Breaking News
November 14, 2018 - Change Within the Eye May Be Early Warning for Macular Degeneration
November 14, 2018 - Study of 500,000 people clarifies the risks of obesity
November 14, 2018 - Ultrasound releases drug to alter activity in targeted brain areas in rats | News Center
November 14, 2018 - Cancer stem cells depend on amino acid metabolism, and it’s proving to be their Achilles’ heel
November 14, 2018 - Epigenetic link found between prenatal exposure to maternal smoking and offspring’s cardio-metabolic health
November 14, 2018 - Meditation, music may change biomarkers of cellular aging and Alzheimer’s disease in older adults
November 14, 2018 - Multidisciplinaryresearch teams selected to study age-related brain disorders
November 14, 2018 - The Current issue of “The view from here” is concerned with Informatics
November 14, 2018 - Researchers identify tool to help transgender women have a more authentic voice
November 14, 2018 - Four faculty members appointed to endowed professorships | News Center
November 13, 2018 - Research finds strongest evidence yet that obesity causes depression
November 13, 2018 - Researchers compare stools of breastfed and formula-fed infants
November 13, 2018 - Entasis Therapeutics Announces Zoliflodacin Phase 2 Results Published in The New England Journal of Medicine
November 13, 2018 - Gene changes driving myopia reveal new focus for drug development
November 13, 2018 - $6 million grant to support study of preeclampsia, atherosclerosis links | News Center
November 13, 2018 - Beneficial gut microbes metabolize high-fiber diet to improve heart health in mouse model
November 13, 2018 - Excessive use of social media through visual postings linked to increase in narcissistic traits
November 13, 2018 - Study finds why obesity both fuels cancer growth and helps immunotherapy to kill tumors
November 13, 2018 - Women prefer and invest more in daughters, while men favor sons
November 13, 2018 - With hospitalization losing favor, judges order outpatient mental health treatment
November 13, 2018 - Transgenic rat model may provide new insights into cerebral amyloid angiopathy
November 13, 2018 - Study identifies factors tied to greater risk of advanced liver disease in cystic fibrosis patients
November 13, 2018 - Risk of blindness among premature babies with low levels of blood platelets
November 13, 2018 - A new strategy for combatting antibiotic-resistant infections
November 13, 2018 - Study aims to find which outreach method is more effective at improving cancer screening rates
November 13, 2018 - Insufficient sleep duration linked with unhealthy lifestyle profile among children
November 13, 2018 - IIASA researchers introduce new, simple measure for human wellbeing
November 13, 2018 - Magnetic nanosprings used as targeted drug delivery agents for anticancer therapy
November 13, 2018 - Scientists examine FCMs containing silver nanoparticles
November 13, 2018 - Failed DNA repair triggers chromosomal chaos
November 13, 2018 - Study shows new emerging role of osteopontin in HCV-related hepatocellular carcinoma
November 13, 2018 - Food insecurity during pregnancy linked to severity of neonatal abstinence syndrome
November 13, 2018 - Majority of Americans are concerned about health threat posed by antibiotic resistance
November 13, 2018 - Addition of Elotuzumab Ups PFS in Refractory Multiple Myeloma
November 13, 2018 - Study finds women with pregnancy-related nausea, vomiting use marijuana more
November 13, 2018 - Lethal heart rhythm more likely to be found in patients with common heart failure
November 13, 2018 - Study provides new clues to origin and development of multiple sclerosis
November 13, 2018 - Climate change could pose threat to male fertility
November 13, 2018 - Researchers discover how mitochondria deploy a powerful punch against disease-causing bacteria
November 13, 2018 - AHA: Traumatic Childhood Could Increase Heart Disease Risk in Adulthood
November 13, 2018 - Feeling the Burn? | NIH News in Health
November 13, 2018 - Women’s birth canals in Kenya, Korea, Kansas not the same: study
November 13, 2018 - Fecal microbiota transplantation effective against ICI-associated colitis
November 13, 2018 - New physical activity guidelines released that urge people to “move more”
November 13, 2018 - Angiotensin receptor blockers improve sodium excretion in blacks
November 13, 2018 - New project seeks to address alarming injury rate in youth footballers
November 13, 2018 - Fish oil or omega 3 fatty acid supplements can prevent heart attacks finds study
November 13, 2018 - The Human Heart-in-a-Jar That Could One Day Replace Animal Testing
November 13, 2018 - Treat patients’ partners without a doctor visit
November 13, 2018 - Belgian beer landscape mapped using scientific insights
November 13, 2018 - ‘Master key’ gene has links to both ASD and schizophrenia
November 13, 2018 - Gladstone scientists gain new insights into the aging brain
November 13, 2018 - Drug therapy can improve outcomes for acutely ill heart patients
November 13, 2018 - Three landmark studies provide better understanding of sudden cardiac arrest
November 13, 2018 - Cholesterol control revised in the latest AHA/ACC guidelines
November 13, 2018 - Vulnerable young teenagers urgently need better sex education, say researchers
November 13, 2018 - Breakthrough research reveals how deadly pneumococcus avoids immune defenses
November 13, 2018 - Researchers discover possible path forward in preventing cancers tied to two viruses
November 13, 2018 - Wishes can help pediatric patients to get better over time
November 13, 2018 - Janssen Reports Positive Topline Results for FLAIR Phase 3 Study of a Novel, Long Acting Injectable Two-Drug Regimen for the treatment of HIV-1
November 13, 2018 - Experimental compound reduces Gulf War illness-like behavior in mice
November 13, 2018 - Small-stature in rainforest populations may be linked to cardiac adaptations
November 13, 2018 - Study shows how pneumococci challenge the immune system
November 13, 2018 - Simple cysts can be safely ignored, study finds
November 13, 2018 - First fully personalized tissue implant engineered from patient’s own materials and cells
November 13, 2018 - FDA Approves Keytruda (pembrolizumab) in Combination with Carboplatin and Either Paclitaxel or Nab-Paclitaxel for the First-Line Treatment of Patients with Metastatic Squamous Non-Small Cell Lung Cancer (NSCLC)
November 13, 2018 - Scientists take big step toward finding non-addictive painkiller
November 13, 2018 - Diabetes medication reduces risk of heart failure hospitalization
November 13, 2018 - Achieving high follow-up rates for violently injured patient population is feasible
November 13, 2018 - Shortage of specific gene ‘silencing’ molecules linked with pediatric low-grade gliomas
November 13, 2018 - Abx-Resistant Enterobacteriaceae Tied to Clinical Failure in UTI
November 13, 2018 - US approves first new type of flu drug in 2 decades
November 13, 2018 - Is zinc the link to how we think? Some evidence, and a word of warning
November 13, 2018 - Dispelling taboos, Michelle Obama talks IVF and miscarriage
November 13, 2018 - Medical experts discuss future challenges of healthcare at HSMA’s inaugural conference
November 13, 2018 - Growth and spread of deadly eye tumor suppressed in cells, animals
November 12, 2018 - Study finds huge shortfall in use of home-based medical care by frail seniors
November 12, 2018 - Cocaine Cut With Anti-Worming Drug, Levamisole, May Cause Brain Damage
November 12, 2018 - Obese mice lose a third of their fat using a natural protein
November 12, 2018 - Behind many a Parkinson’s case lurks a mutation in a gene called LRRK2 — why?
New model could help stem opioid crisis

