Impact of enhanced practices on opioid overdose deaths

Abstract

BACKGROUND AND AIMS: The opioid crisis is still a public health emergency in the United States, despite recent declines in opioid overdose deaths (OODs) and increased availability of evidence-based practices (EBPs) for opioid use disorder (OUD). The geographic variability in OODs drives the need for localized decision-making, where interventions are tailored to the unique needs of communities. This study aimed to develop and calibrate a simulation model that evaluates the impact of enhanced implementation of EBP on OODs at the community-level.

DESIGN: We developed OPSiM (Opioid Policy Simulation Model), a community-level microsimulation model that simulates the course of opioid use, OUD, treatment, recovery and overdose-related events. The model was parameterized with data from the HEALing Communities Study and looked at six scenarios of EBPs implemented in 2025 with sustainment through 2030: (1) maintain 2024 EBP levels (status quo); (2) increase initiation of medications for opioid use disorder (MOUD); (3) increase MOUD retention; (4) increase MOUD initiation and retention; (5) increase distribution of naloxone; and (6) both scenarios 4 and 5.

SETTING: Twenty-nine communities in Massachusetts, New York, and Ohio, USA.

PARTICIPANTS: Simulated community residents with non-prescribed opioid use or OUD.

MEASUREMENTS: Estimated number of OODs per 100 000 individuals between 2025 and 2030 in each community, averaged across the 26 communities.

FINDINGS: Under the status quo, the model projected 158 OODs (range across communities: 39-468) per 100 000 individuals between 2025 and 2030. Increasing medications for the treatment of OUD (MOUD) retention alone reduced OODs by 6% (range: 3-15%), while increasing MOUD initiation alone reduced OODs by 9% (range: 8-12%). Increasing both MOUD initiation and retention had a synergistic effect, reducing OODs by 21% (range: 15-31%). Reduction in OODs in response to increased MOUD initiation and/or retention was similar across urban and rural communities. The effect of increasing naloxone distribution varied substantially across communities due to differing saturation levels; in some communities, additional naloxone kits provided only marginal benefits. Rural communities were further from saturation whereas most urban communities were at or close to saturation.

CONCLUSIONS: A tailored, multi-pronged approach that scales up medications for opioid use disorder alongside widespread naloxone distribution, and that addresses community-specific needs and capacities, will be most effective at reducing opioid overdose deaths in the United States.