New evidence has been published that opioid agonists such as methadone and buprenorphine could significantly reduce drug-related deaths if used more widely in the community and in prison, and for a longer period of time, published in Lancet Psychology.
Treatment of people who are addicted to opioids with methadone or buprenorphine also known as ‘opioid agonist treatment’ (OAT) reduces many of the harms associated with injecting drug use. including death by overdose, suicide, injury, or other causes. OAT also reduces the risk of the spread of HIV virus or hepatitis C and increases contact with HIV treatment and improves its outcomes, which may reduce deaths from these diseases.
Globally, mortality is high among people who inject drugs (mainly opioid drugs), with poor OAT access and its effects may be limited by a short period of treatment.
An international team led by the NIHR Health Protection Research Unit in Behavioral Science and Assessment at the University of Bristol described various scenarios to predict how many drug-related deaths could be prevented over a 20-year period by OAT scaling among injecting drug users. .
They explained three global scenarios – Kyiv (Ukraine), Tehran (Iran) and Perry County in Kentucky (USA) – chosen because of their differences across several important factors: risk of community mortality, incidence of HIV, treatment HIV and proportions of people who inject drugs using OAT in the community and in prison.
The circumstances considered the number of drug-related deaths that were prevented:
- there was no increase in OAT use
- The OAT scale was used for use by 40 percent of people who inject drugs in the community
- OAT has been scaled for use by 40 percent of people who inject drugs in the community and increase the average time on OAT from 4-14 months to two years, and
- OAT went up in the community (as 3 above) and for prison numbers.
For each setting, they predicted the number of deaths from hypertension, suicide, injury, and HIV-related infection and hepatitis C.
The researchers found that scaling up OAT use to 40 percent could prevent between 12 percent and 24 percent of drug-related deaths, including 13-19 percent of overweight deaths, with greater impact in cases of high HIV mortality (Tehran and Kyiv).
Improving the length of time people were on OAT and providing prison-based OAT was expected to have a significant additional impact, avoiding between 27 percent and 48 percent of drug-related deaths.
The different effects of OAT contributed differently to its overall effect in scenario 4 due to changes in the frequency of different health harms; The impact of OAT on reducing HIV transmission was most significant in Kyiv and Tehran accounting for 43-68 per cent of postponed deaths, but the impact of OAT on reducing deaths was far more significant in Perry County, accounting for 63 percent of averted deaths.
OAT is an emergency intervention that has been proven to be highly cost-effective by significantly reducing the health and social harms associated with opioid dependence and injecting drug use. Our analysis has shown that the significant public health burden caused by injecting drug use can be significantly reduced through scaling up OAT. “
Dr Jack Stone, Principal Author of Research, NIHR Health Protection Research Unit in Behavioral Science and Assessment, University of Bristol
“The impact is probably greatest in cases with high HIV mortality and can be increased by improving retention in OAT and providing prison-based OAT. Previous studies have shown ‘reducing the impact and cost-effectiveness of OAT on reducing mortality as a result of mere consideration of a limitation. OAT range of benefits. “
Professor Peter Vickerman, senior co-author of the NIHR Health Protection Research Unit in Behavioral Science and Assessment at Bristol University, said: “This is the most complete modeling analysis yet of the potential impact at OAT on injecting drug – related mortality and provides strong evidence that scaling up OAT is a priority for improving injecting drug health and high mortality. “
Professor Matt Hickman, senior co-author of the NIHR Health Protection Research Unit in Behavioral Science and Assessment at the University of Bristol, said, “Recent global reviews have shown that OAT coverage is low in many countries. OAT is a life-saving intervention – scaling up and keeping people injecting drugs on OAT is critical to tackling the opioid-related death health crisis’ “
Professor Louisa Degenhardt, co-author of the National Drug and Alcohol Research Center, UNSW Sydney, Australia, said “This study provides further evidence of the importance, at a population level, of OAT delivered at scale, not only to people living in opioid dependence in the community, but importantly, to people in prison. We hope that this evidence will help to increase OAT growth in all cases. “