In a new report, researchers from the Massachusetts General Hospital (MGH) Institute for Technology Assessment predicted that the opioid overdose epidemic in the United States is likely to worsen in the coming years — particularly if interventions do not begin to meet the changing nature of the crisis and continue to focus primarily on reducing prescription access.
The report, published in JAMA Network Open, states that although the epidemic began with prescription opioids in the 1990s, the current driving force is illicit drugs like heroin and fentanyl. And this change has reduced the potential impact of programs targeted at reducing access to prescription opioids.
The researchers suggest that a multipronged approach will be needed to address the ongoing crisis, including strategies to identify those with opioid use disorder, improved access to medications like methadone and buprenorphine, and expansion of harm reduction services such as the overdose-reversal drug naloxone.
“The opioid epidemic started with a sharp increase in opioid prescriptions for pain in the 1990s; but since 2010 the crisis has shifted, with a leveling off of deaths due to prescription opioid overdoses and an increase in overdose deaths due to heroin,” said Jagpreet Chhatwal, Ph.D., of the MGH Institute for Technology Assessment (MGH-ITA), corresponding author of the report.
“In the past five years, deaths have accelerated with the introduction of the powerful synthetic opioid fentanyl into the opioid supply, leading to a continuing increase in overdose deaths at time when the supply of prescription opioids is decreasing.”
“If we rely solely on controlling the supply of prescription opioids, we will fail miserably at stemming the opioid overdose crisis,” Chhatwal said.
“Illicit opioids now cause the majority of overdose deaths, and such deaths are predicted to increase by 260 percent — from 19,000 to 68,000 — between 2015 and 2025,” said Chhatwal, also an assistant professor of radiology at Harvard Medical School.
The researchers looked at data from sources such as the National Survey on Drug Use and Health and the Centers for Disease Control and Prevention to develop the Opioid Policy Model, reflecting the U.S. epidemic trajectory from 2002 to 2015. They then used that model to make predictions for probable outcomes from 2016 to 2025.
Under a status quo scenario, in which no further reduction in the misuse of prescription opioids occurs in coming years, the model predicts that the annual number of opioid overdose deaths will increase from 33,100 in 2015 to 81,700 in 2025 — a 147 percent increase.
The model also projects that, during those years, a total of around 700,000 people will die from an opioid overdose, 80 percent from illicit drugs like heroin and fentanyl.
The authors also estimate that, by 2025, half of all new opioid users will begin with illicit rather than prescription drugs. In all scenarios tested, interventions directed towards reducing misuse of prescription opioids were projected to decrease overdose deaths by only 3 to 5 percent.
“This study demonstrates that initiatives focused on the prescription opioid supply are insufficient to bend the curve of opioid overdose deaths in the short and medium term,” said coauthor Marc Larochelle, M.D., M.P.H., of the Grayken Center for Addiction at Boston Medical Center, an assistant professor of Medicine at Boston University School of Medicine.
“We need policy, public health and health care delivery efforts to amplify harm reduction efforts and access to evidence-based treatment.”
Source: Massachusetts General Hospital