EFFECT of reductions in OPIOID prescribing on opioid use disorder and fatal overdose in the united states: A dynamic Markov model.

BACKGROUND AND AIMS Despite prescribing declines between 2011-2019, opioid morbidity and mortality in the United States (U.S.) continued to rise during this period. We estimated the relationship between opioid prescribing, opioid use disorder (OUD), and fatal opioid overdose in the U.S. DESIGN Dynamic Markov model. SETTING U.S., using data from the National Survey on Drug Use and Health, Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey, and National Epidemiologic Survey on Alcohol and Related Conditions III. PARTICIPANTS Simulated U.S. individuals 12+ years of age from general population or with prescription opioid medical use, prescription opioid nonmedical use, illicit opioid (e.g., heroin, illicit fentanyl) use, prescription OUD, illicit OUD with a history of prior prescription opioid nonmedical use, or non-fatal or fatal opioid overdose. MEASUREMENTS Active OUD cases and fatal prescription opioid overdoses. FINDINGS Between 2010 and 2019, opioid prescribing declined 42.5%. Although fatal opioid overdoses increased by 103.2%, these reductions in opioid prescribing averted an estimated 9,600 [95% uncertainty interval (UI): 7,205, 15,478] deaths starting in 2011 relative to continued prescribing at 2010 levels - and are projected to avert another 50,918 [95% UI: 38,829, 79,795] overdose deaths between 2020 and 2029. The median time from initial opioid prescription to fatal opioid overdose was 5.2 years. Of the 2.4 million [95% UI: 2.2 million, 2.7 million] individuals in the U.S. with estimated active OUD in 2019, 65% [95% UI: 59%, 71%] were attributable to initial opioid use occurring prior to 2011, whereas 14% [95% UI: 12%, 17%] were attributable to initial opioid use occurring between 2017-2019. The impact - by 2029 - of additional reductions in prescribing initiated in 2020 would be more than three times greater than that of similar reductions initiated in 2025. CONCLUSIONS Observed reductions in opioid prescribing volume in the U.S. from 2010 to 2019 appear to have saved about 9,600 lives by 2019 and are anticipated to avert over 50,000 fatal overdoses by 2029.