Encouraging rigorous, actionable research for opioid epidemic interventions in the United States
The opioid epidemic in the United States has been declared a public health emergency. The growth of opioid use disorder and opioid-related overdose deaths calls for rigorous research to determine which interventions and policies are effective at preventing opioid misuse, treating people experiencing opioid use disorder (OUD), and curtailing its associated health risks. Ongoing studies by J-PAL affiliated researchers show promising and innovative interventions. Further collaborative and action-oriented research between behavioral scientists, policymakers, and health care providers is needed to address the pressing concerns of the opioid epidemic.
Facing a growing opioid crisis in the United States
Over the past ten years, the United States has faced a massive growth in opioid-related overdoses and substance use disorders. In 2021 alone, over 80,000 people died from an overdose involving opiate use. A history of overprescription has allowed for an over-access of opiate drugs across communities in the United States. Further exacerbated by the Covid-19 pandemic and the use of synthetic opiates, opioid-related overdose deaths have continued to rise, signaling a strong need for intervention. The widespread effects of the opioid epidemic, which has been named a public health emergency, call for actionable and collaborative research.
The opioid crisis also disproportionately affects Black and low-income individuals, furthering health disparities in the United States. From 2020 to 2021, opioid mortality rates for Black individuals surpassed other racial groups. This gap demonstrates the need for equitable interventions that acknowledge these inequities in the opioid epidemic.
Advancing the evidence base to identify effective solutions
While there are a multitude of programs and policies that seek to address the opioid crisis, the continual rise of opioid-related overdoses calls for a deeper understanding of the effectiveness of these interventions. Randomized evaluations, conducted through close collaboration with researchers and health care providers, are essential to determining effective solutions to the opioid epidemic.
To date, J-PAL North America has supported a variety of research projects—from pilot studies to full randomized evaluations—in the opioid space to advance the evidence base and promote innovative, equitable interventions including:
Provider and pharmacy-focused interventions
Given concerns about over-prescription, three studies examine potential solutions to curtailing the unnecessary supply of opiate drugs.
Even when states adopt Prescription Monitoring Programs (PMPs) to facilitate safer prescribing of opiate drugs, many providers do not use them to guide their prescribing. A randomized evaluation with the Minnesota state government assessed the efficacy of a letter campaign, including three “treatment” letters, to providers who may not have been following the latest opioid prescribing guidelines. The study's interventions showed no significant effect on prescription rates among prescribers. However, letters highlighting the state’s new requirement to check the PMP before prescribing opioids did lead prescribers to start using the programs, which may help them minimize drug interactions and overdose risk in the future.
Unsecure disposal of left-over medications provides indirect access to individuals who were not originally prescribed opiate drugs, also known as secondary users. To address these secondary user concerns, an ongoing pilot project of a buyback program is studying different tactics to boost return rates of opiate drugs among study participants. The mechanisms employed include informing patients at the point of dispensing medication, sending reminders via text message, and providing financial incentives upon return.
Naloxone, a prescription opioid-overdose reversal drug, is indicated to be a key strategy to slowing down overdose deaths. Thus, public health authorities recommend dispensing the medication along with high-dose opioid prescriptions. In collaboration with an online pharmacy platform licensed to dispense naloxone, a pilot study is exploring strategies to increase take-up of overdose reversal drugs through an online advertising campaign. By comparing the randomized advertisements across counties, the study is measuring how traffic to the pharmacy site and naloxone purchases are affected. Together, these studies provide tangible solutions to mitigate and address the over-access of opiate drugs across the United States.
Abstinence interventions
Contingency management, a well-known approach in medical literature, explores how offering incentive payments for healthy behaviors can aid individuals with opioid use disorder (OUD) toward drug abstinence.
One study is using a contingency management approach to improve the welfare and decrease the medical costs of individuals with OUDs. The research team is evaluating two adjusting incentive schemes designed to treat people experiencing OUDs. The first focuses on “escalating” schedules, which increases incentive amounts in relation to the success of opiate abstinence. The other is a “de-escalating” approach, which decreases incentive amounts with the success of opiate abstinence. Given the state of the opioid crisis following the rise of Covid-19, this study offered a virtual option for abstinence incentives. This approach reduces barriers to OUD treatment, specifically benefitting those living in poverty and low-income individuals. Results from these projects shed light on barriers to abstinence and provided insight into optimal designs of incentive programs.
Identifying key areas for future research
These research projects provide insight into the pressing questions of the opioid epidemic today. J-PAL North America is dedicated to supporting randomized evaluations of strategies that aim to make health care delivery and access more efficient, effective, and equitable. We engage closely and collaboratively with policymakers, health care providers, and researchers to inform intervention approaches strategically.
Areas for further research may include:
- offering pathways to housing and preventing homelessness
- syringe service programs
- an uptake of Vivitrol among criminal justice involved populations
- peer counseling programs for mothers with OUDs and babies with neonatal abstinence syndrome
- harm-reduction interventions, which seek to mitigate opiate-related overdose deaths, prevent the spread of infectious diseases, and their associated risks.
More recommendations can also be found in a review of strategies indicated to be effective in the opioid epidemic space.
We welcome readers interested in exploring these topics to reach out to Alejandro Noriega, the US Health Care Delivery Initiative manager, or to subscribe to J-PAL North America’s Health Care Delivery newsletter to stay up to date on the latest evaluations, news, and requests for proposals.
