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 among people who inject drugs (PWID) in Kentucky (USA), Kyiv (Ukraine), and Tehran (Iran).
Methods: We developed a dynamic model of HIV and HCV transmission, incarceration, and mortality through overdose, injury, suicide, disease-related or other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated ‘preventable drug-related deaths’ (‘pDRD’: HIV/HCV/overdose/suicide/injury) averted over 2020-2040 for four scenarios, added incrementally, compared to 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 contribute differentially to mortality across settings: overdose contributes 27-47% (range of median projections) of pDRDs over 2020-2040, suicide 6-17%, injury 3-17%, HIV 0-59% and HCV 2-18%. Existing OAT coverage in Tehran (31%) could have substantial impact, averting 13% pDRDs, but will have negligible impact (<2%) in Kyiv and Kentucky due to low OAT coverage (<4%). Scaling-up community OAT to 40% could avert 12-24% pDRDs, including 13-19% of overdose deaths, with greater impact in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have significant additional impact, averting 27-48% pDRDs.
Interpretation: OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics among PWID. Maximising these impacts requires research and investment into achieving higher coverage, longer retention and provision of OAT in prisons and the community.
Methods: We developed a dynamic model of HIV and HCV transmission, incarceration, and mortality through overdose, injury, suicide, disease-related or other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated ‘preventable drug-related deaths’ (‘pDRD’: HIV/HCV/overdose/suicide/injury) averted over 2020-2040 for four scenarios, added incrementally, compared to 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 contribute differentially to mortality across settings: overdose contributes 27-47% (range of median projections) of pDRDs over 2020-2040, suicide 6-17%, injury 3-17%, HIV 0-59% and HCV 2-18%. Existing OAT coverage in Tehran (31%) could have substantial impact, averting 13% pDRDs, but will have negligible impact (<2%) in Kyiv and Kentucky due to low OAT coverage (<4%). Scaling-up community OAT to 40% could avert 12-24% pDRDs, including 13-19% of overdose deaths, with greater impact in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have significant additional impact, averting 27-48% pDRDs.
Interpretation: OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics among PWID. Maximising these impacts requires research and investment into achieving higher coverage, longer retention and provision of OAT in prisons and the community.
Original language | English |
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Pages (from-to) | 301-309 |
Number of pages | 9 |
Journal | Lancet Psychiatry |
Volume | 8 |
Issue number | 4 |
Early online date | 25 Feb 2021 |
DOIs | |
Publication status | Published - Apr 2021 |
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Professor Matt Hickman
- Bristol Medical School (PHS) - Professor in Public Health and Epidemiology
- Bristol Population Health Science Institute
- Health Protection Research Unit (HPRU)
- Centre for Academic Mental Health
- Infection and Immunity
- Centre for Academic Primary Care
Person: Academic , Member, Group lead