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Increased opioid agonist treatment could reduce drug deaths

Friday February 26th 2021

Scaling up the use of opioid agonists could help to reduce drug-related deaths substantially, new international research claims.

A team led by the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol in the UK modelled different scenarios to predict how many drug related deaths could be prevented over 20 years by increasing opioid agonist treatment (OAT) among people who inject drugs.

In what is the most comprehensive modelling analysis yet of the potential impact of agonists on reducing mortality among people who inject drugs, the research team focused on three global settings: Kyiv in Ukraine; Tehran in Iran; and Perry County, Kentucky, USA.

These were chosen because of their differences in mortality risk in the community, HIV prevalence, HIV treatment and proportions of people who inject drugs using OAT in the community and prison.

Writing in Lancet Psychiatry, the team say they modelled four different scenarios to establish how many drug-related deaths would be prevented.

These were: no increase in the use of OAT; use of OAT scaled up to being used by 40% of people who inject drugs in the community; OAT scaled up to being used by 40% of people who inject drugs in the community and increasing the average length of time on OAT from four-14 months to two years; and scaling up OAT to that in the third scenario and adding prison populations.

For each scenario they predicted how many deaths from overdose, suicide, injury, and HIV and hepatitis C related disease could be prevented.

They found if OAT was used by up to 40% of those who inject drugs in the community, it could prevent between 12% and 24% of all drug-related deaths, with a greater impact in Tehran and Kyiv, where there are higher HIV mortality rates.

The team calculated that increasing the length of OAT time and including prison populations could prevent between 27% and 48% of drug-related deaths. However, in this fourth scenario, the effect of OAT on reducing HIV transmission in Kyiv and Tehran could be between 43% and 68%, while it could reduce overdose mortality in Perry County by 63%.

Dr Jack Stone from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol and lead author of the study, said: "OAT is a critical intervention which has been shown to be highly cost-effective through substantially reducing the health and social harms associated with opioid dependence and injecting drug use.

"Our analysis has shown that the substantial public health burden caused by injecting drug use can be markedly reduced through scaling up of OAT.

"The impact may be greatest in settings with significant HIV mortality and can be maximised by improving retention in OAT and providing prison-based OAT. Previous studies have likely underestimated the impact and cost-effectiveness of OAT on reducing mortality due to only considering a limited range of benefits of OAT."

Co-author Professor Louisa Degenhardt, of the National Drug and Alcohol Research Centre, UNSW Sydney, Australia, added: "This study provides more evidence of the importance, at the population level, of OAT provided at scale, not only for people who are opioid dependent living in the community, but very importantly, for people who are in prison. We hope that this evidence can assist with increasing provision of OAT in all settings."

Stone J et al. Modelling the intervention effect of opioid agonist treatment in multiple mortality outcomes in people who inject drugs: a three-setting analysis. Lancet Psychiatry 26 February 2021

[abstract]

Tags: Australia | Drug & Alcohol Abuse | UK News

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