The study suggests a comprehensive approach is needed — one that goes way further than what America has done so far.
The opioid epidemic is the deadliest drug overdose crisis in US history — on track to kill more people over the next decade than currently live in entire American cities like Miami or Baltimore.
A new study, published in the American Journal of Public Health on Thursday by Stanford researchers Allison Pitt, Keith Humphreys, and Margaret Brandeau, tries to parse out how America can reduce the death toll. Using a mathematical model, the study brings together research and expert opinions to calculate the epidemic’s death toll and how different policy ideas can stem the toll.
First, a shocking number: 510,000. That’s a rough estimate of how many people will die over the next decade due to opioid-related causes, which include overdoses and other causes of death tied to opioids, such as HIV infections from sharing syringes. But the researchers caution that the number, as with other estimates in the study, are fuzzy and subject to change — given that this is, after all, trying to predict the future.
“The trend that we’ve seen in the last year would suggest that there’s reason to believe that [the death toll] could be even greater, really,” Pitt told me, referring to data showing a rise in opioid overdose deaths in 2017. “But it’s really hard to say.”
The good news is the study found America can do some things to reduce the death toll.
The bad news is it implied the US has to go much further than policymakers have so far — dramatically scaling up proven addiction treatment modalities, needle exchanges, and access to the opioid overdose antidote naloxone. And while pulling back excess opioid painkiller prescriptions is another important piece, the study suggested that some of the ways policymakers have proposed doing that may be downright harmful, at least over a 10-year window.
The study looked at potential solutions
The study emphasized that there is no one silver bullet for the opioid crisis (as experts have told me before). There are some policies that have a bigger impact than others, but none by themselves get close to ending the crisis on their own.
“No single policy is likely to substantially reduce deaths over 5 to 10 years,” the researchers wrote.
The model, for example, estimated that wider availability of naloxone could reduce opioid-related deaths by 21,200 over 10 years; that medication-based treatments for opioid addiction like buprenorphine and methadone would reduce deaths by 12,500; and that reductions in painkiller prescribing for acute pain would reduce deaths by 8,000.
Again, the researchers cautioned that the individual numbers here aren’t too important. Since this is a model making predictions, these figures are not totally accurate. Instead, what’s important is the overall story that they tell us.
How different policy interventions would affect opioid-related deaths over 10 years
On the harm reduction and treatment front, the model suggested that several interventions — more naloxone, more needle exchanges, more medication-based treatment, and more psychosocial treatment — would have unambiguously good effects, reducing both heroin and painkiller deaths over the next 10 years. But none of them would have giant effects on their own, with potentially hundreds of thousands of deaths still taking place even with the interventions.
Where it gets a little messier is the prescription painkiller control side. With these policies, the model suggested that some interventions could actually increase the number of deaths within five and, in fewer cases, 10 years.