Model tracks 21-year opioid crisis to better understand its evolving nature and guide the country’s policy response

A data-driven simulation model designed to help policymakers better understand and address the country’s rampant opioid crisis has been developed by a team of scientists from Massachusetts General Hospital (MGH). In a study from the journal PNAS, the researchers report that the model, known as SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects), presents the most detailed model to date of the crisis by capturing how the interconnections between the stages of prescribing and illicit opioid use, from initiation and treatment of addiction to relapse and overdose mortality, have evolved over time.

“The opioid crisis is so complex that it demands a dynamic simulation tool capable of generating reliable data and a holistic view of this major public health challenge,” says lead author Mohammad Jalali, PhD, of MGH Institute for Technology Assessment. “SOURCE provides a dynamic understanding of the trajectory of the opioid crisis that can serve as a framework to project future scenarios and inform public policy planning. »

Opioid overdose has been responsible for more than half a million deaths in the United States over the past 21 years. Opioid-related deaths have risen sharply since 2013, claiming almost 70,000 lives in 2020 alone, largely due to the illicit spread of fentanyl, a powerful opioid that is often mixed with heroin with an effect deadly. Millions of people suffer from opioid use disorders, with serious health, social and economic consequences for the country. In 2017, the National Academies of Sciences, Engineering, and Medicine called for the development of a quantitative system model to help understand the crisis and guide policy analysis and decision-making. In response, a team of researchers from MGH and the US Food and Drug Administration (FDA) developed SOURCE.

SOURCE uses national opioid use data from 1999 to 2020 to track the stages of opioid use and abuse, including initiation of use, treatment, relapse and overdose death. “Unlike other national models of the crisis, SOURCE replicates how the risks of opioid abuse have evolved over time in response to various behavioral and other factors, and how they may change in the future, providing a platform to project and analyze potential policy impacts and solutions,” says co-author Tse Yang Lim, PhD, of the Massachusetts Institute of Technology (MIT).

Among the factors driving these changes are social influence – that is, the spread of drug-using behaviors through social exposure – and risk perception, fear of the perceived risk of death by overdose which can discourage initiation into drug use. SOURCE also quantified the impact of increased distribution of the overdose reversal drug naloxone, as well as the proliferation of the deadly synthetic substance fentanyl, on overdose death rates. Overall, SOURCE predicts that deaths from opioid overdose will increase over the next few years before declining as opioid use disorder declines.

Using SOURCE, researchers are examining potential strategies for dealing with the opioid crisis as part of an ongoing modeling effort, while continuing to refine the model to reflect the ever-evolving nature of the crisis. “Despite the projected decline, opioid-related deaths over the next 10 years will still exceed half a million people,” co-author Erin Stringfellow, PhD, points out with MGH. “Fentanyl poisoning of the unregulated drug supply will continue to be a serious problem, which is why leaders across the country must work as hard as possible to keep people who use drugs safe. »

Jalali is an assistant professor at Harvard Medical School. Tse Yang Lim recently graduated with a doctorate from MIT. Stringfellow is a postdoctoral research associate at the MGH Institute for Technology Assessment. Co-authors include Keith Humphreys, professor and section director for mental health policy at Stanford University, and several FDA researchers.

The study was supported by the United States Food and Drug Administration.

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Materials provided by Massachusetts General Hospital. Note: Content may be edited for style and length.

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