Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States
Qiushi Chen, Marc R Larochelle, Davis T Weaver, Anna P Lietz, Peter P Mueller, Sarah Mercaldo, Sarah E Wakeman, Kenneth A Freedberg, Tiana J Raphel, Amy B Knudsen, Pari V Pandharipande, Jagpreet Chhatwal, Qiushi Chen, Marc R Larochelle, Davis T Weaver, Anna P Lietz, Peter P Mueller, Sarah Mercaldo, Sarah E Wakeman, Kenneth A Freedberg, Tiana J Raphel, Amy B Knudsen, Pari V Pandharipande, Jagpreet Chhatwal
Abstract
Importance: Deaths due to opioid overdose have tripled in the last decade. Efforts to curb this trend have focused on restricting the prescription opioid supply; however, the near-term effects of such efforts are unknown.
Objective: To project effects of interventions to lower prescription opioid misuse on opioid overdose deaths from 2016 to 2025.
Design, setting, and participants: This system dynamics (mathematical) model of the US opioid epidemic projected outcomes of simulated individuals who engage in nonmedical prescription or illicit opioid use from 2016 to 2025. The analysis was performed in 2018 by retrospectively calibrating the model from 2002 to 2015 data from the National Survey on Drug Use and Health and the Centers for Disease Control and Prevention.
Interventions: Comparison of interventions that would lower the incidence of prescription opioid misuse from 2016 to 2025 based on historical trends (a 7.5% reduction per year) and 50% faster than historical trends (an 11.3% reduction per year), vs a circumstance in which the incidence of misuse remained constant after 2015.
Main outcomes and measures: Opioid overdose deaths from prescription and illicit opioids from 2016 to 2025 under each intervention.
Results: Under the status quo, the annual number of opioid overdose deaths is projected to increase from 33 100 in 2015 to 81 700 (95% uncertainty interval [UI], 63 600-101 700) in 2025 (a 147% increase from 2015). From 2016 to 2025, 700 400 (95% UI, 590 200-817 100) individuals in the United States are projected to die from opioid overdose, with 80% of the deaths attributable to illicit opioids. The number of individuals using illicit opioids is projected to increase by 61%-from 0.93 million (95% UI, 0.83-1.03 million) in 2015 to 1.50 million (95% UI, 0.98-2.22 million) by 2025. Across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3.0% to 5.3%.
Conclusions and relevance: This study's findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.
Conflict of interest statement
Conflict of Interest Disclosures: Dr Larochelle reported receiving grant K23 DA042168 from the National Institute on Drug Abuse and a Boston University School of Medicine Department of Medicine Career Investment Award during the conduct of the study; and receiving grants from Optum Labs, the National Center for Advancing Translational Sciences/Boston University Clinical & Translational Science Institute, the Centers for Disease Control and Prevention, and the University of Maryland Baltimore/Office of National Drug Control Policy outside the submitted work. Dr Pandharipande reported receiving grants from the Medical Imaging and Technology Alliance outside the submitted work. No other disclosures were reported.
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References
- CDC WONDER Multiple cause of death 1999-2017. . Accessed June 29, 2017.
- Langston AA, Prichard JM, Muppidi S, et al. . Favorable impact of pre-transplant ATG on outcomes of reduced-intensity hematopoietic cell transplants from partially mismatched unrelated donors. Bone Marrow Transplant. 2014;49(2):-. doi:10.1038/bmt.2013.168
- Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/MLR.0000000000000625
- Dowell D, Haegerich TM, Chou R. Cdc guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624-1645. doi:10.1001/jama.2016.1464
- Bao Y, Pan Y, Taylor A, et al. . Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians. Health Aff (Millwood). 2016;35(6):1045-1051. doi:10.1377/hlthaff.2015.1673
- Brady JE, Wunsch H, DiMaggio C, Lang BH, Giglio J, Li G. Prescription drug monitoring and dispensing of prescription opioids. Public Health Rep. 2014;129(2):139-147. doi:10.1177/003335491412900207
- Moyo P, Simoni-Wastila L, Griffin BA, et al. . Impact of prescription drug monitoring programs (PDMPs) on opioid utilization among Medicare beneficiaries in 10 US States. Addiction. 2017;112(10):1784-1796. doi:10.1111/add.13860
- National Alliance for Model State Drug Laws Compilation of prescription monitoring program maps. . Accessed December 27, 2018.
- Rutkow L, Chang HY, Daubresse M, Webster DW, Stuart EA, Alexander GC. Effect of Florida’s prescription drug monitoring program and pill mill laws on opioid prescribing and use. JAMA Intern Med. 2015;175(10):1642-1649. doi:10.1001/jamainternmed.2015.3931
- Yarbrough CR. Prescription drug monitoring programs produce a limited impact on painkiller prescribing in Medicare Part D. Health Serv Res. 2018;53(2):671-689. doi:10.1111/1475-6773.12652
- Office of National Drug Control Policy Draft interim report. . Accessed December 27, 2018.
