Team reveals cost-effective and life-saving treatment for nation’s opioid disorder epidemic

Expanding access to a treatment that combines medication and counseling for opioid addiction may generate significant cost savings while also saving many lives, according to a study by researchers at Stanford and the Veterans Health Administration.

Opioid use disorder (OUD) has become a public health crisis and is a significant cause of morbidity, death, lost productivity and excess costs to the criminal justice system. At least 2 million people in the United States have a substance use disorder related to prescription opioid pain medication.

“Opioid overdoses in the United states likely reached a record high in 2020 because of COVID-19 increasing substance use, exacerbating stress and social isolation, and interfering with opioid treatment,” the researchers write in their original investigation in JAMA Psychiatry.

The Centers for Disease Control and Prevention last December announced that more than 81,000 drug overdoses occurred in the United States in the 12 months ending in May 2020, the highest number of overdose deaths ever recorded in a 12-month period.

So a Stanford team of decision scientists with colleagues at the VA Palo Alto Health Care System developed a mathematical model to assess the cost-effectiveness of various interventions to treat opioid use disorder. They looked at the cost-effectiveness from two perspectives: the health-care sector and the criminal justice system.

Their model considered 26 different treatment combinations involving medication-assisted treatment such as oral buprenorphine or methadone and injectable, extended-release naltrexone, combined with a treatment such as psychotherapy and overdose education. They estimated the lifetime costs and quality-adjusted life years (QALYs) associated with the different treatment options and determined that medication-assisted treatment would prevent a substantial number of overdoses and result in approximately one additional quality-adjusted year of life for patients who receive this therapy.

“This treatment has very important benefits. It prevents overdose deaths, improves quality of life, and results in patients living longer — a very substantial benefit,” said Douglas K.Owens, director of Stanford Health Policy, a professor of medicine and a senior investigator at the VA Palo Alto Health Care System. Owens is also a senior fellow at the Freeman Spogli Institute for International Studies.

A few years ago, the team realized the opioid epidemic was threatening the hard-fought gains in the prevention and control of HIV and the hepatitis C virus. They launched a 10-year project with a MERIT award from the National Institute on Drug Abuse and with funding from the Department of Veterans Affairs to address the impact of opioids on the treatment of other diseases. Owens and Margaret Brandeau, PhD, professor of management science and engineering, have led this team of decision scientists for two decades.

“The U.S. opioid epidemic has decimated lives and families,” said Brandeau, who is co-senior author of the study with Owens. “And it has only gotten worse with COVID-19. Opioid use has increased while at the same time access to treatment has diminished.”

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