Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts.
Boston University School of Medicine, Boston, Massachusetts.
JAMA Netw Open. 2021 Feb 1;4(2):e2037259. doi: 10.1001/jamanetworkopen.2020.37259.
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.
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.
Reduction in overdose mortality, medication treatment capacity needs, and naloxone needs.
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.
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.
美国正面临阿片类药物过量的危机。为此，美国卫生与公众服务部已将目标设定为到 2022 年将过量死亡率降低 40%。
确定 3 种干预措施（使更多人开始接受阿片类药物使用障碍药物治疗[MUD]、提高 MUD 的 6 个月保留率和增加纳洛酮的分发）的具体组合，这些措施与模拟人群中阿片类药物过量的减少至少 40%相关。
设计、地点和参与者：本决策分析模型使用动态人群水平状态转换模型来预测两年内的结果。在马萨诸塞州的模拟城市和农村社区中，将每个干预方案与不干预的反事实情况进行比较。模拟模型用于确定社区一级干预措施与阿片类药物过量率之间的关联。所研究的 3 种干预措施是使更多人开始接受 MUD、提高个人对 MUD 的保留率和增加纳洛酮的分发。数据分析于 2020 年 7 月至 11 月进行。
减少过量死亡率、药物治疗能力需求和纳洛酮需求。
没有单一的干预措施能使模拟社区的过量死亡率降低 40%。实现这一目标需要使用 MUD 和纳洛酮。要实现 40%的降幅，需要每月有 10%至 15%的估计阿片类药物使用障碍人群中尚未接受 MUD 的人开始接受 MUD，至少有 45%至 60%的人至少保留 6 个月，同时增加纳洛酮的分发。在所有可行的环境和方案中，要使过量死亡率降低 40%，需要每月至少有 10%的未接受治疗的阿片类药物使用障碍人群开始接受 MUD。
在这项建模研究中，只有 MUD 治疗能力和 MUD 保留率提高的社区才经历了过量死亡率降低 40%的情况。这些发现可以为制定减少阿片类药物过量死亡的社区一级干预措施提供框架。
