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 Young, Jennifer Havens, William C Miller, Matthew Hickman, Peter Vickerman

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

27 Citations (Scopus)
49 Downloads (Pure)

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.
Original languageEnglish
Pages (from-to)301-309
Number of pages9
JournalLancet Psychiatry
Volume8
Issue number4
Early online date25 Feb 2021
DOIs
Publication statusPublished - Apr 2021

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