Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic

Abstract

Objectives: To estimate health outcomes of policies to mitigate the opioid epidemic.

Methods: We used dynamic compartmental modeling of US adults, in various pain, opioid use, and opioid addiction health states, to project addiction-related deaths, life years, and quality-adjusted life years from 2016 to 2025 for 11 policy responses to the opioid epidemic.

Results: Over 5 years, increasing naloxone availability, promoting needle exchange, expanding medication-assisted addiction treatment, and increasing psychosocial treatment increased life years and quality-adjusted life years and reduced deaths. Other policies reduced opioid prescription supply and related deaths but led some addicted prescription users to switch to heroin use, which increased heroin-related deaths. Over a longer horizon, some such policies may avert enough new addiction to outweigh the harms. No single policy is likely to substantially reduce deaths over 5 to 10 years.

Conclusions: Policies focused on services for addicted people improve population health without harming any groups. Policies that reduce the prescription opioid supply may increase heroin use and reduce quality of life in the short term, but in the long term could generate positive health benefits. A portfolio of interventions will be needed for eventual mitigation.

FIGURE 1—

Estimated Effects of Reduced Prescribing for Chronic Pain on Addiction Incidence: United States, 2016–2025 Note. SOUD = severe prescription opioid use disorder; SHUD = severe heroin use disorder. Mean effects of the reduced prescribing for chronic pain policy on monthly incidence, relative to without intervention, of SOUD and SHUD.

FIGURE 2—

Estimated Effects of Reduced Prescribing for Chronic Pain on Addiction Prevalence and Deaths: United States, 2016–2025 Note. SOUD = severe prescription opioid use disorder; SHUD = severe heroin use disorder. Mean effects of the reduced prescribing for chronic pain policy on prevalence and deaths, relative to without intervention, of or from SOUD and SHUD.