy,

Hübner,

Lachmann

et al. 2023

ChemMedChem

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Converting known ligands into photoswitchable derivatives offers the opportunity to modulate compound structure with light and hence, biological activity. In doing so, these probes provide unique control when evaluating G‐protein‐coupled receptor (GPCR) mechanism and function. Further conversion of such compounds into covalent probes, known as photoswitchable tethered ligands (PTLs), offers additional advantages. These include localization of the PTLs to the receptor binding pocket. Covalent localization increases local ligand concentration, improves site selectivity and may improve the biological differences between the respective isomers. This work describes chemical, photophysical and biochemical characterizations of a variety of PTLs designed to target the μ‐opioid receptor (μOR). These PTLs were modeled on fentanyl, with the lead disulfide‐containing agonist found to covalently interact with a cysteine‐enriched mutant of this medically‐relevant receptor.

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

Cited by 45 publications

References 31 publications

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

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

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

Development of Photoswitchable Tethered Ligands that Target the μ‐Opioid Receptor

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