Using Economic Evaluation to Inform Responses to the Opioid Epidemic in the United States: Challenges and Suggestions for Future Research

Abstract

Background: Several aspects of the opioid epidemic and of public health care organization in the United States (US) make the conduct of economic evaluation and the design of policies to respond to this crisis particularly challenging. Objectives: This commentary offers suggestions for how economic evaluation may address and overcome four key features of the opioid epidemic: 1) its magnitude and geographical distribution, 2) its intersection with multiple epidemics, 3) its rapidly changing dynamics, 4) its multi-sectoral causes and consequences. Results: We first offer pragmatic suggestions to address the difficulties in delivering a coordinated response given the fragmented nature of health care in the US. In view of the broad suite of responses required to address opioid use disorder and its associated comorbidities, we highlight the need for economic evaluations which consider interventions throughout the continuum of care (i.e. primary, secondary and tertiary levels of prevention). We examine how the use of predictive modelling alongside economic evaluation might be adopted to address the rapidly evolving situation affecting distinct populations and geographic areas and encourage investments in epidemic preparedness. Finally, we propose methods to capture the interdependence of various sectors of government affected by the opioid crisis in economic evaluations to ensure optimal levels of investment towards a comprehensive response. Conclusions: The opioid epidemic in the US represents an unprecedented public health challenge, but sound epidemiological modelling and economic analysis can help to guide use of limited resources committed to addressing it in ways that can have greatest impact in limiting its adverse consequences.

The Future of the United States Overdose Crisis: Challenges and Opportunities

“…Three priorities should be pursued. First, the expansion of social and economic policies that aim to raise income and provide buffers against job loss in poor and working-class communities, and policies that aim to protect workers, could prove to be a promising primary prevention strategy [45][46][47] to reduce initiation of misuse of both opioids and stimulants, thus reducing the risk for polydrug use and overdose. Prior evidence suggests that the adoption of more generous unemployment in-surance benefits reduces the harmful effects of job loss on overdose.…”

Interpol review of forensic management, 2019–2022

“…The opioid crisis has brought to light the interconnectedness of public health, medical care, forensic laboratories, and medical examiner/coroner offices as a system of systems that requires coordination for the allocation of scarce economic resources. Research efforts to provide an economic evaluation of such resource allocation attempts to find the optimal investments to stem the growth in substance abuse and death [ 71 ]. Epidemiological and economic analysis offers detail on trends and economic impact to support the allocation of public funds for greater awareness of emerging trends.…”

“…The opioid epidemic exploded as an unprecedented public health crisis and has been a drain on already scarce forensic laboratory resources [ 71 ]. The next wave of the opioid crisis has arrived with the introduction of new and more dangerous synthetic drugs and new psychoactive substances (NPS), killing thousands of people annually (National Institute on Drug Abuse (NIDA}, 2022; [ 70 ].…”

“…This public health crisis is also a human epidemic of despair, mental health collapse, and unemployment among other intertwined comorbidities [ 69 ]. Improved communication and partnerships with hospitals, regulators, and police are needed to help those afflicted and to track epidemiological trend data [ 71 ]. Syndromic surveillance and epidemiological modeling can aid in recognizing outbreaks of drug outbreaks to better prepare drug treatment programs, syringe exchanges, or prioritize geographical locations of naloxone [ 73 ].…”

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“…On the other hand, the aberrant use of opioids among patients is a serious concern in the U.S., and therefore, has led to discussions regarding epidemiological modeling and economic analysis to better allocate limited resources to attenuate the effects of the ongoing opioid epidemic. [ 23 ]. In a retrospective study, less than 50% of U.K. patients suffering from cancer received a strong opioid before their passing; however, the percentage was higher in Norway, reaching 60% [ 24 , 25 ].…”