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Abstract
Deaths due to opioid overdose have tripled in the last decade. Efforts to curb this trend have focused on restricting the prescription opioid supply; however, the near-term effects of such efforts are unknown. To project effects of interventions to lower prescription opioid misuse on opioid overdose deaths from 2016 to 2025. This system dynamics (mathematical) model of the US opioid epidemic projected outcomes of simulated individuals who engage in nonmedical prescription or illicit opioid use from 2016 to 2025. The analysis was performed in 2018 by retrospectively calibrating the model from 2002 to 2015 data from the National Survey on Drug Use and Health and the Centers for Disease Control and Prevention. Comparison of interventions that would lower the incidence of prescription opioid misuse from 2016 to 2025 based on historical trends (a 7.5% reduction per year) and 50% faster than historical trends (an 11.3% reduction per year), vs a circumstance in which the incidence of misuse remained constant after 2015. Opioid overdose deaths from prescription and illicit opioids from 2016 to 2025 under each intervention. Under the status quo, the annual number of opioid overdose deaths is projected to increase from 33 100 in 2015 to 81 700 (95% uncertainty interval [UI], 63 600-101 700) in 2025 (a 147% increase from 2015). From 2016 to 2025, 700 400 (95% UI, 590 200-817 100) individuals in the United States are projected to die from opioid overdose, with 80% of the deaths attributable to illicit opioids. The number of individuals using illicit opioids is projected to increase by 61%-from 0.93 million (95% UI, 0.83-1.03 million) in 2015 to 1.50 million (95% UI, 0.98-2.22 million) by 2025. Across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3.0% to 5.3%. This study's findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.
Highlights
In the last decade, US deaths due to opioid-related overdoses have tripled, increasing from approximately 17 500 in 2006 to 42 200 in 2016.1 In October 2017, the US Department of Health and Human Services declared the opioid crisis a national public health emergency.[2]
Opioid Overdose Crisis Projections We projected that under the status quo, the total number of opioid overdose deaths in the United States will increase from 33 100 in 2015 to 81 700 (95% uncertainty interval (UI), 63 600-101 700) by 2025 (a 147% increase) (Figure 2)
The majority of these deaths would result from illicit opioid use—overdose deaths from illicit opioids are projected to increase from 18 900 in 2015 to 67 900 (95% UI, 52 20086 700) in 2025 (a 259% increase)
Summary
Efforts to curb the course of the opioid overdose epidemic have principally focused on restricting the supply of prescription opioid analgesics through prescription drug monitoring programs, opioid prescribing guidelines,[4] dose-limit laws, prescription drug take-back days, and law enforcement approaches.[5,6,7,8,9,10,11] One premise of these supply-side interventions is that they will decrease the number of individuals exposed to opioid analgesics and subsequently prevent individuals from developing an opioid use disorder (OUD), lowering the number of opioid overdose deaths. Previous studies have shown that such interventions may lead to a modest decrease in the prescription opioid supply, especially programs with enrollment and/or use mandates.[5,6,7,10,12,13,14] analyses of these programs have failed to demonstrate a consistent benefit on fatal or nonfatal opioid overdoses.[15]
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