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

Abstract

Opioid overdose deaths remain a major public health crisis. We used a system dynamics simulation model of the U.S. opioid-using population age 12 and older to explore the impacts of 11 strategies on the prevalence of opioid use disorder (OUD) and fatal opioid overdoses from 2022 to 2032. These strategies spanned opioid misuse and OUD prevention, buprenorphine capacity, recovery support, and overdose harm reduction. By 2032, three strategies saved the most lives: (i) reducing the risk of opioid overdose involving fentanyl use, which may be achieved through fentanyl-focused harm reduction services; (ii) increasing naloxone distribution to people who use opioids; and (iii) recovery support for people in remission, which reduced deaths by reducing OUD. Increasing buprenorphine providers’ capacity to treat more people decreased fatal overdose, but only in the short term. Our analysis provides insight into the kinds of multifaceted approaches needed to save lives.

Identifying drivers of increasing opioid overdose deaths among black individuals: a qualitative model drawing on experience of peers and community health workers

“…This study supports evidence that peers and CHWs can fill this gap by providing safe spaces and culturally responsive care. Previous scholarship demonstrates peer relationships improve recovery outcomes for PWUD [ 37 – 39 ] and help people stay in remission rather than return to drug use, which is thought to be the most important factor in reducing OUD over time [ 40 ]. We add that shared racial identity and neighborhood context among peers are key to building trust.…”

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

“…SOURCE ( 21 , 22 ) is a mechanistic compartmental model that tracks opioid-using populations through the following states: initiation and misuse of prescription opioids and heroin, OUD, and remission; treatment with medications for OUD (MOUD), which includes buprenorphine, MMT, or XR-NTX; and fatal and nonfatal opioid overdose. Each of the misuse, OUD, treatment, and remission states has different overdose death hazards.…”

“…Moreover, it assumes buprenorphine receipt increases with more buprenorphine providers, thereby decreasing OODs. Second, in SOURCE, opioid prescribing contributes a small number of OODs among patients, as well as a greater number of OODs due to diversion ( 22 ). Thus, reductions in opioid prescribing translate into fewer OODs.…”

“…An enumeration of distinct contributors to the unprecedented rise in OODs in 2020 can inform the public health response to the overdose crisis, even as COVID-19's effects on overdoses wane. To quantify the effects of different factors, we used SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects), a validated and calibrated national-level simulation model originally built to examine the effects of policy strategies on OODs and opioid use disorder (OUD) ( 21 , 22 ). SOURCE uses data from as early as 1999 to incorporate the effects of secular trends on OODs and OUD, thus making it ideal for examining the extent to which the OOD rise in 2020 was consistent with prior trends.…”

Editorial: Ketamine for treatment of acute and chronic pain: The relationship of mechanism and exposure to therapeutic outcome

“…Ketamine and its metabolites will certainly be the Research Topic of many more relevant studies in the near future. Finally, we are all aware of the ongoing opioid pandemic that is partly related to abuse of illicit, mostly synthetic opioids (predominantly in the USA and Canada) and partly related to relentless prescription of licit opioids by physicians across a range of specialties (predominantly in the EU) ( 9 , 10 ). This Research Topic of articles in Frontiers in Pain Research strongly suggest that the wise and targeted use of ketamine in the treatment of acute pain and in the prevention of chronic pain is a serious alternative to opioids and, consequently, could significantly reduce the damage that opioids do to individual patients, their family and friends, and society as a whole.…”