Rates of receiving medication for opioid use disorder and opioid overdose deaths during the early synthetic opioid crisis: a county-level analysis

BACKGROUND: Medications for opioid use disorder are associated with lower risk of drug overdoses at the individual level. However, little is known about whether these effects translate to population-level reductions. We investigated whether county-level efforts to increase access to medication for opioid use disorder in 2012-2014 were associated with opioid overdose deaths in New York State during the first years of the synthetic opioid crisis.

METHODS: We performed an ecologic county-level study including data from 60 counties (2010-2018). We calculated rates of people receiving medication for opioid use disorder among the population misusing opioids in 2012-2014 and categorized counties into quartiles of this exposure. We modeled synthetic and non-synthetic opioid overdose death rates using Bayesian hierarchical models.

RESULTS: Counties with higher rates of receiving medications for opioid use disorder in 2012-2014 had lower synthetic opioid overdose deaths in 2016 (highest vs lowest quartile: rate ratio [RR] = 0.33, 95% credible interval [CrI] = 0.12,0.98; and second-highest vs. lowest: RR = 0.20, 95% CrI = 0.07,0.59) and 2017 (quartile second-highest vs lowest: RR = 0.22, 95% CrI = 0.06,0.83), but not 2018. There were no differences in non-synthetic opioid overdose death rates comparing higher quartiles vs lowest quartile of exposure.

CONCLUSIONS: A spatio-temporal modeling approach incorporating counts of the population misusing opioids provided information about trends and interventions in the target population. Higher rates of receiving medications for opioid use disorder in 2012-2014 was associated with lower rates of synthetic opioid overdose deaths early in the crisis.