Estimated Reductions in Opioid Overdose Deaths With Sustainment of Public Health Interventions in 4 US States.
Estimated Reductions in Opioid Overdose Deaths With Sustainment of Public Health Interventions in 4 US States.
复制标题
DOI：
10.1001/jamanetworkopen.2023.14925
复制
发表时间：
2023-06-01
影响因子：
13.8
通讯作者：
Barbosa, Carolina
中科院分区：
文献类型：
--
作者：
Chhatwal, Jagpreet;Mueller, Peter P.;Chen, Qiushi;Kulkarni, Neeti;Adee, Madeline;Zarkin, Gary;LaRochelle, Marc R.;Knudsen, Amy B.;Barbosa, Carolina
在美国4个州，持续的公共卫生干预与阿片类药物相关过量死亡（OOD）的减少有什么关系？在模拟肯塔基州、马萨诸塞州、纽约州和俄亥俄州（4个受阿片类药物流行影响的州）阿片类药物流行的决策分析模型中，阿片类药物使用障碍药物的开始和保留增加2- 5倍沿着纳洛酮供应增加可使OOD在肯塔基州减少13%-17%，在马萨诸塞州减少17%-27%，与现状相比，纽约为15%至22%，俄亥俄州为15%至22%。将这些干预措施再持续3年，5年结束时，肯塔基州每年的OOD数量可减少18%至27%，马萨诸塞州为28%至46%，纽约为22%至34%，俄亥俄州为25%至41%。这些研究结果表明，持续实施综合干预措施对于减少阿片类药物过量死亡的年度人数和防止受阿片类药物流行严重影响的州的死亡人数再次增加至关重要。该决策分析模型估计了在不同公共卫生干预持续时间下阿片类药物相关过量死亡的预计数量变化，包括增加阿片类药物使用障碍和纳洛酮分配工作的药物开始和保留。2021年，超过8万名美国居民死于阿片类药物过量。公共卫生干预措施，如帮助结束成瘾长期（治愈）社区研究（HCS），正在启动，目标是减少阿片类药物相关的过量死亡（OOD）。与现状相比，估计在干预持续时间的不同情景下，预计的业务中断数量的变化。该决策分析模型模拟了2020年至2026年参与HCS的4个州（即肯塔基州、马萨诸塞州、纽约和俄亥俄州）的阿片类药物流行情况。参与者是从阿片类药物滥用过渡到阿片类药物使用障碍（OUD），过量，治疗和复发的模拟人群。该模型使用来自全国药物使用和健康调查，美国疾病控制和预防中心以及各州其他来源的2015年至2020年数据进行校准。该模型解释了COVID-19大流行期间OUD（MOUD）的开始用药减少和OOD的增加。将MOUD启动增加2或5倍，将MOUD保留率提高到临床试验环境中达到的水平，增加纳洛酮分布努力，并进一步安全阿片类药物处方。模拟了最初2年的干预持续时间，并可能再维持3年。在不同的干预措施组合和持续时间下，预计减少的业务中断次数。与现状相比，在干预的第二年年底，估计OOD的年减少率在肯塔基州为13%至17%，在马萨诸塞州为17%至27%，在纽约为15%至22%，在俄亥俄州为15%至22%。在肯塔基州、马萨诸塞州、纽约和俄亥俄州，将所有干预措施再持续3年，估计可将第5年末的OOD年度数量减少18%至27%、28%至46%、22%至34%。干预措施持续的时间越长，结果就越好;但是，如果干预措施不能持续，这些积极的成果就会付诸东流。在这项对美国4个州阿片类药物流行的决策分析模型研究中，发现需要持续实施干预措施，包括增加MOUD和纳洛酮供应，以减少OOD并防止死亡再次增加。
What is the association of sustaining public health interventions with the reduction in opioid-related overdose deaths (OODs) in 4 US states? In this decision analytical model that simulated the opioid epidemic in Kentucky, Massachusetts, New York, and Ohio, 4 states highly affected by the opioid epidemic, a 2- to 5-fold increase in initiation and retention of medications for opioid use disorder along with increased supply of naloxone could reduce OODs by an estimated 13% to 17% in Kentucky, 17% to 27% in Massachusetts, 15% to 22% in New York, and 15% to 22% in Ohio after 2 years, compared with the status quo. Sustaining these interventions for 3 additional years could reduce the annual number of OODs at the end of 5 years by 18% to 27% in Kentucky, 28% to 46% in Massachusetts, 22% to 34% in New York, and 25% to 41% in Ohio. These findings suggest that sustained implementation of a combination of interventions is critical for achieving a reduction in the annual number of opioid overdose deaths and preventing deaths from increasing again in states highly affected by the opioid epidemic. This decision analytical model estimates the change in the projected number of opioid-related overdose deaths under different durations of public health interventions, including increasing initiation and retention of medications for opioid use disorder and naloxone distribution efforts. In 2021, more than 80 000 