Reducing overdose deaths among persons with opioid use disorder in connecticut

Scheidell, Joy D.; Townsend, Tarlise N.; Zhou, Qinlian; Manandhar-Sasaki, Prima; Rodriguez-Santana, Ramon; Jenkins, Mark; Buchelli, Marianne; Charles, Dyanna L.; Frechette, Jillian M.; Su, Jasmine I-Shin; Braithwaite, R. Scott

doi:10.1186/s12954-024-01026-6

Harm Reduction Journal

Table 1 Model parameters

From: Reducing overdose deaths among persons with opioid use disorder in connecticut

Parameter	Base case	Range	Source
Population
	Number
People with opioid use disorder (POUD) in Connecticut	90,895	N/A	Krawczyk et al. 2022 [32]
Incarcerated POUD (baseline)	2748	N/A	Ferguson et al. 2019 [34]
	Proportion
Previously incarcerated	0.14	N/A	Winkelman et al. 2018 [35], Krawczyk et al. 2022 [32]
Had a prior overdose	0.31	0.27–0.35
People who inject drugs			Heimer et al. 2014 [38]
Among never incarcerated	0.05	0.04–0.06	Expert opinion (CTDOC) + calibration adjustment
Among ever incarcerated	0.3	0.24–0.36	Expert opinion (CTDOC)
Baseline MOUD in community			Expert opinion (CTDOC)
+MOUD ± remission	0.17	0.1–0.4	Expert opinion (CTDOC)
−MOUD −remission	0.63	Complement
−MOUD +remission^a	0.2	0.13–0.43	Expert opinion (CTDPH)
Baseline naloxone access in community
Own naloxone in community	0.03	0.02–0.04	Freeman 2018 [39]
Distribution of naloxone kits in community			Freeman 2018
Intranasal	0.8	Complement
Intramuscular	0.2	0.16–0.24
Transition rates (annual)^b
Community-to-community (baseline relapse risk period/ > 1 mo post-release)
+MOUD +remission → −MOUD −remission^c	0.13–0.33^e
Rate ratio for relapse during 1-month post-release	10
+MOUD +remission → −MOUD +remission	0.16–0.31^f		See appendix for multiple references
−MOUD +remission → −MOUD −remission	0.01	0.01–0.15
−MOUD +remission → +MOUD +remission	0.29	0.07–0.72
−MOUD −remission → +MOUD +remission ^d	0.34	0.12–0.35
−MOUD −remission → −MOUD +remission	1.07	0.17–1.16
−MOUD −remission → overdose
PWID no prior overdose	1.8	1.4–2.2	Coffin 2013 (For high propensity to relapse group, +MOUD −remission + →MOUD +remission, use same values)
PWID with prior overdose	5.6	2.8–6.7	Coffin 2013
Non-PWID no prior overdose	0.03	0.02–0.04	Coffin 2013
Non-PWID with prior overdose	0.11	0.09–0.13	Coffin 2013
Naloxone acquisition in community (annual)
In an SSP	0.51		Expert opinion (CTHRA) & CT DMHAS
Non-SSP	0.1
Probabilities (one-time)
Community-to-incarceration
+MOUD +remission → −MOUD +remission ^g	0.57		See appendix for multiple references
+MOUD +remission → +MOUD +remission ^h	0.43	[N/A exogeneous policy setting]
−MOUD +remission → +MOUD +remission	0.01
−MOUD +remission → −MOUD +remission	0.99
−MOUD −remission → +MOUD +remission	0.3
−MOUD −remission → −MOUD +remission	0.7
Incarceration (SI or LI)-to-community
+MOUD +remission → −MOUD +remission	0.17–0.21^j	0.06–0.3	See appendix for multiple references
+MOUD +remission → −MOUD −remission	0.30–0.38^k	Complement
+MOUD +remission → −MOUD −remission	0.40–0.53^l	0.2–0.73
−MOUD +remission → −MOUD +remission	0.15	Complement
−MOUD +remission → −MOUD −remission	0.54	0.21–0.41
−MOUD +remission → +MOUD +remission ⁱ	0.31
Overdose → overdose death (without naloxone or EMS)	0.10	0.06–0.22
Overdose being witnessed
PWID	0.79	0.55–0.90
Non-PWID	0.79	0.55–0.90
EMS called	0.6	0.58–0.62
Intervention effects^m
MOUD on OD prevention, community concurrent usersⁿ,^o	RR 0.62	0.41–0.92	Larochelle et al. 2018[36]
Naloxone on ODD prevention	RR 0.92	0.8–0.97	Coffin 2013[8]
Emergency medical services called on ODD prevention	RR 0.92	0.8–0.97	Coffin 2013 [8]
Utilities
−MOUD +remission	0.82	0.67–0.97	Rhee 2019 [40]
Decrement in utility due to –MOUD −remission	0.09	0–0.38	Rhee 2019
Decrement in utility due to Incarceration	0.06	0–0.18	Chong 2009 [41]
Cost (2021 USD)
Incarceration, annual	$42,837	28,558–64,256	CTDOC
Naloxone, per dose
IM	$15	Oct-23	Rosenberg 2018 [42]
IN	$60	40–90
MOUD, annual
Incarceration	$7630^r	5081–51017	CTDOC [cost table]
Community	$4099^s	1396–29,186	Expert opinion, Murphy 2019, [43] Clemans-Cope 2020 [44]
Crime, annual^p	$68,302	45,535–102,453	Krebs 2016 [45]
Productivity loss, annual ^q	$32,427	21,618–48,641	BLS 2023[46]/expert opinion
Emergency medical services dispatch	$1638	1092–2457	Larimer 2009 [47]
Admittance to emergency department	$4652	3101–6978	Mallow 2018 [48]

^aAsymptotes towards 50% above age 50
^bIn the community, only those who have a low propensity for relapse can transition to three states (−MOUD +remission, +MOUD +remission, −MOUD −remission). Those who have a high propensity for relapse can transition between two states only (−MOUD −remission, +MOUD −remission)
^cFor high propensity to relapse group, +MOUD −remission → −MOUD −remission, use same values
^dFor high propensity to relapse group, −MOUD -remission → +MOUD –remission, use same values
^eSee appendix for MOUD type-specific values
^fSee appendix for MOUD type-specific values
^gFor high propensity to relapse group, +MOUD −remission → −MOUD +remission, use same values
^hFor high propensity to relapse group, +MOUD −remission → +MOUD +remission, use same values
ⁱFor high propensity to relapse group, −MOUD +remission → +MOUD −remission, use same values
^jSee appendix for MOUD type-specific values
^kSee appendix for MOUD type-specific values
^lSee appendix for MOUD type-specific values
^mRR: risk ratio
ⁿMethadone includes 4-week induction period (Sordo et al 2017)
^oApplied to the “−MOUD −remission → overdose” rates
^pApplied to −MOUD remission individuals only
^qApplied to incarcerated or −MOUD −remission individuals only
^rWeighted average of methadone, buprenorphine-naloxone, XR-naltrexone and XR-buprenorphine. See appendix for MOUD type-specific values
^sWeighted average of methadone, buprenorphine-naloxone, XR-naltrexone and XR-buprenorphine. See appendix for MOUD type-specific values

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