New Study Sheds Light on Reducing Opioid Epidemic

The opioid epidemic is the deadliest drug overdose crisis in US history — on track to kill more people over the next decade than currently live in entire American cities like Miami or Baltimore.

A new study, published in the American Journal of Public Health on Thursday by Stanford researchers Allison Pitt, Keith Humphreys, and Margaret Brandeau, tries to explain how America can reduce the death toll. Using a mathematical model, the study brings together research and expert opinions to calculate the epidemic’s death toll and how different policy ideas can stem the toll.

First, a shocking number: 510,000. That’s a rough estimate of how many people will die over the next decade due to opioid-related causes, which include overdoses and other causes of death tied to opioids, such as HIV infections from sharing syringes. But the researchers caution that the number, as with other estimates in the study, are fuzzy and subject to change — given that this is, after all, trying to predict the future.

“The trend that we’ve seen in the last year would suggest that there’s reason to believe that [the death toll] could be even greater, really,” Pitt told me, referring to data showing a rise in opioid overdose deaths in 2017. “But it’s really hard to say.” The study found America can do some things to reduce the death toll. The bad news is it implied the US must go much further than policymakers have so far — dramatically scaling up proven addiction treatment modalities, needle exchanges, and access to the opioid overdose antidote naloxone.

The study looked at potential solutions. The study emphasized that there is no one silver bullet for the opioid crisis. There are some policies that have a bigger impact than others, but none by themselves get close to ending the crisis on their own. “No single policy is likely to substantially reduce deaths over 5 to 10 years,” the researchers wrote.
The model, for example, estimated that wider availability of naloxone could reduce opioid-related deaths by 21,200 over 10 years; that medication-based treatments for opioid addiction like buprenorphine and methadone would reduce deaths by 12,500; and that reductions in painkiller prescribing for acute pain would reduce deaths by 8,000.

The researchers’ model found that over a 10-year window, reductions in chronic pain prescribing, rescheduling painkillers to increase restrictions on them, and prescription drug monitoring programs increase opioid-related deaths by as much as the tens of thousands — because they increase heroin deaths more than they cut painkiller deaths.

But some other interventions on the prescribing front fare better: reductions in acute pain prescribing, reductions in prescribing for transitioning pain, drug reformulation to make opioids less prone to misuse, and more excess opioid disposal. All these policies seem to prevent more deaths than they cause in a 10-year window (although not always in a five-year window), based on the model.

Researchers concluded that a “portfolio” of options will be needed to make a significant impact on the crisis, since, based on their estimates, each policy would on its own reduce opioid-related deaths by single-digit percentages, at best.

Reference: https://www.vox.com/policy-and-politics/2018/8/23/17769392/opioid-epidemic-drug-overdose-death-study
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