Modeling Mitigation Strategies to Reduce Opioid-Related Morbidity and Mortality in the US

This decision analytical model estimates the future burden of opioid-related morbidity and mortality in the US from 2020 to 2029 and examines strategies that may be associated with mitigation of the opioid epidemic. Question What is the projected burden of the opioid epidemic in fatal overdoses, and interventions such as prescribing reductions, naloxone distribution, and treatment expansion associated with mitigation of the epidemic? Findings In this decision analytical model of the US population aged 12 years or older, under status quo, an estimated 484429 individuals were projected to die of fatal opioid overdose over 10 years. A combination of reducing opioid prescribing, increasing naloxone distribution, and expanding treatment for opioid use disorder was associated with an estimated 179151 lives saved when compared with the status quo. Meaning The findings of this study suggest that the number of fatal opioid overdoses in the US is expected to remain high for at least 10 years, but evidence-based interventions may prevent a substantial fraction of these deaths. Importance The US opioid epidemic is complex and dynamic, yet relatively little is known regarding its likely future impact and the potential mitigating impact of interventions to address it. Objective To estimate the future burden of the opioid epidemic and the potential of interventions to address the burden. Design, Setting, and Participants A decision analytic dynamic Markov model was calibrated using 2010-2018 data from the National Survey on Drug Use and Health, Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey, the US Census, and National Epidemiologic Survey on Alcohol and Related Conditions-III. Data on individuals 12 years or older from the US general population or with prescription opioid medical use; prescription opioid nonmedical use; heroin use; prescription, heroin, or combined prescription and heroin opioid use disorder (OUD); 1 of 7 treatment categories; or nonfatal or fatal overdose were examined. The model was designed to project fatal opioid overdoses between 2020 and 2029. Exposures The model projected prescribing reductions (5% annually), naloxone distribution (assumed 5% reduction in case-fatality), and treatment expansion (assumed 35% increase in uptake annually for 4 years and 50% relapse reduction), with each compared vs status quo. Main Outcomes and Measures Projected 10-year overdose deaths and prevalence of OUD. Results Under status quo, 484429 (95% confidence band, 390543-576631) individuals were projected to experience fatal opioid overdose between 2020 and 2029. Projected decreases in deaths were 0.3% with prescribing reductions, 15.4% with naloxone distribution, and 25.3% with treatment expansion; when combined, these interventions were associated with 179151 fewer overdose deaths (37.0%) over 10 years. Interventions had a smaller association with the prevalence of OUD; for example, the combined intervention was estimated to reduce OUD prevalence by 27.5%, from 2.47 million in 2019 to 1.79 million in 2029. Model projections were most sensitive to assumptions regarding future rates of fatal and nonfatal overdose. Conclusions and Relevance The findings of this study suggest that the opioid epidemic is likely to continue to cause tens of thousands of deaths annually over the next decade. Aggressive deployment of evidence-based interventions may reduce deaths by at least a third but will likely have less impact for the number of people with OUD.