When it comes to the opioid crisis, all regions haven't been impacted equally.
While that's been understood for some time, a new study published in JAMA Network Open shows a new approach to tracking the epidemic to help policymakers understand the evolution of the crisis more clearly.
The research team released an online viewer that allows members of the public and policymakers alike to look at state-level data over time.
In doing so, researchers hope to help policy officials better wrap their arms around the complex problem as they seek more targeted public health interventions.
For example, the results show a striking geographic pattern with a marked rise in synthetic opioid deaths on the east coast in recent years.
“We’re not saying there are more opioid users on the East Coast,” Mathew V. Kiang, the lead author on the study, told FierceHealthcare. "There’s no difference in use across the United States."
Instead, the study shows the speed and size of change in mortality rates from state to state and for different types of opioids, he said. The trend seen on the east coast is a function of the heroin supply in the region, Kiang said.
Additionally, if you look at data between 2000 and 2010, you’ll see a uniform increase across the entire United States. According to Kiang, that’s because the supply consisted almost entirely of natural or semisynthetic opioids—that is, prescription painkillers—which are all the same quality because pharmaceutical companies manufacture them.
As the market has moved toward illicit drugs, the origin of the heroin supply has begun to matter much more. That’s when geographic patterns, such as the recent rapid rise of deaths from synthetic opioids cutting into the east coast heroin supply, come into sharp relief.
In contrast, Kiang said California barely registers as a hot spot on the map because its heroin supply mostly consists of a brown, sticky variety that’s harder to cut with synthetic opioids. Its supply, use and mortality have therefore remained relatively stable.
A tool for policymakers
Where most data presentations have chosen an arbitrary reference year as a baseline, the researchers instead tracked the speed and size of changes in opioid-related mortality using annual data from 1999 through 2016 to give a snapshot of the epidemic’s current dynamics.
They also calculated life expectancy lost, because that metric provides an apples-to-apples comparison with other public health concerns, such as deaths from automobile accidents or firearms incidents. The online tool provides these comparisons as an overlay on both a state and national level.
According to Kiang, this approach gives policymakers access to data that not only tells them how bad the current situation is, but whether it’s getting better or worse, and how quickly. That also gives policymakers a chance to prioritize their efforts and ensure they deploy their limited resources in the most efficient way.
Instead, the differences in the mortality rates represent changes in supply, particularly when it comes to deaths related to synthetic opioids.
In addition to providing policymakers a heat map for tracing geographic trends in opioid supply, this methodology also offers a way to track the relative success of interventions.
Ohio and Massachusetts have taken measures to increase the availability of naloxone and aggressively push treatment options into their states. As newer data roll in, different trends should be evident if they exist.
Ultimately, the researchers’ goal is to provide policymakers with the tools they need to recognize the problem and get people help.
“We need to make treatment as accessible, available and affordable as it is to get heroin,” Kiang said.