- Wen H, Schackman BR, Aden B, Bao Y. States with prescription drug monitoring mandates saw a reduction In opioids prescribed to medicaid enrollees. Health Aff (Millwood). 2017;36(4):733-741. doi:10.1377/hlthaff.2016.1141
- Sun BC, Charlesworth CJ, Lupulescu-Mann N, et al. . Effect of automated prescription drug monitoring program queries on emergency department opioid prescribing. Ann of Emerg Med. 2018;71(3):337-347.e6. doi:10.1016/j.annemergmed.2017.10.023
- Haffajee RL, Mello MM, Zhang F, Zaslavsky AM, Larochelle MR, Wharam JF. Four states with robust prescription drug monitoring programs reduced opioid dosages. Health Aff (Millwood). 2018;37(6):964-974. doi:10.1377/hlthaff.2017.1321
- Fink DS, Schleimer JP, Sarvet A, et al. . Association between prescription drug monitoring programs and nonfatal and fatal drug overdoses: a systematic review. Ann Intern Med. 2018;168(11):783-790. doi:10.7326/M17-3074
- Cicero TJ, Ellis MS, Harney J. Shifting patterns of prescription opioid and heroin abuse in the United States. N Engl J Med. 2015;373(18):1789-1790. doi:10.1056/NEJMc1505541
- Cicero TJ, Ellis MS, Kasper ZA. Increased use of heroin as an initiating opioid of abuse. Addict Behav. 2017;74:63-66. doi:10.1016/j.addbeh.2017.05.030
- Pardo B. Do more robust prescription drug monitoring programs reduce prescription opioid overdose? Addiction. 2017;112(10):1773-1783. doi:10.1111/add.13741
- Patrick SW, Fry CE, Jones TF, Buntin MB. Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates. Health Aff (Millwood). 2016;35(7):1324-1332. doi:10.1377/hlthaff.2015.1496
- Paulozzi LJ, Kilbourne EM, Desai HA. Prescription drug monitoring programs and death rates from drug overdose. Pain Med. 2011;12(5):747-754. doi:10.1111/j.1526-4637.2011.01062.x
- US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality National Survey on Drug Use and Health. Ann Arbor, MI: Inter-university Consortium for Political and Social Research; 2015.
- Husereau D, Drummond M, Petrou S, et al. . Consolidated Health Economic Evaluation Reporting Standards (CHEERS)—explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16(2):231-250. doi:10.1016/j.jval.2013.02.002
- Homer JB, Hirsch GB. System dynamics modeling for public health: background and opportunities. Am J Public Health. 2006;96(3):452-458. doi:10.2105/AJPH.2005.062059
- Analysis of complex survey samples [computer program]. Version 3.31-5. CRAN R packages 2016.
- Stout NK, Knudsen AB, Kong CYJ, McMahon PM, Gazelle GS. Calibration methods used in cancer simulation models and suggested reporting guidelines. Pharmacoeconomics. 2009;27(7):533-545. doi:10.2165/11314830-000000000-00000
- Frank RG, Pollack HA. Addressing the fentanyl threat to public health. N Engl J Med. 2017;376(7):605-607. doi:10.1056/NEJMp1615145
- O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths involving fentanyl, fentanyl analogs, and U-47700—10 states, July-December 2016. MMWR Morb Mortal Wkly Rep. 2017;66(43):1197-1202. doi:10.15585/mmwr.mm6643e1
- Massachusetts Department of Public Health Data brief: opioid-related overdose deaths among Massachusetts residents. . Accessed December 27, 2018.
- National Center for Health Statistics Provisional drug overdose death counts. . Accessed August 14, 2018.
- Pitt AL, Humphreys K, Brandeau ML. Modeling health benefits and harms of public policy responses to the US opioid epidemic. Am J Public Health. 2018;108(10):1394-1400. doi:10.2105/AJPH.2018.304590
- The White House President Donald J. Trump’s initiative to stop opioid abuse and reduce drug supply and demand. . Accessed December 27, 2018.
- Springer SA, Korthuis PT, Del Rio C. Integrating treatment at the intersection of opioid use disorder and infectious disease epidemics in medical settings: a call for action after a national academies of sciences, engineering, and medicine workshop. Ann Intern Med. 2018;169(5):335-336. doi:10.7326/M18-1203
- Volkow ND, Wargo EM. Overdose prevention through medical treatment of opioid use disorders. Ann Intern Med. 2018;169(3):190-192. doi:10.7326/M18-1397
- Larochelle MR, Bernson D, Land T, et al. . Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3):137-145. doi:10.7326/M17-3107
- Wakeman SE, Barnett ML. Primary care and the opioid-overdose crisis—buprenorphine myths and realities. N Engl J Med. 2018;379(1):1-4. doi:10.1056/NEJMp1802741
- Unick GJ, Ciccarone D. US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations. Int J Drug Policy. 2017;46:112-119. doi:10.1016/j.drugpo.2017.06.003
Source: PubMed