Institute for Technology Assessment, Massachusetts General Hospital, Boston.
Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2023 Jun 1;6(6):e2314925. doi: 10.1001/jamanetworkopen.2023.14925.
In 2021, more than 80 000 US residents died from an opioid overdose. Public health intervention initiatives, such as the Helping to End Addiction Long-term (HEALing) Communities Study (HCS), are being launched with the goal of reducing opioid-related overdose deaths (OODs).
To estimate the change in the projected number of OODs under different scenarios of the duration of sustainment of interventions, compared with the status quo.
DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model simulated the opioid epidemic in the 4 states participating in the HCS (ie, Kentucky, Massachusetts, New York, and Ohio) from 2020 to 2026. Participants were a simulated population transitioning from opioid misuse to opioid use disorder (OUD), overdose, treatment, and relapse. The model was calibrated using 2015 to 2020 data from the National Survey on Drug Use and Health, the US Centers for Disease Control and Prevention, and other sources for each state. The model accounts for reduced initiation of medications for OUD (MOUDs) and increased OODs during the COVID-19 pandemic.
Increasing MOUD initiation by 2- or 5-fold, improving MOUD retention to the rates achieved in clinical trial settings, increasing naloxone distribution efforts, and furthering safe opioid prescribing. An initial 2-year duration of interventions was simulated, with potential sustainment for up to 3 additional years.
Projected reduction in number of OODs under different combinations and durations of sustainment of interventions.
Compared with the status quo, the estimated annual reduction in OODs at the end of the second year of interventions was 13% to 17% in Kentucky, 17% to 27% in Massachusetts, 15% to 22% in New York, and 15% to 22% in Ohio. Sustaining all interventions for an additional 3 years was estimated to reduce the annual number of OODs at the end of the fifth year by 18% to 27% in Kentucky, 28% to 46% in Massachusetts, 22% to 34% in New York, and 25% to 41% in Ohio. The longer the interventions were sustained, the better the outcomes; however, these positive gains would be washed out if interventions were not sustained.
In this decision analytical model study of the opioid epidemic in 4 US states, sustained implementation of interventions, including increased delivery of MOUDs and naloxone supply, was found to be needed to reduce OODs and prevent deaths from increasing again.
2021 年，超过 8 万名美国居民死于阿片类药物过量。正在启动公共卫生干预倡议，如“帮助终结成瘾长期（HEALing）社区研究（HCS）”，旨在减少阿片类药物相关的过量死亡（OOD）。
估计在干预持续时间不同的情况下，与现状相比，预计 OOD 数量的变化。
设计、地点和参与者：本决策分析模型模拟了参与 HCS 的 4 个州（肯塔基州、马萨诸塞州、纽约州和俄亥俄州）的阿片类药物流行情况，时间范围为 2020 年至 2026 年。参与者是一个模拟人群，从阿片类药物滥用转变为阿片类药物使用障碍（OUD）、过量、治疗和复发。该模型使用 2015 年至 2020 年国家药物使用和健康调查、美国疾病控制和预防中心以及每个州的其他来源的数据进行校准。该模型考虑了在 COVID-19 大流行期间减少阿片类药物使用障碍（MOUD）的起始药物治疗和增加 OOD 的情况。
将 MOUD 的起始剂量增加 2 倍或 5 倍，将 MOUD 的保留率提高到临床试验设定的水平，增加纳洛酮的分发工作，并进一步安全开具阿片类药物处方。模拟了最初为期 2 年的干预措施，有可能再持续 3 年。
不同组合和持续时间的干预措施对减少 OOD 数量的预测。
与现状相比，在干预的第二年结束时，肯塔基州每年减少 OOD 的估计值为 13%至 17%，马萨诸塞州为 17%至 27%，纽约州为 15%至 22%，俄亥俄州为 15%至 22%。估计如果再持续 3 年，在第五年结束时，肯塔基州每年减少 OOD 的数量将减少 18%至 27%，马萨诸塞州减少 28%至 46%，纽约州减少 22%至 34%，俄亥俄州减少 25%至 41%。干预持续时间越长，结果越好；然而，如果不持续干预，这些积极的收益将被抵消。
在这项对美国 4 个州阿片类药物流行的决策分析模型研究中，发现需要持续实施干预措施，包括增加 MOUD 和纳洛酮供应，以减少 OOD 并防止死亡人数再次增加。
