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. 2019 Sep;114(9):1602-1613.
doi: 10.1111/add.14664. Epub 2019 Jun 28.

Modelling the combined impact of interventions in averting deaths during a synthetic-opioid overdose epidemic

Michael A Irvine  1   2 , Margot Kuo  2   3 , Jane A Buxton  2   3 , Robert Balshaw  4 , Michael Otterstatter  2 , Laura Macdougall  2 , M-J Milloy  5 , Aamir Bharmal  6 , Bonnie Henry  7 , Mark Tyndall  2   3 , Daniel Coombs  1 , Mark Gilbert  2   3
Affiliations

Modelling the combined impact of interventions in averting deaths during a synthetic-opioid overdose epidemic

Michael A Irvine et al. Addiction. 2019 Sep.

Abstract

Background and aims: The province of British Columbia (BC) Canada has experienced a rapid increase in illicit drug overdoses and deaths during the last 4 years, with a provincial emergency declared in April 2016. These deaths have been driven primarily by the introduction of synthetic opioids into the illicit opioid supply. This study aimed to measure the combined impact of large-scale opioid overdose interventions implemented in BC between April 2016 and December 2017 on the number of deaths averted.

Design: We expanded on the mathematical modelling methodology of our previous study to construct a Bayesian hierarchical latent Markov process model to estimate monthly overdose and overdose-death risk, along with the impact of interventions.

Setting and cases: Overdose events and overdose-related deaths in BC from January 2012 to December 2017.

Interventions: The interventions considered were take-home naloxone kits, overdose prevention/supervised consumption sites and opioid agonist therapy MEASUREMENTS: Counterfactual simulations were performed with the fitted model to estimate the number of death events averted for each intervention and in combination.

Findings: Between April 2016 and December 2017, BC observed 2177 overdose deaths (77% fentanyl-detected). During the same period, an estimated 3030 (2900-3240) death events were averted by all interventions combined. In isolation, 1580 (1480-1740) were averted by take-home naloxone, 230 (160-350) by overdose prevention services and 590 (510-720) were averted by opioid agonist therapy.

Conclusions: A combined intervention approach has been effective in averting overdose deaths during British Columbia's opioid overdose crisis in the period since declaration of a public health emergency (April 2016-December 2017). However, the absolute numbers of overdose deaths have not changed.

Keywords: Bayesian modelling; opioid agonist therapy; opioid overdose crisis; overdose prevention sites; public health intervention; take-home naloxone.

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Conflict of interest statement

Declaration of competing interests: The authors declare no competing interests

Figures

Figure 1:
Figure 1:
Provincial data summary. (a) Number of illicit-drug overdose related deaths in province broken down by fentanyl-detected and those not related to fentanyl. (b) Provincial take-home naloxone kits used. (c) Overdoses witnessed at an overdose prevention site or supervised consumption site (d) Estimated number of patients on opioid agonist therapy. Black dashed line represents when the provincial public health emergency was declared.
Figure 1:
Figure 1:
Provincial data summary. (a) Number of illicit-drug overdose related deaths in province broken down by fentanyl-detected and those not related to fentanyl. (b) Provincial take-home naloxone kits used. (c) Overdoses witnessed at an overdose prevention site or supervised consumption site (d) Estimated number of patients on opioid agonist therapy. Black dashed line represents when the provincial public health emergency was declared.
Figure 2:
Figure 2:
Flow-chart for incorporation of intervention into analysis. An individual who is not on OAT (or interrupting OAT treatment) is at risk of an overdose. During an overdose event there is a probability that THN is administered effectively and a probability that the overdose occurs at an OPS. If either event occurs then the individual survives the overdose as it is assumed THN was administered effectively and no overdose deaths have occurred at an OPS throughout the entire study period. If neither occurs then there is a certain probability the individual dies after an overdose.
Figure 3:
Figure 3:
Total provincial annual deaths observed and averted broken down by each intervention. THN - Take Home Naloxone, OAT- Opioid Agonist Therapy, OPS - Overdose Prevention Site.
See this image and copyright information in PMC

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