0742 GMT July 20, 2019
Reducing access to powerful painkillers — through dose limits, prescribing guidelines and prescription drug monitoring programs — has been prioritized as a key response to the epidemic, aol.com wrote.
But without more aggressive action to rein in the illegal opioids that now drive more deaths than painkillers, the new research indicated that simply limiting the supply of prescription drugs will do little to curb the crisis' death toll.
"People who start using prescription opioids, at some point, may transition to the next stage, (and) as the supply-side shifts happen, we see increased availability of illicit opioids," said Jagpreet Chhatwal, an assistant professor at Harvard Medical School and a senior scientist at Massachusetts General Hospital's Institute for Technology Assessment. He is a co-senior author of the study, published Friday in JAMA Network Open.
Under what researchers call current conditions, annual opioid overdose deaths are projected to reach 81,700 by 2025 — a 147 percent increase from 10 years earlier — and 1.5 million Americans will be using illegal opioids like heroin and fentanyl by the same time, according to the study.
Overall, Chhatwal and his team of researchers project 700,400 people could die of an opioid overdose from 2016 to 2025.
To look at how targeting prescription drug misuse stands to impact the crisis, researchers analyzed the trajectory of the epidemic based on four base-case scenarios: If prescription opioid misuse remains at 2015 levels; if misuse falls by 7.5 percent per year, based on the pattern from 2011 to 2015; if misuse falls at a slightly faster rate of 11.3 percent; and if there were no new incidence of misuse after 2015 — a theoretical situation, Chhatwal said, not one grounded in reality.
The outlook was bleak for all four scenarios. At best under the more realistic models of declining prescription drug misuse, overall opioid overdose mortality could fall by just 3.8 percent to 5.3 percent by 2025.
"This is a complex problem, and it's difficult to know how changing one thing in this whole equation will change the direction of the epidemic," Chhatwal says.
The findings closely align with a US News analysis of nearly two decades of opioid mortality published this week. The opioid death rate in the US has risen fivefold since 1999, reaching 14.9 deaths per 100,000 population in 2017, and is likely to remain at a dangerously high level in the years to come.
The US News analysis, drawing from long-term patterns, offers a look into how the crisis has shifted and which changes in the death rate are most significant. Chhatwal's analysis adds insight on the potential future of the opioid epidemic, based on data over a prolonged time.
"This analysis reinforces the importance of looking at data over time," said Rocco Perla, co-founder of The Health Initiative. Perla carried out the US News analysis with the assistance of Lloyd Provost, a statistician with the consulting firm Associates in Process Improvement, and has independently reviewed Chhatwal's study.
"This model affirms that the opioid crisis has, at best, reached an elevated new normal and will likely get worse," Perla said.
The current crisis unfolded in three waves, the US News analysis shows, and can be traced to the 1990s and the advent of opioid painkiller OxyContin. Later, a surging death rate and a realization that addiction was overtaking the country led to a crackdown on prescription opioids, and with their painkiller supply curbed, many addicted patients turned to heroin.
In more recent years, deaths have been driven by a surge of the potent and lethal synthetic opioid fentanyl, often combined with drugs like heroin without users' knowledge.
"Our attempts at solutions actually made things worse," said Dr. Mike Brumage, an assistant dean at the West Virginia University School of Public Health.
"Restricting opioid prescriptions, without programs in place to transition people addicted, ended up pushing people into the illicit injection drug world, with all the attendant consequences."
The new study's findings indicate a ‘multipronged approach’ is necessary to meaningfully curb the opioid death toll, Chhatwal said — one that will require intensive collaboration at the federal, state and local levels.
"Prescription opioids are just one small part of it," he said.
"We will have to improve access to treatment (and) naloxone, which is the antidote for overdose. That will likely have a major impact on reducing opioid deaths, but we don't know how much we can quantify that yet."
Chhatwal said his next area of research will be measuring exactly how effective these interventions, when taken together, are at reducing opioid deaths. Ideally, the findings can help guide public health policy.
"I think that's an obvious extension of this work," he says.
"If this won't work, what will?"