Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs: a three-setting analysis

Jack Stone; Louisa Degenhardt; Jason Grebely; Sarah Larney; Frederick L. Altice; Pavlo Smyrnov; Afarin Rahimi-Movaghar; Maryam Alavi; April M. Young; Jennifer R. Havens; William C. Miller; Matthew Hickman; Peter Vickerman

doi:10.1016/S2215-0366(20)30538-1

Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs: a three-setting analysis

Jack Stone, Louisa Degenhardt, Jason Grebely, Sarah Larney, Frederick L. Altice, Pavlo Smyrnov, Afarin Rahimi-Movaghar, Maryam Alavi, April M. Young, Jennifer R. Havens, William C. Miller, Matthew Hickman, Peter Vickerman

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

Background: Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran). Methods: We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020–40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4–11%; prison 0–40%); scaling up community OAT to 40% coverage; increasing average OAT duration from 4–14 months to 2 years; and scaling up prison-based OAT. Outcomes: Drug-related harms contributed differentially to mortality across settings: overdose contributed 27–47% (range of median projections) of preventable drug-related deaths over 2020–40, suicide 6–17%, injury 3–17%, HIV 0–59%, and HCV 2–18%. Existing OAT coverage in Tehran (31%) could have a substantial effect, averting 13% of preventable drug-related deaths, but will have negligible effect (averting <2% of preventable drug-related deaths) in Kyiv and Perry County due to low OAT coverage (<4%). Scaling up community OAT to 40% could avert 12–24% of preventable drug-related deaths, including 13–22% of overdose deaths, with greater effect in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have a significant additional effect, averting 27–51% of preventable drug-related deaths. Interpretation: OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics in people who inject drugs. Maximising these effects requires research and investment into achieving higher coverage and provision and longer retention of OAT in prisons and the community. Funding: UK National Institute for Health Research, US National Institute on Drug Abuse.

Original language	English
Pages (from-to)	301-309
Number of pages	9
Journal	The Lancet Psychiatry
Volume	8
Issue number	4
DOIs	https://doi.org/10.1016/S2215-0366(20)30538-1
State	Published - Apr 2021

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Ltd

Funding

This study was funded by the NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol, in partnership with Public Health England (PHE). The views expressed are those of the author and not necessarily those of NIHR, the Department of Health and Social Care, or PHE. JS, PV, and LD acknowledge funding from NIAID/NIDA (R01 AI147490). JS, FLA, and PV acknowledge support from NIDA (R01 DA033679). JS, MH, and LD acknowledge support from NHMRC (APP1150078). MH is an NIHR senior investigator and acknowledges NIHR School of Public Health Research. PV acknowledges support from the NIHR HPRU in Blood Borne and Sexually Transmitted Infections at University College London, and NIDA (R01 DA037773 and R01 DA047952). LD and SL are supported by NHMRC fellowships and NIH grants (NIDA R01DA1104470). The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government. FLA is supported on research related to this grant from NIDA (R01 DA043125, R01 DA029910, U01 DA045384, R21 DA047902, R01 DA030768, K24 DA017072, R01 DA025943, R01 DA030762, R21 DA041953). JRH, AMY, and the Social Networks in Appalachian People (SNAP) study were funded by grants from NIDA (R01 DA033862, R01 DA024598). We wish to acknowledge Hamid Sharifi and Alireza Noroozi for providing information for Tehran. JS and PV report grants from UK National Institute of Health Research (NIHR), during the conduct of the study. LD reports grants from Indivior and Seqirus, outside the submitted work. JG reports grants and personal fees from Abbvie, Gilead Sciences, Merck, and Cepheid, and grants from Hologic and Indivior, outside the submitted work. SL reports grants from Indivior, outside the submitted work. FLA reports grants paid to his organisation (for which he is principal investigator) from National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA), Fogarty International Center, US Health Resources and Services Administration, US Substance Abuse and Mental Health Services Administration, Gilead Foundation, and Merck; and personal fees for consulting, lectures, and speakers bureau from PracticePoint Communications, Clinical Care Options, Merck, Abbvie, and Gilead Sciences. JRH reports grants from Indivior, outside the submitted work. WCM reports grants from NIH, during the conduct of the study. MH reports personal fees from MSD and Gilead, outside the submitted work. All other authors declare no competing interests.

Funders	Funder number
Department of Health and Social Care
Merck
Australian Government Research Training Program
Gilead Foundation
NIHR Health Protection Research Unit
Substance Abuse and Mental Health Services Administration
AbbVie
National Institute for Health Research
Health Resources and Services Administration
Gilead Sciences
Hamid Sharifi and Alireza Noroozi
Fogarty International Center
Public Health England
University Hospitals Bristol NHS Foundation Trust and the University of Bristol
School for Public Health Research
NIHR HPRU
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse	R21DA047902, R01DA033862, U01DA045384, R01DA030762, K24DA017072, R01DA044170, R01DA033679, R21DA041953, R01DA030768, R01DA047952, R01DA025943, R01DA043125, R01DA024598, R01DA029910, R01DA037773
NIHR HPRU	R01 DA037773, R01 DA047952
National Institutes of Health (NIH)	R01DA1104470
Australian National Health and Medical Research Council	APP1150078, 1150078
Department of Health and Ageing, Australian Government	R01 DA030768, R01 DA025943, R21 DA047902, R01 DA029910, R01 DA033862, R01 DA024598, R01 DA030762, R01 DA043125, U01 DA045384, R21 DA041953, K24 DA017072
Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases	R01AI147490
National Heart, Lung, and Blood Institute Family Blood Pressure Program	R01HL150078
National Center for Advancing Translational Sciences (NCATS)	UL1TR001863

