Nav: Home

Overdose deaths could increase with 'changing nature' of opioid epidemic

February 07, 2019

The opioid epidemic in the United States could be responsible for 700,000 overdose deaths between 2016 and 2025, according to a new study published today in JAMA Network Open.

"Preventing people from misusing prescription opioids is important and could help prevent some overdose deaths in the long term, but our study shows that the effect would be limited in reducing the overdose deaths in the immediate future," said Qiushi Chen, an assistant professor in the Harold and Inge Marcus Department of Industrial and Manufacturing Engineering at Penn State and the lead author on the paper. "The majority of overdose deaths are now from illicit opioids, such as heroin and fentanyl instead of prescription opioids, and this changing nature of the epidemic has reduced the potential impact of programs targeting prescription opioids."

In an effort to understand the outcomes that programs to limit prescription opioid misuse actually produce, Chen worked with colleagues from Massachusetts General Hospital, Harvard Medical School, and Boston University Medical School.

"The opioid crisis has been a national public health emergency for more than a year, and it's getting worse," said Jagpreet Chhatwal, an assistant professor at Harvard Medical School and a decision scientist at Massachusetts General Hospital Institute for Technology Assessment (MGH-ITA). Chhatwal is the senior author on the paper. "We set out to understand how reduction in incidences of prescription opioid misuse, by interventions of restricting opioid prescriptions supply, would influence the outcomes of overdose deaths in the next decade."

Chen and the team developed a mathematical model to simulate the opioid crisis from 2002 to 2025. Using data available from Centers for Disease Control (CDC) and the National Survey on Drug Use and Health (NSDUH), the researchers calibrated the model to match the trends of overdose deaths from specific types of opioid consumption - recreational prescription misuse to opioid use disorder with prescription and illicit opioids - observed from 2002 through 2015. They then used the model to project probable outcomes of the epidemic, based on the continuing trends, through 2025.

The researchers found that, if that status quo continues, the annual number of opioid overdose deaths will increase from 33,100 in 2015 to 81,700 in 2025 - a 147 percent increase. Eighty percent of those overdose deaths will result from the use of illicit opioids, such as heroin or fentanyl. In every scenario tested, the researchers found that interventions aimed at reducing prescription opioid misuse decreased overdose deaths by three to five percent.

Under an extreme modeling scenario, a hypothetical situation where literally no new incidences of prescription opioid misuse occurred after 2015, the researchers found that number of deaths in 2025 would still remain higher than in 2015.

"More and more people are using illicit opioids. In the past, people might start using pain pills non-medically, which could then lead to illicit opioid usage, but data suggests that even more people are now starting with recreational use of illicit opioids," Chen said. "Prescription opioids are now not necessarily the gateway that people must use to get to illicit opioids."

According to the NSDUH, 30 percent of people who developed opioid use disorder did not start with prescription pills, but rather began immediately with heroin or fentanyl. Chen and his team project that the trend will continue, and, by 2025, nearly half of people with opioid use disorder will have initiated their opioid use with illicit drugs.

"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 co-author Marc LaRochelle, an assistant professor in the Grayken Center for Addiction at the Boston Medical Center. "We need policy, public health and health care delivery efforts to amplify harm reduction efforts and access to evidence-based treatment."
-end-
Other contributors on this paper include Davis Weaver, a medical student at Case Western University who was a research associate at the MGH-ITA; Anna Lietz, a research associate at the MGH-ITA; Peter Mueller, a postdoctoral fellow at MGH-ITA and Harvard Medical School; Sarah Wakeman, the medical director of the Substance Use Disorders Initiative at MGH and an assistant professor of medicine at Harvard University; Kenneth Freedberg, a professor of medicine at Harvard Medical School and MGH and the director of the Program in Epidemiology and Outcomes Research at the Harvard University Center for Aids Research; Tiana Raphel, a medical student at University of Texas Southwestern Medical School who was a research associate at the MGH-ITA; Amy Knudsen, an assistant professor of radiology at Harvard Medical School and a senior scientist at the MGH-ITA; and Pari Pandharipande, an associate professor of radiology at Harvard Medical School and the director of the MGH-ITA.

