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New study highlights importance of sustained interventions to reduce opioid overdose deaths

Study authors used mathematical modeling to simulate opioid overdose crisis in Kentucky, Massachusetts, New York and Ohio under different interventions

RESEARCH TRIANGLE PARK, N.C. — A new study led by researchers at nonprofit research institute RTI International and Massachusetts General Hospital (MGH)/Harvard Medical School has found that a substantial scale-up of medication for opioid use disorder (MOUD) initiation and retention, along with increased naloxone distribution, is crucial for reducing overdose deaths. The study, published in JAMA Network Open, also highlighted that if the scale of interventions is reduced, opioid overdose deaths are likely to increase again.

The opioid crisis in the U.S. has led to an alarming rise in overdose deaths. In response to this crisis, the National Institutes of Health (NIH), in partnership with the Substance Abuse and Mental Health Services Administration launched the HEALing Communities Study in 2019, aiming to reduce opioid overdose deaths by implementing multiple evidence-based interventions across 67 highly impacted communities in four states: Kentucky, Massachusetts, New York and Ohio.

For this study, the research team used mathematical modeling to simulate the opioid epidemic in these four states from 2020 to 2026. The model projected opioid overdose deaths under status quo, (i.e., continuing at the current rates of MOUD and naloxone supply), and under different combinations of interventions that increased MOUD treatment retention rate to the level observed in clinical trials, expanded treatment outreach increasing MOUD initiation rates by two-to-five-fold, increased supply of naloxone, and increased prescription opioid safety efforts reducing the incidence of prescription opioid misuse by 50%.

Compared with the status quo, opioid-related overdose deaths could be reduced by 13-17% in Kentucky, 17-27% in Massachusetts, 15-22% in New York and 15-22% in Ohio if the interventions listed above were all increased for two years, according to the model. After five years of interventions, the reductions in mortality would reach 18-27% in Kentucky, 28-46% in Massachusetts, 22-34% in New York and 25-41% in Ohio.

“Our study shows that substantial scale-up of a combination of interventions can potentially change the trajectory of the opioid overdose crisis in the U.S.,” said Carolina Barbosa, Ph.D., senior health economist at RTI and co-senior author of the study.

The study also showed that not sustaining interventions beyond two years could bring the annual overdose deaths close to that projected under the status quo. “Importantly, all the positive gains projected by our model would be wiped out if the interventions, particularly increased initiation and retention rates of MOUD and supply of naloxone, are not sustained; so continued funding and on-the-ground efforts would be essential to lasting success,” said lead author Jagpreet Chhatwal, Ph.D., director of the MGH Institute for Technology Assessment and associate professor at Harvard Medical School.

The model was calibrated using data from the National Survey on Drug Use and Health, the Centers for Disease Control and Prevention and other sources for each state.

These findings provide valuable insights to policymakers, guiding efforts to address the ongoing opioid overdose crisis. “While the study focused on four highly impacted states, its implications likely extend to other states or communities addressing the opioid overdose crisis,” said co-senior author Amy Knudsen, Ph.D., senior scientist at the MGH Institute for Technology Assessment and assistant professor at Harvard Medical School.

The research was conducted as part of the HEALing Communities Study, a multiyear effort funded by NIH’s National Institute on Drug Abuse, through the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative, under award numbers UM1DA049394, UM1DA049406, UM1DA049412, UM1DA049415 and UM1DA049417. Launched in April 2018, the initiative is focused on improving prevention and treatment strategies for opioid misuse and addiction and enhancing pain management. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Researchers from Massachusetts General Hospital, Harvard Medical School, Pennsylvania State University, the Boston University School of Medicine and Boston Medical Center contributed to the study.

View the full study

Learn more about RTI’s substance use research