Evaluating diversion and treatment policies for opioid use disorder

Abstract

The United States (US) opioid crisis contributed to 81,806 fatalities in 2022. It has strained hospitals, treatment facilities, and law enforcement agencies due to the enormous resources and procedures needed to respond to the crisis. As a result, many individuals who use opioids never receive or finish the treatment they need and instead have many interactions with hospitals or the criminal justice system. This paper introduces a discrete event simulation model that evaluates three opioid use disorder treatment policies: arrest diversion, re-entry case management, and overdose diversion. Publicly available data from 2011 to 2019 in Dane County, Wisconsin, was used to forecast opioid-related outcomes through 2032. Through analyzing a variety of policy-mix implementations, the study offers a versatile framework for evaluating policies at various implementation levels. The results demonstrate that treatment policies that create new pathways and programming by utilizing treatment services and successfully divert at least 20% of eligible individuals can lead to more opioid-resilient communities. The benefits increase when more policies are enacted and/or offered to more individuals, with the largest impact from overdose diversion, followed by re-entry case management, and the smallest impact from arrest diversion. The statistically significant 10-year cumulative total reduction in societal costs from 2023 through 2032 ranges from $39 M (USD) to $584 M (USD), excluding implementation costs of policies. To reverse the opioid crisis within a community, treatment policies may need to be combined with other strategies, such as harm reduction, supply reduction, and use prevention.