Increased use of heroin as an initiating opioid of abuse

Cicero, Theodore J.; Ellis, Matthew S.; Kasper, Zachary A.

doi:10.1016/j.addbeh.2017.05.030

Cited by 135 publications

(118 citation statements)

References 13 publications

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“…Error bars represent 95% confidence intervals of the observed outcomes from the National Survey on Drug Use and Health (NSDUH) data, and shaded regions represent the bootstrapped 95% uncertainty intervals of the model outcomes. Cicero (2017) 17 indicates the source of calibration targets; and OPyM, opioid policy model.…”

Section: Resultsmentioning

confidence: 99%

“…Using data from the National Survey on Drug Use and Health (NSDUH), 21 the Centers for Disease Control and Prevention (CDC), 1 and published data, 17 we developed a mathematical model, the Opioid Policy Model , to simulate the opioid overdose crisis in the United States from 2002 to 2025. We calibrated the model to reproduce observed trends of opioid misuse and opioid overdose deaths up to year 2015, and then used it to project these outcomes from 2016 to 2025.…”

Section: Methodsmentioning

confidence: 99%

“…Observable data, used as calibration targets, included the annual prevalence for each compartment for 2002 through 2015 from NSDUH, 21 the annual number of overdose deaths from all opioids and from illicit opioids only for 2002 through 2015 from the CDC Wide-Ranging Online Data for Epidemiologic Research, 1 and the percentage of individuals who initiate opioid use with illicit (rather than prescription) opioids from 2005 to 2015 from the published literature (eTables 2 and 3 in the Supplement). 17 We applied a directed search algorithm 25 to identify the values of calibrated parameters such that model outcomes closely matched observable data between 2002 and 2015. To account for uncertainty in the calibrated parameter values, we repeated the calibration process 1000 times, resulting in 1000 independent sets of calibrated model parameters (eFigure 3 and eTable 4 in the Supplement).…”

Section: Methodsmentioning

confidence: 99%

“…This assumption was made to account for the possibility of an increasing rate of overdose deaths from illicit opioid use, driven by continued infiltration of highly potent synthetic opioids such as fentanyl and carfentanil 26,27 and the increasing incidence rate of illicit opioids as the first opioid of use, as observed in the preceding years. 1,17 However, because these rates are unlikely to continue to increase indefinitely, we assumed that the increasing trends of both rates would stabilize by 2020 (eAppendix 3 and eFigure 4 in the Supplement). This assumption was based on data from Massachusetts that showed saturation in the use of fentanyl and stabilization of the overdose rate in the state in 2017, 28 implying that such stabilization could happen in other states in the near future.…”

Section: Methodsmentioning

confidence: 99%

“…Many people who previously may have misused prescription opioids now use illicit opioids such as heroin and fentanyl (a synthetic opioid), 16 and an increasing number of people initiate opioid use with illicit rather than prescription opioids. 17 As such, the effect of interventions focused on lowering the prescription opioid supply and prescription opioid misuse on the future trajectory of the opioid epidemic is less clear. 18,19,20 …”

Section: Introductionmentioning

confidence: 99%

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Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States

et al. 2019

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Key PointsQuestionWhat is the projected effect of lowering incident nonmedical prescription opioid use on the future trajectory of the opioid overdose crisis in the United States?FindingsIn this system dynamics model study, under current conditions, the opioid overdose crisis is expected to worsen—with the annual number of opioid overdose deaths projected to reach nearly 82 000 by 2025, resulting in approximately 700 000 deaths from 2016 to 2025. Interventions focused on lowering the incidence of prescription opioid misuse were projected to result in a 3.0% to 5.3% decrease in opioid overdose deaths over this period.MeaningPrevention of prescription opioid misuse alone is projected to have a modest effect on lowering opioid overdose deaths in the near future, and multipronged approach is needed to dramatically change the course of the epidemic.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States

et al. 2019

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Underlying Factors in Drug Overdose Deaths

Dowell

Noonan

Houry

2017

JAMA

134

108

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Drug overdose accounted for 52 404 deaths in the United States in 2015, 1 which are more deaths than for AIDS at its peak in 1995. Provisional data from the US Centers for Disease Control and Prevention (CDC) indicate drug overdose deaths increased again from 2015 to 2016 by more than 20% (from 52 898 deaths in the year ending in January 2016 to 64 070 deaths in the year ending in January 2017). 2 Increases are greatest for overdoses related to the category including illicitly manufactured fentanyl (ie, synthetic opioids excluding methadone), which more than doubled, accounting for more than 20 000 overdose deaths in 2016 vs less than 10 000 deaths in 2015. This difference is enough to account for nearly all the increase in drug overdose deaths from 2015 to 2016. 2 Since 2010, overdose deaths involving predominantly illicit opioids (heroin, synthetic nonmethadone opioids, or both) have increased by more than 200% (Figure). Why have overdose deaths related to illicit opioids increased so substantially? Data from the National Survey on Drug Use and Health reveal moderate increases in people reporting past-year heroin use from 2010 to 2015 (Figure). Increasing numbers of individu-VIEWPOINT

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Government Actions to Curb the Opioid Epidemic

Kinnard

Philbin

Beletsky

2018

JAMA

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To the Editor Drs Kolodny and Frieden 1 outlined steps the government should take to curb the opioid epidemic, such as improving surveillance of prescribers through the use of databases, improving reporting and responses to overdoses, promoting more cautious guidelines for use of narcotics, increasing access and reimbursement for nonopioid and nonpharmacologic management of pain, interrupting supply of heroin and illicitly produced synthetic opioids, increasing access to addiction treatment, and reducing harm to current users. However, they left out the role the Drug Enforcement Administration (DEA) can play in its ability to block drug manufacturers and drug distributors from shipping suspiciously large narcotic shipments.Shipment seizure was hampered when the Ensuring Patient Access and Effective Drug Enforcement Act of 2016 2 was signed into law. Designed to ensure patient access to prescription opioids for legitimate use, it also changed the criteria used to justify opioid shipment seizures when sheer numbers of pills ordered by pain clinics, physicians, and pharmacies made it likely that these agents were supplying prescription opioids for diversion onto the black market. The DEA previously had authority to seize shipments that imposed "imminent danger," but the law requires the DEA to demonstrate that a shipment would represent a "substantial likelihood of an immediate threat." 2 This legal bar is much higher and basically prevents the DEA from using immediate suspension orders in cases involving drug manufacturers and distributors. This law was lobbied for by pharmaceutical companies and drug distributors between 2014 and 2016. [3][4][5] Since its passage, immediate suspension orders against physicians, pharmacies, drug distributors, and drug companies have decreased. 3

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Increased use of heroin as an initiating opioid of abuse

Cited by 135 publications

References 13 publications

Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States

Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States

Underlying Factors in Drug Overdose Deaths

Government Actions to Curb the Opioid Epidemic

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