US residents died from an opioid overdose. Public health intervention initiatives, such as the Helping to End Addiction Long-term (HEALing) Communities Study (HCS), are being launched with the goal of reducing opioid-related overdose deaths (OODs). To estimate the change in the projected number of OODs under different scenarios of the duration of sustainment of interventions, compared with the status quo. This decision analytical model simulated the opioid epidemic in the 4 states participating in the HCS (ie, Kentucky, Massachusetts, New York, and Ohio) from 2020 to 2026. Participants were a simulated population transitioning from opioid misuse to opioid use disorder (OUD), overdose, treatment, and relapse. The model was calibrated using 2015 to 2020 data from the National Survey on Drug Use and Health, the US Centers for Disease Control and Prevention, and other sources for each state. The model accounts for reduced initiation of medications for OUD (MOUDs) and increased OODs during the COVID-19 pandemic. Increasing MOUD initiation by 2- or 5-fold, improving MOUD retention to the rates achieved in clinical trial settings, increasing naloxone distribution efforts, and furthering safe opioid prescribing. An initial 2-year duration of interventions was simulated, with potential sustainment for up to 3 additional years. Projected reduction in number of OODs under different combinations and durations of sustainment of interventions. Compared with the status quo, the estimated annual reduction in OODs at the end of the second year of interventions was 13% to 17% in Kentucky, 17% to 27% in Massachusetts, 15% to 22% in New York, and 15% to 22% in Ohio. Sustaining all interventions for an additional 3 years was estimated to reduce the annual number of OODs at the end of the fifth year by 18% to 27% in Kentucky, 28% to 46% in Massachusetts, 22% to 34% in New York, and 25% to 41% in Ohio. The longer the interventions were sustained, the better the outcomes; however, these positive gains would be washed out if interventions were not sustained. In this decision analytical model study of the opioid epidemic in 4 US states, sustained implementation of interventions, including increased delivery of MOUDs and naloxone supply, was found to be needed to reduce OODs and prevent deaths from increasing again.
登录
查看更多内容
影响因子：
2.8
作者：
Husereau D;Drummond M;Augustovski F;de Bekker-Grob E;Briggs AH;Carswell C;Caulley L;Chaiyakunapruk N;Greenberg D;Loder E;Mauskopf J;Mullins CD;Petrou S;Pwu RF;Staniszewska S;CHEERS 2022 ISPOR Good Research Practices Task Force
通讯作者：
CHEERS 2022 ISPOR Good Research Practices Task Force
DOI：
10.1111/add.13265
发表时间：
2016-05
期刊：
Addiction (Abingdon, England)
影响因子：
--
作者：
Bird SM;McAuley A;Perry S;Hunter C
通讯作者：
Hunter C
影响因子：
13.8
作者：
Cartus AR;Li Y;Macmadu A;Goedel WC;Allen B;Cerdá M;Marshall BDL
通讯作者：
Marshall BDL
影响因子：
12.7
作者：
Friedman, Joseph;Akre, Samir
通讯作者：
Akre, Samir
在19009年大流行期间，处方阿片类镇痛药和丁丙诺啡的阿片类药物使用障碍。
影响因子：
13.8
作者：
Currie JM;Schnell MK;Schwandt H;Zhang J
通讯作者：
Zhang J