Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2020 Nov 2;3(11):e2023677. doi: 10.1001/jamanetworkopen.2020.23677.
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.
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.
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.
Projected 10-year overdose deaths and prevalence of OUD.
Under status quo, 484 429 (95% confidence band, 390 543-576 631) 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 179 151 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.
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.
美国阿片类药物流行情况复杂且多变，但对于其未来的影响以及应对措施可能带来的缓解影响，人们知之甚少。
估计阿片类药物流行的未来负担以及应对该负担的干预措施的潜力。
设计、地点和参与者：使用 2010-2018 年国家药物使用和健康调查、疾病控制和预防中心、国家健康和营养检查调查、美国人口普查和国家酒精和相关条件调查 III 的数据，对一个决策分析动态马尔可夫模型进行了校准。研究对象为美国一般人群中 12 岁或以上的个人，包括处方阿片类药物使用、处方阿片类药物非医疗使用、海洛因使用、处方、海洛因或联合处方和海洛因阿片类药物使用障碍（OUD）、7 种治疗类别之一、非致命或致命过量用药。该模型旨在预测 2020 年至 2029 年期间的致命阿片类药物过量用药。
该模型预测了处方减少（每年减少 5%）、纳洛酮分发（假设病例死亡率降低 5%）和治疗范围扩大（假设在 4 年内每年接受治疗的人数增加 35%，并减少 50%的复发），与现状相比，每种情况都进行了比较。
预计在 10 年内发生的过量死亡人数和 OUD 流行率。
在现状下，预计 2020 年至 2029 年期间将有 484429 人（95%置信区间，390543-576631）经历致命的阿片类药物过量用药。处方减少可使死亡人数减少 0.3%，纳洛酮分发可使死亡人数减少 15.4%，治疗范围扩大可使死亡人数减少 25.3%；这些干预措施联合使用，在 10 年内可减少 179151 例过量死亡（37.0%）。干预措施对 OUD 的流行率影响较小；例如，联合干预预计将使 2019 年的 OUD 流行率从 247 万人减少到 2029 年的 179 万人，减少 27.5%。模型预测对未来致命和非致命过量用药率的假设最为敏感。
这项研究的结果表明，在未来十年中，阿片类药物流行情况可能仍会导致数万人每年死亡。积极部署基于证据的干预措施至少可以减少三分之一的死亡人数，但对 OUD 患者人数的影响可能较小。
