Table 2 Simulated outcomes for varying levels of buprenorphine diversion within the comprehensive opioid policy agent-based model
From: Examining buprenorphine diversion through a harm reduction lens: an agent-based modeling study
Model scenario | Total cumulative overdoses over 5Ā years mean (CI)a | Total cumulative fatal overdoses over 5Ā years mean (CI)a | Number and percent of averted fatal overdoses vs. status quo |
|---|---|---|---|
Main analysis | |||
A. Status Quo (50% of those prescribed divert buprenorphine, 10% of individuals with OUD use diverted buprenorphine) | 80,833 (77,736, 84,016) | 10,658 (9699, 11,679) | n/a |
B. Controlled prescription only (0% of those prescribed divert buprenorphine, 0% of individuals with OUD use diverted buprenorphine) | 81,192 (78,241, 84,091) | 10,741 (9895, 11,650) | ā+ā83 (0.78%) |
C. Increased diversion (95% of those prescribed divert buprenorphine, 50% of individuals with OUD use diverted buprenorphine) | 78,898 (76,087, 81,425) | 10,301 (9439, 11,244) | āĀ 357 (āĀ 3.35%) |
Sensitivity 1: Increased overdose risk with diverted buprenorphine (from 2.08 to 4.16 per 100 p-y) | |||
A. Status Quo | 80,162 (77,310, 83,511) | 10,536 (9557, 11,443) | n/a |
B. Controlled prescription onlyb | 81,192 (78,241, 84,091) | 10,741 (9895, 11,650) | ā+ā205 (1.95%) |
C. Increased diversion | 77,924 (74,981, 80,634) | 10,288 (9558, 11,149) | āĀ 248 (āĀ 2.35%) |
Sensitivity 2: increased probability of using diverted buprenorphine from 15 to 25% | |||
A. Status Quo | 80,564 (77,643, 83,014) | 10,603 (9793, 11,458) | n/a |
B. Controlled prescription onlyb | 81,192 (78,241, 84,091) | 10,741 (9895, 11,650) | ā+ā138 (1.30%) |
C. Increased diversion | 78,189 (75,313, 80,931) | 10,288 (9436, 11,147) | āĀ 315 (āĀ 2.97%) |
Sensitivity 3: increased probability of using diverted buprenorphine from 15 to 50% | |||
A. Status Quo | 79,767 (77,018, 82,332) | 10,475 (9582, 11,340) | n/a |
B. Controlled prescription onlyb | 81,192 (78,241, 84,091) | 10,741 (9895, 11,650) | ā+ā266 (2.54%) |
C. Increased diversion | 75,372 (72,221, 78,788) | 9897 (8999, 10,738) | āĀ 578 (āĀ 5.52%) |
Sensitivity 4: 3% of diverted buprenorphine available to opioid-naĆÆve agents with a 1% probability of use and 0.3% fatal overdose probability | |||
A. Status Quo | 80,857 (77,932, 83,861) | 10,666 (9931, 11,339) | n/a |
B. Controlled prescription onlyb | 81,192 (78,241, 84,091) | 10,741 (9895, 11,650) | ā+ā75 (0.70%) |
C. Increased diversion | 79,163 (76,738, 81,804) | 10,362 (9571, 11,120) | āĀ 293 (āĀ 2.75%) |