New model could help stem opioid crisis

image_pdfDownload PDFimage_print
Credit: CC0 Public Domain

Stanford University researchers have developed a mathematical model that could help public health officials and policymakers curb an opioid epidemic that took the lives of an estimated 49,000 Americans last year.

The model includes data about prescriptions, addictions and overdoses in the United States. It can be used to consider “what if” scenarios similar to those that business leaders run through to project how changing product features or prices are likely to affect sales and profits, said Margaret Brandeau, Ph.D., professor of management science and engineering.

Brandeau is the senior author of a paper that describes how the model analyzes opioid use and addiction among Americans whose initial exposure to these drugs came either from being prescribed pills or gaining illicit access to pills.

The paper will be published Aug. 23 in the American Journal of Public Health. The lead author is graduate student Allison Pitt.

‘Like squeezing a balloon’

Using models is relatively new in the realm of public health, where responsibility for solving problems is widely diffused among a variety of governmental and private sector decision-makers, said co-author Keith Humphreys, Ph.D., the Esther Ting Memorial Professor and a professor of psychiatry and behavioral sciences.

“Confronting this crisis is like squeezing a balloon,” said Humphreys, an expert on substance abuse. “When you touch one aspect of the situation, an unpleasant consequence often pops up somewhere else.”

The paper cites the daunting facts of the opioid crisis: Between 1990 and 2010, there was a 400 percent spike in prescriptions for opioid painkillers. Today, roughly 3.5 million Americans have become addicted to opioids as a result of an initial exposure to opioid pills. Yet, as doctors have begun responding to the crisis by reducing prescriptions, overdose deaths have increased because former pill addicts, unable to get the quality-controlled drug, have started buying and overdosing on heroin.

