A significant challenge in addressing the country’s opioid crisis is that policies based on past patterns of behavior can have unintended consequences as those patterns change over time. Working with the U.S. Food and Drug Administration (FDA), Mohammad Jalali and his research colleagues created a data-driven simulation model that incorporates key behavioral feedbacks such as social influence and risk perceptions . Called SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects), the model projected three key strategies that could save more than 100,000 lives over the next ten years.
Dr. Jalali is a research scientist at Massachusetts General Hospital (MGH), an assistant professor at Harvard Medical School, and a senior lecturer at MIT’s Sloan School of Management in the System Dynamics group. SOURCE is the most operationally detailed national model of the opioid crisis to date and provides an integrated framework for policy decision-making.
According to SOURCE projections, the opioid crisis will get worse before it gets better and will claim more than half a million additional lives over the next 10 years. And while the number of people abusing prescription opioids or heroin is already falling, their risk of overdose – especially for those who use heroin – has increased dramatically since 2013 due to the spread of the illegally manufactured fentanyl.
In response, the researchers used SOURCE to project eleven different strategies and found three that could save more than 100,000 lives during that time. The three key strategies, which must be implemented together, are: 1) harm reduction from fentanyl; 2) naloxone delivery; and 3) recovery support for people in remission from opioid use disorder (OUD), the group most at risk for overdose. In the short term, building the capacity of buprenorphine providers to treat more patients with TOU also has a life-saving effect by helping to overcome current capacity limitations of the treatment system.
Their paper analyzing rescue strategies was published today in Scientists progresswhile SOURCE is described in a research article recently published in the Proceedings of the National Academy of Sciences.
This broader perspective is essential for progress. It’s like playing the mole. If you don’t look at the whole system and its interconnected parts, then fixing one aspect of the problem can make other aspects worse.”
Dr. Mohammad Jalali, researcher at Massachusetts General Hospital (MGH), assistant professor at Harvard Medical School and lecturer at MIT’s Sloan School of Management in the System Dynamics group
SOURCE replicates the historical trajectory of the opioid crisis, using 22 years of data on prescription opioid use and abuse, heroin use, overdose deaths, and more. Considering these processes allows SOURCE to explain historical changes in opioid use and overdose trends, as well as their future course. For example, SOURCE finds that the risks of opioid use deter potential new insiders. As a result, the main source of OUD in the future will be people in remission who relapse. Thus, supporting the recovery of people in remission to reduce relapses could have a major impact, saving tens of thousands of lives.
SOURCE found that specific strategies to reduce fentanyl risk, such as drug control services that help people use drugs more safely, could have a dramatic impact on opioid overdose deaths.
SOURCE also shows that while increased distribution of the anti-overdose drug naloxone has helped mitigate this growing risk, the positive effects of naloxone still lag far behind the growing threat of fentanyl. Going forward, model analysis shows that naloxone should nonetheless remain a key component of the national strategy to prevent overdose deaths.
Due to the falling OUD, SOURCE predicts that opioid overdose deaths will continue to rise in the near future before eventually falling. “Although we expect deaths to peak in the next few years, we are still talking about more than half a million deaths over the next decade. Our projections really underline the urgency of tackling to the crisis of substance use and overdose,” says co-author and MIT Ph.D. Sloan Tse Yang Lim.
Co-author Erin Stringfellow, a researcher at MGH and Harvard Medical School agrees: “If we wait for the crisis to peak, it will be too late. We must use these strategies together, and now, to have their maximum impact. These strategies will only become more important if our projections for fentanyl penetration into the drug supply turn out to be too optimistic. »
Jalali adds: “SOURCE is a powerful analytical tool for projecting and exploring policy outcomes and testing strategies. There is a lot of exciting work to be done building on this model.
In addition to Jalali, Lim, and Stringfellow, the co-authors are from Harvard Medical School, MGH, McLean Hospital, FDA, Stanford University, and Portland State University.