ASJC Scopus subject areas

Psychiatry and Mental health
Biological Psychiatry

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/S2215-0366(20)30538-1

Cite this

Stone, J., Degenhardt, L., Grebely, J., Larney, S., Altice, F. L., Smyrnov, P., Rahimi-Movaghar, A., Alavi, M., Young, A. M., Havens, J. R., Miller, W. C., Hickman, M., & Vickerman, P. (2021). Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs: a three-setting analysis. The Lancet Psychiatry, 8(4), 301-309. https://doi.org/10.1016/S2215-0366(20)30538-1

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title = "Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs: a three-setting analysis",

abstract = "Background: Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran). Methods: We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020–40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4–11\%; prison 0–40\%); scaling up community OAT to 40\% coverage; increasing average OAT duration from 4–14 months to 2 years; and scaling up prison-based OAT. Outcomes: Drug-related harms contributed differentially to mortality across settings: overdose contributed 27–47\% (range of median projections) of preventable drug-related deaths over 2020–40, suicide 6–17\%, injury 3–17\%, HIV 0–59\%, and HCV 2–18\%. Existing OAT coverage in Tehran (31\%) could have a substantial effect, averting 13\% of preventable drug-related deaths, but will have negligible effect (averting <2\% of preventable drug-related deaths) in Kyiv and Perry County due to low OAT coverage (<4\%). Scaling up community OAT to 40\% could avert 12–24\% of preventable drug-related deaths, including 13–22\% of overdose deaths, with greater effect in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have a significant additional effect, averting 27–51\% of preventable drug-related deaths. Interpretation: OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics in people who inject drugs. Maximising these effects requires research and investment into achieving higher coverage and provision and longer retention of OAT in prisons and the community. Funding: UK National Institute for Health Research, US National Institute on Drug Abuse.",

author = "Jack Stone and Louisa Degenhardt and Jason Grebely and Sarah Larney and Altice, \{Frederick L.\} and Pavlo Smyrnov and Afarin Rahimi-Movaghar and Maryam Alavi and Young, \{April M.\} and Havens, \{Jennifer R.\} and Miller, \{William C.\} and Matthew Hickman and Peter Vickerman",

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doi = "10.1016/S2215-0366(20)30538-1",

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Stone, J, Degenhardt, L, Grebely, J, Larney, S, Altice, FL, Smyrnov, P, Rahimi-Movaghar, A, Alavi, M, Young, AM , Havens, JR, Miller, WC, Hickman, M & Vickerman, P 2021, 'Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs: a three-setting analysis', The Lancet Psychiatry, vol. 8, no. 4, pp. 301-309. https://doi.org/10.1016/S2215-0366(20)30538-1

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T1 - Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs

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AU - Stone, Jack

AU - Degenhardt, Louisa

AU - Grebely, Jason

AU - Larney, Sarah

AU - Altice, Frederick L.

AU - Smyrnov, Pavlo

AU - Rahimi-Movaghar, Afarin

AU - Alavi, Maryam

AU - Young, April M.

AU - Havens, Jennifer R.

AU - Miller, William C.

AU - Hickman, Matthew

AU - Vickerman, Peter

PY - 2021/4

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N2 - Background: Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran). Methods: We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020–40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4–11%; prison 0–40%); scaling up community OAT to 40% coverage; increasing average OAT duration from 4–14 months to 2 years; and scaling up prison-based OAT. Outcomes: Drug-related harms contributed differentially to mortality across settings: overdose contributed 27–47% (range of median projections) of preventable drug-related deaths over 2020–40, suicide 6–17%, injury 3–17%, HIV 0–59%, and HCV 2–18%. Existing OAT coverage in Tehran (31%) could have a substantial effect, averting 13% of preventable drug-related deaths, but will have negligible effect (averting <2% of preventable drug-related deaths) in Kyiv and Perry County due to low OAT coverage (<4%). Scaling up community OAT to 40% could avert 12–24% of preventable drug-related deaths, including 13–22% of overdose deaths, with greater effect in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have a significant additional effect, averting 27–51% of preventable drug-related deaths. Interpretation: OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics in people who inject drugs. Maximising these effects requires research and investment into achieving higher coverage and provision and longer retention of OAT in prisons and the community. Funding: UK National Institute for Health Research, US National Institute on Drug Abuse.

AB - Background: Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran). Methods: We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020–40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4–11%; prison 0–40%); scaling up community OAT to 40% coverage; increasing average OAT duration from 4–14 months to 2 years; and scaling up prison-based OAT. Outcomes: Drug-related harms contributed differentially to mortality across settings: overdose contributed 27–47% (range of median projections) of preventable drug-related deaths over 2020–40, suicide 6–17%, injury 3–17%, HIV 0–59%, and HCV 2–18%. Existing OAT coverage in Tehran (31%) could have a substantial effect, averting 13% of preventable drug-related deaths, but will have negligible effect (averting <2% of preventable drug-related deaths) in Kyiv and Perry County due to low OAT coverage (<4%). Scaling up community OAT to 40% could avert 12–24% of preventable drug-related deaths, including 13–22% of overdose deaths, with greater effect in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have a significant additional effect, averting 27–51% of preventable drug-related deaths. Interpretation: OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics in people who inject drugs. Maximising these effects requires research and investment into achieving higher coverage and provision and longer retention of OAT in prisons and the community. Funding: UK National Institute for Health Research, US National Institute on Drug Abuse.

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Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs: a three-setting analysis

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

UN SDGs

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