Jack Stone1, Louisa Degenhardt2, Jason Grebely3, Sarah Larney4, Frederick L Altice5, Pavlo Smyrnov6, Afarin Rahimi-Movaghar7, Maryam Alavi3, April M Young8, Jennifer R Havens9, William C Miller10, Matthew Hickman9, Peter Vickerman9. 1. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. Electronic address: jack.stone@bristol.ac.uk. 2. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia. 3. Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. 4. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Département de Médecine Famille et de Médecine d'Urgence, Université de Montréal, Montréal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada. 5. Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA. 6. Alliance for Public Health, Kyiv, Ukraine. 7. Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran. 8. Center on Drug and Alcohol Research, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA; Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA. 9. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. 10. Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA.
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.
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.
Authors: Matthew Hickman; Colin Steer; Kate Tilling; Aaron G Lim; John Marsden; Tim Millar; John Strang; Maggie Telfer; Peter Vickerman; John Macleod Journal: Addiction Date: 2018-04-19 Impact factor: 6.526
Authors: Louisa Degenhardt; Amy Peacock; Samantha Colledge; Janni Leung; Jason Grebely; Peter Vickerman; Jack Stone; Evan B Cunningham; Adam Trickey; Kostyantyn Dumchev; Michael Lynskey; Paul Griffiths; Richard P Mattick; Matthew Hickman; Sarah Larney Journal: Lancet Glob Health Date: 2017-10-23 Impact factor: 26.763
Authors: Jack Stone; Hannah Fraser; Aaron G Lim; Josephine G Walker; Zoe Ward; Louis MacGregor; Adam Trickey; Sam Abbott; Steffanie A Strathdee; Daniela Abramovitz; Lisa Maher; Jenny Iversen; Julie Bruneau; Geng Zang; Richard S Garfein; Yung-Fen Yen; Tasnim Azim; Shruti H Mehta; Michael-John Milloy; Margaret E Hellard; Rachel Sacks-Davis; Paul M Dietze; Campbell Aitken; Malvina Aladashvili; Tengiz Tsertsvadze; Viktor Mravčík; Michel Alary; Elise Roy; Pavlo Smyrnov; Yana Sazonova; April M Young; Jennifer R Havens; Vivian D Hope; Monica Desai; Ellen Heinsbroek; Sharon J Hutchinson; Norah E Palmateer; Andrew McAuley; Lucy Platt; Natasha K Martin; Frederick L Altice; Matthew Hickman; Peter Vickerman Journal: Lancet Infect Dis Date: 2018-10-29 Impact factor: 71.421
Authors: Anh T Vo; Christopher Magana; Matthew Hickman; Annick Borquez; Leo Beletsky; Natasha K Martin; Javier A Cepeda Journal: Int J Drug Policy Date: 2021-08-11
Authors: Thomas D Brothers; Dan Lewer; Nicola Jones; Samantha Colledge-Frisby; Michael Farrell; Matthew Hickman; Duncan Webster; Andrew Hayward; Louisa Degenhardt Journal: PLoS Med Date: 2022-07-19 Impact factor: 11.613
Authors: Roman Ivasiy; Lynn M Madden; Scott O Farnum; Natalia Shumskaya; Samy J Galvez de Leon; Daniel J Bromberg; Ainura Kurmanalieva; Aibek Duishenaliev; Ruslan Tokubaev; Frederick L Altice Journal: Drug Alcohol Depend Rep Date: 2022-07-19
Authors: Jack Stone; Adelina Artenie; Matthew Hickman; Natasha K Martin; Louisa Degenhardt; Hannah Fraser; Peter Vickerman Journal: Lancet Public Health Date: 2022-01-07
Authors: Antoine Chaillon; Chrianna Bharat; Jack Stone; Nicola Jones; Louisa Degenhardt; Sarah Larney; Michael Farrell; Peter Vickerman; Matthew Hickman; Natasha K Martin; Annick Bórquez Journal: Addiction Date: 2021-12-04 Impact factor: 7.256