Penn State

Related Public Health Articles:

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.
The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.
BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.
The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.
Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.
Bloomberg American Health Initiative releases special public health reports supplement
With US life expectancy now on the decline for two consecutive years, the Bloomberg American Health Initiative is releasing a supplement to Public Health Reports, the scholarly journal of the US Surgeon General.
Data does the heavy lifting: Encouraging new public health approaches to promote the health benefits of muscle-strengthening exercise (MSE)
According to a new study in the American Journal of Preventive Medicine, almost 75 percent of US adults do not comply with public health guidelines recommending two or more muscle-strengthening exercise (MSE) sessions a week, with nearly 60 percent of the population doing no MSE at all.
The Lancet Public Health: Moderate carbohydrate intake may be best for health
Low-carb diets that replace carbohydrates with proteins and fats from plant sources associated with lower risk of mortality compared to those that replace carbohydrates with proteins and fat from animal sources.
Mass. public safety, public health agencies collaborate to address the opioid epidemic
A new study shows that public health and public safety agencies established local, collaborative programs in Massachusetts to connect overdose survivors and their personal networks with addiction treatment, harm reduction, and other community support services following a non-fatal overdose.
Cyber attacks can threaten public health
Gordon and Landman have authored a Perspective piece in the New England Journal of Medicine that addresses the growing threat of attacks on information systems and the potential implications on public health.
More Public Health News and Public Health Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Teaching For Better Humans 2.0
More than test scores or good grades–what do kids need for the future? This hour, TED speakers explore how to help children grow into better humans, both during and after this time of crisis. Guests include educators Richard Culatta and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#556 The Power of Friendship
It's 2020 and times are tough. Maybe some of us are learning about social distancing the hard way. Maybe we just are all a little anxious. No matter what, we could probably use a friend. But what is a friend, exactly? And why do we need them so much? This week host Bethany Brookshire speaks with Lydia Denworth, author of the new book "Friendship: The Evolution, Biology, and Extraordinary Power of Life's Fundamental Bond". This episode is hosted by Bethany Brookshire, science writer from Science News.
Now Playing: Radiolab

Dispatch 3: Shared Immunity
More than a million people have caught Covid-19, and tens of thousands have died. But thousands more have survived and recovered. A week or so ago (aka, what feels like ten years in corona time) producer Molly Webster learned that many of those survivors possess a kind of superpower: antibodies trained to fight the virus. Not only that, they might be able to pass this power on to the people who are sick with corona, and still in the fight. Today we have the story of an experimental treatment that's popping up all over the country: convalescent plasma transfusion, a century-old procedure that some say may become one of our best weapons against this devastating, new disease.   If you have recovered from Covid-19 and want to donate plasma, national and local donation registries are gearing up to collect blood.  To sign up with the American Red Cross, a national organization that works in local communities, head here.  To find out more about the The National COVID-19 Convalescent Plasma Project, which we spoke about in our episode, including information on clinical trials or plasma donation projects in your community, go here.  And if you are in the greater New York City area, and want to donate convalescent plasma, head over to the New York Blood Center to sign up. Or, register with specific NYC hospitals here.   If you are sick with Covid-19, and are interested in participating in a clinical trial, or are looking for a plasma donor match, check in with your local hospital, university, or blood center for more; you can also find more information on trials at The National COVID-19 Convalescent Plasma Project. And lastly, Tatiana Prowell's tweet that tipped us off is here. This episode was reported by Molly Webster and produced by Pat Walters. Special thanks to Drs. Evan Bloch and Tim Byun, as well as the Albert Einstein College of Medicine.  Support Radiolab today at Radiolab.org/donate.