Effectiveness of Policies for Addressing the US Opioid Epidemic: A Model-Based Analysis from the Stanford-Lancet Commission on the North American Opioid Crisis

Abstract

Background: The opioid epidemic causes significant morbidity and mortality in the United States, and has been exacerbated by COVID-19.Methods: We extend and update a previously developed model to assess the effectiveness of the following interventions, alone and combined, for controlling the U.S. opioid epidemic: reduced prescribing, drug rescheduling, prescription monitoring programs, tamper-resistant drug reformulation, excess opioid disposal, naloxone availability, needle exchange, pharmacotherapy, and psychosocial treatment. We measure life years, quality-adjusted life years (QALYs), and opioid-related deaths over five and ten years.Findings: Under the status quo, our model predicts that approximately 522,000 opioid-related deaths will occur from 2020 to 2024 (range 424,000 - 575,000), rising to 1,172,000 (range 956,000 - 1,308,000) by 2029. Expansion of naloxone availability had the largest effect: with 30% expansion, approximately 25% of opioid deaths would be averted. Pharmacotherapy, needle exchange, and psychosocial treatment are uniformly beneficial, reducing opioid-related deaths while leading to gains in life years and QALYs. Reduced prescribing for acute and transitioning pain (at the end of the first month of acute pain) would reduce lives lost over five and ten years. Reducing chronic pain prescribing, rescheduling drugs, and increasing excess opioid disposal programs would increase total deaths over five years as some opioid users escalate to heroin, but decrease deaths over ten years. Combined interventions would lead to greater increases in life years, QALYs, and deaths averted, although in many cases the results are subadditive.Interpretation: A combination of expanded health services for addicted individuals and reduced opioid prescribing would moderately lessen the severity of the opioid crisis over the next decade. Tragically, even with improved public policies, significant morbidity and mortality is inevitable.Funding: Grant R37-DA15612 from the National Institute on Drug Abuse and a grant from Stanford University School of Medicine to support the Stanford-Lancet Commission on the North American Opioid Crisis.Declaration of Interests: The authors have no conflict of interest to report.