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Projected Estimates of Opioid Mortality After Community-Level Interventions

Authors
  • Linas, Benjamin P.1, 2
  • Savinkina, Alexandra1
  • Madushani, R. W. M. A.1
  • Wang, Jianing1
  • Eftekhari Yazdi, Golnaz1
  • Chatterjee, Avik3, 4
  • Walley, Alexander Y.3, 4
  • Morgan, Jake R.5
  • Epstein, Rachel L.1, 2
  • Assoumou, Sabrina A.1, 2
  • Murphy, Sean M.5, 6
  • Schackman, Bruce R.5, 6
  • Chrysanthopoulou, Stavroula A.7
  • White, Laura F.5
  • Barocas, Joshua A.1, 2
  • 1 Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
  • 2 Boston University School of Medicine, Boston, Massachusetts
  • 3 Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
  • 4 Grayken Center for Addiction at Boston Medical Center, Boston, Massachusetts
  • 5 Boston University School of Public Health, Boston, Massachusetts
  • 6 Department of Healthcare Quality and Research, Weill Cornell Medical College, New York, New York
  • 7 School of Public Health, Brown University, Providence, Rhode Island
Type
Published Article
Journal
JAMA Network Open
Publisher
American Medical Association
Publication Date
Feb 15, 2021
Volume
4
Issue
2
Identifiers
DOI: 10.1001/jamanetworkopen.2020.37259
PMID: 33587136
PMCID: PMC7885041
Source
PubMed Central
Disciplines
  • Substance Use and Addiction
License
Green
External links

Abstract

Importance The United States is experiencing a crisis of opioid overdose. In response, the US Department of Health and Human Services has defined a goal to reduce overdose mortality by 40% by 2022. Objective To identify specific combinations of 3 interventions (initiating more people to medications for opioid use disorder [MOUD], increasing 6-month retention with MOUD, and increasing naloxone distribution) associated with at least a 40% reduction in opioid overdose in simulated populations. Design, Setting, and Participants This decision analytical model used a dynamic population-level state-transition model to project outcomes over a 2-year horizon. Each intervention scenario was compared with the counterfactual of no intervention in simulated urban and rural communities in Massachusetts. Simulation modeling was used to determine the associations of community-level interventions with opioid overdose rates. The 3 examined interventions were initiation of more people to MOUD, increasing individuals’ retention with MOUD, and increasing distribution of naloxone. Data were analyzed from July to November 2020. Main Outcomes and Measures Reduction in overdose mortality, medication treatment capacity needs, and naloxone needs. Results No single intervention was associated with a 40% reduction in overdose mortality in the simulated communities. Reaching this goal required use of MOUD and naloxone. Achieving a 40% reduction required that 10% to 15% of the estimated OUD population not already receiving MOUD initiate MOUD every month, with 45% to 60%% retention for at least 6 months, and increased naloxone distribution. In all feasible settings and scenarios, attaining a 40% reduction in overdose mortality required that in every month, at least 10% of the population with OUD who were not currently receiving treatment initiate an MOUD. Conclusions and Relevance In this modeling study, only communities with increased capacity for treating with MOUD and increased MOUD retention experienced a 40% decrease in overdose mortality. These findings could provide a framework for developing community-level interventions to reduce opioid overdose death.

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