Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 2;3(11):e2023677.
doi: 10.1001/jamanetworkopen.2020.23677.

Modeling Mitigation Strategies to Reduce Opioid-Related Morbidity and Mortality in the US

Jeromie Ballreich  1   2   3 , Omar Mansour  3 , Ellen Hu  3 , Francine Chingcuanco  3 , Harold A Pollack  3   4 , David W Dowdy  3   5 , G Caleb Alexander  2   3   5   6
Affiliations

Modeling Mitigation Strategies to Reduce Opioid-Related Morbidity and Mortality in the US

Jeromie Ballreich et al. JAMA Netw Open. .

Abstract

Importance: 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.

Objective: 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.

Exposures: 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.

Main outcomes and measures: Projected 10-year overdose deaths and prevalence of OUD.

Results: 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.

Conclusions and relevance: 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Ballreich reported receiving consulting fees from Monument Analytics during the conduct of the study and is an employee of The Johns Hopkins University outside the submitted work. Mr Mansour and Ms Chingcuanco reported serving as paid employees of Monument Analytics. Ms Hu reported receiving consulting fees from Monument Analytics during the conduct of the study. Dr Pollack reported receiving consulting fees from Monument Analytics during the conduct of the study and is an employee of the University of Chicago outside the submitted work. Dr Dowdy reported receiving consulting fees from Monument Analytics during the conduct of the study and is an employee of The Johns Hopkins University outside the submitted work.

Figures

Figure 1.
Figure 1.. Model of US Opioid Epidemic (APOLLO)
H indicates prescription heroin use with prior prescription opioid use; HN, heroin use without prior prescription opioid use; MAT, medications for addiction treatment.
Figure 2.
Figure 2.. Projected Cumulative Number of Opioid Overdose Deaths Under Status Quo and Intervention Scenarios, 2020-2029
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths—United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018;67(5152):1419-1427. doi:10.15585/mmwr.mm675152e1 - DOI - PMC - PubMed
    1. Phillips JK, Ford MA, Bonnie RJ, eds; National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press; 2017:272-273. - PubMed
    1. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65(50-51):1445-1452. doi:10.15585/mmwr.mm655051e1 - DOI - PubMed
    1. Olfson M, Wall M, Wang S, Crystal S, Blanco C. Risks of fatal opioid overdose during the first year following nonfatal overdose. Drug Alcohol Depend. 2018;190:112-119. doi:10.1016/j.drugalcdep.2018.06.004 - DOI - PMC - PubMed
    1. Jalal H, Buchanich JM, Roberts MS, Balmert LC, Zhang K, Burke DS. Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. Science. 2018;361(6408):6408. doi:10.1126/science.aau1184 - DOI - PMC - PubMed

Publication types