Researchers at Massachusetts General Hospital (MGH) have created a data-driven simulation model to aid decision-makers in understanding and addressing the nation’s raging opioid issue.
According to a study published in the journal PNAS, the SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects) model captures how the connections between stages of prescription and illicit opioid use, from initiation and addiction treatment to relapse and overdose mortality, have changed over time and offers the most in-depth model of the crisis to date.
“The opioid crisis is so complex that it demands a dynamic simulation tool that can generate reliable data and a big picture perspective on this major public health challenge,” says senior author Mohammad Jalali, PhD, with the MGH Institute for Technology Assessment. “SOURCE provides a dynamic understanding of the trajectory of the opioid crisis that can serve as a framework for projecting future scenarios and informing public policy planning.”
Over the past 21 years, overdoses from opioids have been the cause of more than 500,000 fatalities in the United States. Since 2013, the number of opioid-related deaths has significantly increased, killing approximately 70,000 people in 2020 alone. This increase is largely due to the illegal distribution of fentanyl, a potent opioid that is frequently combined with heroin to lethal effect.
Opioid use disorder affects millions of people and has serious health, social, and economic repercussions for the nation. The creation of a quantitative system model was requested by the National Academies of Sciences, Engineering, and Medicine in 2017 to aid in crisis understanding and to inform policy analysis and decision-making.
In response, SOURCE was created by a group of researchers from MGH and the US Foods and Drug Administration (FDA). SOURCE tracks the stages of opioid use and misuse, including usage beginning, treatment, relapse, and overdose mortality, using national data on opioid use from 1999 through 2020.
Despite the projected decline, opioid deaths over the next 10 years will still exceed half a million people. Fentanyl’s poisoning of the unregulated drug supply will continue to be a severe problem, which is why leaders across the country need to be working as hard as they can to keep people who use drugs safe.
Erin Stringfellow
“Unlike other national models of the crisis, SOURCE replicates how the risks of opioid misuse have evolved over time in response to various behavioral and other factors, and how they may change in the future, providing a platform for projecting and analyzing potential policy impacts and solutions,” explains co-author Tse Yang Lim, PhD, with Massachusetts Institute of Technology (MIT).
Social impact, or the spread of drug use practices through social exposure, and risk perception where fear of the alleged risk of overdose death might deter drug usage are among the causes causing these shifts.
The effects of naloxone’s greater availability on overdose fatality rates as well as the spread of the deadly synthetic opioid fentanyl have been quantified by SOURCE. SOURCE predicts that overall, overdose deaths will rise over the following few years before beginning to decline as the prevalence of opioid use disorder falls.
As part of an ongoing modeling effort, the researchers are using SOURCE to look at potential solutions to the opioid problem while continuing to improve the model to represent the situation’s still-evolving nature.
“Despite the projected decline, opioid deaths over the next 10 years will still exceed half a million people,” emphasizes co-author Erin Stringfellow, PhD, with MGH. “Fentanyl’s poisoning of the unregulated drug supply will continue to be a severe problem, which is why leaders across the country need to be working as hard as they can to keep people who use drugs safe.”
Assistant Professor Jalali works at Harvard Medical School. Tse Yang Lim just received her PhD from MIT. Postdoctoral research associate Stringfellow works with the MGH Institute for Technology Assessment.
Keith Humphreys, a professor and the section head for mental health policy at Stanford University, and a number of experts from the FDA are co-authors of the study. The study was supported by the U.S. Food and Drug Administration.
