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Why the "right" guidelines for solving the opioid epidemic over time

Congress has passed and President Trump has signed a new law designed to avert the opioid epidemic. The motivation for new legislation is clear: the opioid crisis is today one of the worst epidemics in US history, which claimed more Americans than both world wars together. However, everyone should keep in mind that the effects of a new policy can change dramatically over time as epidemics are dynamic.

My colleagues, Allison Pitt and Margaret Brandeau, and I present a predictive model of the effects of various opioid policies in this issue of the American Journal of Public Health. As model projects in the first five years and years 6 to 10 have an impact on the application of a specific directive, it becomes clear how effective the guidelines are in terms of time.

For example, stricter planning for opioids, which are more difficult to prescribe, leads to a huge loss of life for the population (1.33 million) in the first five years, as those affected are currently dependent on prescription opioids. Some of these individuals will stop using opioids (including addiction treatment in some cases), others are likely to switch to heroin (including heroin in combination with fentanyl) and as a result die from overdoses. However, in years 6 to 10, this policy has a positive effect on the life years of the population, as the benefits of not making opioids dependent on the next generation of patients outweigh the effects that cause some already pill-dependent individuals to heroin switch.

Two other measures that increase access to the overdose drug naloxone and drug-based treatment (eg methadone, naltrexone) extend life in both five-year periods. Unlike prescription policy changes, these guidelines only apply to people who are already addicted. They contribute directly and in the long term to the life expectancy of the population. Our predictive model showed that this applies to all other prevalent services for opioid addicts (eg, psychosocial treatments, needle exchange programs).

If services targeting people who are already opioid-dependent harm nobody and have a lasting positive impact on the health of the population over time, then why not just apply such measures and never change the way opioids are prescribed? Put simply, epidemics do not go away when politics is limited to treating people who are already ill. To counteract the HIV / AIDS epidemic, preventative measures such as the promotion of safe sex, as well as campaigns to promote hand washing and to cover the mouth while sneezing were essential for the arrest of flu epidemics. The same lesson applies to the opioid epidemic: Passively waiting for people's addictions and then trying to help them, the epidemic will last forever, especially as the US prescribes more opioids per capita than any other nation in the world Margin.

As the number of people who could become addicted is much larger than the number of addicts at a given time, the potential gains from preventive measures have a greater impact over the years. To appreciate the strength of prevention, it is important to remember that in the second five years of implementation, years of life gained through the tighter planning of opioids (410,000) are greater than those of extended naloxone and drug-supported treatment combined.

Since the net effect on life years of the first five and the second five years is still negative over a decade, the aggravation of opioids is probably a bad idea. However, other opioid reduction strategies mentioned in our model research (eg reducing opioids for people with sprained ankles) bring faster health benefits and therefore deserve consideration, even if they have only short-term costs.


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