Dose limits, prescribing guidelines, prescription drug monitoring programs, and similar interventions will have a “modest effect, at best” on the number of opioid overdose deaths in the future, a mathematical model projected.
Lowering the incidence of prescription opioid misuse from 2015 levels would decrease overdose deaths only 3% to 5% by 2025, according to Jagpreet Chhatwal, PhD, of Massachusetts General Hospital in Boston, and colleagues, writing in JAMA Network Open.
“If our aim is to bend the overdose death curve and fix the opioid overdose crisis in the near future, we will fail miserably by relying solely on controlling the supply of prescription opioids,” Chhatwal told MedPage Today.
Because deaths from illicit opioids appear to be rising, additional policy interventions are needed urgently, he added: “While initiatives designed to reduce exposure to prescription opioids are useful for preventing people from misusing opioids in the first place, these initiatives, in isolation, will not have much impact on opioid overdose deaths.”
“We’re currently in a very dynamic environment with many laws, regulations, and initiatives to address the opioid crisis,” observed Mark Bicket, MD, of the Johns Hopkins University School of Medicine in Baltimore, who was not involved with the study.
While making predictions that control for these elements is challenging, “it’s clear we need to focus on more than one strategy to make a meaningful impact on overdose deaths,” Bicket told MedPage Today: “Overdose deaths from opioids appear to be reaching a plateau, but deaths from synthetic opioids like illicit fentanyl appear to be rising, based on the most recent data from the CDC.”
In their analysis, Chhatwal and colleagues used data from the National Survey on Drug Use and Health (NSDUH) and the CDC from 2002 to 2015 to calibrate a systems dynamic model to project probable opioid outcomes to 2025. They analyzed the trajectory of the opioid epidemic based on four scenarios: if prescription opioid misuse remained at 2015 levels (reference); if it fell by 7.5%, per year, based on patterns from 2011 to 2015; if it fell even faster at 11.3%; and a hypothetical situation of no new incidence of misuse after 2015.
Under all scenarios, reducing the incidence of prescription opioid misuse decreased overdose deaths by 3.0% to 5.3%.
Based on 2015 levels, the annual number of opioid overdose deaths would increase from 33,100 in 2015 to 81,700 (95% uncertainty interval [UI], 63,600-101,700) in 2025, according to the model — a 147% increase. A total of 704,000 people (95% UI 590,200-817,100) would die from an opioid overdose during those years, with 80% of the deaths attributable to illicit opioids. Illicit opioids would be used by 61% more people, and about half of all new opioid users would begin with illicit rather than prescription drugs.
The projections echoed ones last year by Stanford University researchers, which showed that no single policy is likely to substantially reduce opioid deaths over 5 to 10 years. “Reducing opioid prescriptions will save lives, but this cannot be the nation’s only policy tool,” Keith Humphreys, PhD, of the Stanford School of Medicine, told MedPage Today.
“A big caveat with these forecasting studies is that they are very sensitive to the data you use and the assumptions made,” added Michael Barnett, MD, MS, of the Harvard T. H. Chan School of Public Health in Boston.
“Even if the exact magnitude and trends in opioid overdose may be different, I think the important point in this study is that reducing medical opioid prescribing will only have a modest impact on the national burden of overdose deaths,” Barnett told MedPage Today. “The largest challenge right now is how can we prevent overdoses and treat addiction in individuals who transition to heroin or fentanyl.”
The study has other limitations, Chhatwal and co-authors noted. The model was calibrated to data sources that underestimated outcomes: NSDUH, for example, excluded homeless and incarcerated populations. And interventions and opioid epidemic dynamics may have substantial variations at the local level, which the researchers could not include in their model.
The researchers reported relationships with the National Institute on Drug Abuse, Optum Labs, the National Center for Advancing Translational Sciences/Boston University Clinical & Translational Science Institute, the Centers for Disease Control and Prevention, the University of Maryland Baltimore/Office of National Drug Control Policy, and the Medical Imaging and Technology Alliance.