Tehran University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Modelling the Intervention Effect of Opioid Agonist Treatment on Multiple Mortality Outcomes in People Who Inject Drugs: A Three-Setting Analysis Publisher Pubmed



Stone J1 ; Degenhardt L2 ; Grebely J3 ; Larney S2, 4, 5 ; Altice FL6 ; Smyrnov P7 ; Rahimimovaghar A8 ; Alavi M3 ; Young AM9, 10 ; Havens JR1 ; Miller WC11 ; Hickman M1 ; Vickerman P1
Authors
Show Affiliations
Authors Affiliations
  1. 1. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
  2. 2. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
  3. 3. Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
  4. 4. Departement de Medecine Famille et de Medecine d'Urgence, Universite de Montreal, Montreal, QC, Canada
  5. 5. Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
  6. 6. Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT, United States
  7. 7. Alliance for Public Health, Kyiv, Ukraine
  8. 8. Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
  9. 9. Center on Drug and Alcohol Research, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
  10. 10. Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, United States
  11. 11. Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, United States

Source: The Lancet Psychiatry Published:2021


Abstract

Background: Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran). Methods: We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020–40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4–11%; prison 0–40%); scaling up community OAT to 40% coverage; increasing average OAT duration from 4–14 months to 2 years; and scaling up prison-based OAT. Outcomes: Drug-related harms contributed differentially to mortality across settings: overdose contributed 27–47% (range of median projections) of preventable drug-related deaths over 2020–40, suicide 6–17%, injury 3–17%, HIV 0–59%, and HCV 2–18%. Existing OAT coverage in Tehran (31%) could have a substantial effect, averting 13% of preventable drug-related deaths, but will have negligible effect (averting <2% of preventable drug-related deaths) in Kyiv and Perry County due to low OAT coverage (<4%). Scaling up community OAT to 40% could avert 12–24% of preventable drug-related deaths, including 13–22% of overdose deaths, with greater effect in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have a significant additional effect, averting 27–51% of preventable drug-related deaths. Interpretation: OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics in people who inject drugs. Maximising these effects requires research and investment into achieving higher coverage and provision and longer retention of OAT in prisons and the community. Funding: UK National Institute for Health Research, US National Institute on Drug Abuse. © 2021 Elsevier Ltd
Related Docs
View other Related Docs
1. Global Patterns of Opioid Use and Dependence: Harms to Populations, Interventions, and Future Action, The Lancet (2019)
2. Opium Tincture-Assisted Treatment for Opioid Use Disorder: A Systematic Review, Journal of Substance Abuse Treatment (2021)
3. Global Burden of Hiv, Viral Hepatitis, and Tuberculosis in Prisoners and Detainees, The Lancet (2016)
4. Mortality and Negative Outcomes of Opioid Use and Opioid Use Disorder: A 6-Year Follow-Up Study, Addiction (2022)
5. Transition to Injecting Drug Use in Iran: A Systematic Review of Qualitative and Quantitative Evidence, International Journal of Drug Policy (2015)
6. Transition to and Away From Injecting Drug Use Among Young Drug Users in Tehran, Iran: A Qualitative Study, Iranian Journal of Psychiatry and Behavioral Sciences (2017)
7. Buprenorphine Abuse and Health Risks in Iran: A Systematic Review, Drug and Alcohol Dependence (2021)
8. Opium Dependence and the Potential Impact of Changes in Treatment Coverage Level: A Dynamic Modeling Study, Health Promotion Perspectives (2021)
Experts (# of related papers)
View all Related Experts
Afarin Rahimi-Movaghar (6)
Alireza Noroozi (4)
Other Related Docs
9. Correlates of Duration Between Initial Drug Use and First Drug Injection Among People Who Inject Drugs in Iran, 2020, BMC Public Health (2025)
10. Substance Use and Hiv Among Female Sex Workers and Female Prisoners: Risk Environments and Implications for Prevention, Treatment, and Policies, Journal of Acquired Immune Deficiency Syndromes (2015)