Against this bleak backdrop, the Stanford model projects that if doctors can cut prescriptions by 25 percent over a 10-year period, while policymakers expand drug treatment programs, addictions and deaths will start falling by 2026.

“People want this to be over sooner, but the model shows that we’ve dug ourselves such a deep hole that it will take time to climb out,” said Brandeau, who also holds the Coleman F. Fung Professorship in the School of Engineering.

Putting the puzzle together

Humphreys said the model puts multiple parts of the opioid-crisis puzzle together so that government and private-sector officials can see how addressing any given aspect of the crisis will affect the big picture.

“This is perhaps the most complex public health challenge we’ve ever faced,” Humphreys said. “We need this tool to avoid policy paralysis.”

Pitt, the lead author, spent the last two years collecting data on opioid use and addiction and other variables. The researchers based their model on data from 2015. Thereafter the model made projections for such variables as what fraction of American adults experience moderate to severe pain each year; how many opioid painkillers are prescribed; how many people have become addicted to opioids by starting with pills; and how many Americans who initially became addicted through exposure to pills die each year from overdoses of pharmaceutical opioids or heroin.

In 2015, when 188 million opioid prescriptions were issued, 3.5 million Americans were already addicted to opioids through initial exposure to pills. Of these, the researchers estimated that roughly 16,000 died as a result of a pill overdoses. Another 22,000 who were initially hooked on pills died that year from heroin overdoses. This crossover from pills to street drugs, which often occurs when pill addicts can no longer get prescription medications, is one tragic aspect of the opioid crisis. In addition to these 38,000 deaths related to pill exposure, an estimated 26,000 more Americans died of overdoses from other drugs, mainly from cocaine and methamphetamine in 2015. But the Stanford study does not factor these deaths into the model.

Instead, the researchers focused on overdoses that could be traced to pill exposure and projected forward 10 years to make educated guesses about how different scenarios would be likely to decrease addiction and death rates stemming from pharmaceutical opioids. The first, or baseline, scenario was to project the status quo. If current trends prevail, the model projects that 188 million prescriptions would still be written in 2026, and that by then an estimated 4.3 million Americans would have become addicts through an initial exposure to pills. Pill-connected overdose deaths would likely soar to an estimated 50,000, compared with 38,000 in 2015.

Considering the ‘what ifs’

After establishing this baseline, the researchers considered various scenarios by which the epidemic might be slowed: What if physicians reduced new prescriptions across the board? What if there were controls on refills? What if there were easy ways for patients to get rid of their excess pills so they don’t get misused? What if various post-addiction treatments were made more available?

The scenario that assumes physicians reduce opioid prescriptions by 25 percent resulted in 2,500 fewer overdoses over 10 years than the status quo. “We must restrict the supply of pills to have any hope of bringing this crisis under control,” Brandeau said.

The model considers the likelihood that as pills become unavailable, more opioid addicts will buy street heroin—a deadlier opioid with a higher chance of overdose. The researchers highlighted two treatment measures that, when combined with prescription cutbacks, seem most effective at reducing overdose deaths. The first policy is to greatly increase the availability of naloxone, a drug that can reverse the effects of an overdose if administered before the person’s body shuts down from what physicians call opioid poisoning. “Emergency rooms can administer naloxone if a person is brought to them in time, but we have to get this life-saving treatment more broadly into the hands of first responders,” Humphreys said.

The researchers also advocate greatly expanding post-addiction drug treatment programs by, for instance, helping opioid addicts quit by providing them with methadone to alleviate the physical symptoms of withdrawal.

The researchers say that these three measures—a 25 percent reduction in prescriptions, greater access to naloxone and greatly expanded methadone treatment—could together reduce overdose deaths by 6,000 over 10 years compared with the status quo estimate of roughly 50,000.

“To effectively combat the epidemic, we need a portfolio of interventions,” said Brandeau. “We need policies to prevent individuals from becoming addicted in the first place, but we also need policies to treat addiction and mitigate its effects.”

The paper’s daunting conclusion that all of these measures can only make a small dent in the death toll is a measure of the magnitude of the crisis. The researchers hope the model could become a springboard for policymakers to take more vigorous action.

“It took us more than a decade to prescribe our way into this crisis,” Brandeau said, “and it will take more than a decade to prescribe and treat our way out.”


Explore further:
US doctors prescribing fewer opioid painkillers: report

Journal reference:
American Journal of Public Health

Provided by:
Stanford University Medical Center

Tagged with:

About author

Related Articles