Table 1.
Parameter values1
| Parameter | Value2 |
|---|---|
| Demographic data | |
| Total population size, age 12+ | 276,077,200 |
| Chronic pain prevalence (moderate to severe) | 8.6% |
| Acute pain prevalence (moderate to severe) | 2.5% |
| Severe opioid use disorder prevalence | 0.49% |
| Severe heroin use disorder prevalence | 0.36% |
| Rate of maturation into the population, people/month | 234,167 |
| Pain natural history | |
| Acute pain incidence for pain-free nonusers, %/month | 2.5% |
| Chronic pain incidence for pain-free nonusers, %/month | 0.30% |
| Chronic pain subsidence, %/month | 8% |
| Probability that acute pain persists without opioid prescription | 15.0% |
| Probability that acute pain persists with opioid prescription | 14.7% |
| Percent of 12+ population with chronic pain of any severity | 43% |
| Percent of chronic pain population with moderate to severe pain | 20% |
| Percent of 12+ population getting surgery or ED trauma visit | 4% |
| Percent of surgeries resulting in moderate to severe pain | 61% |
| Percent of prescription-holding SOUD population who suffer from chronic pain | 65% |
| Percent of SOUD without Rx and SHUD populations who have with chronic pain | 45% |
| Risk ratio for chronic pain developing during acute pain treatment with vs. without opioids | 0.98 |
| Prescribing behavior | |
| Percent of acute pain patients prescribed opioids | 38% |
| Probability of continued use of opioids for pain that persists from acute | 50% |
| Percent of total population prescribed opioids for chronic pain | 4% |
| Probability of chronic pain sufferer being prescribed opioids, %/month | 7.6% |
| Probability of SOUD individual being prescribed opioids, %/month | 7.6% |
| Probability of opioid prescription renewal for chronic pain patients without SOUD, %/month | 97% |
| Probability of opioid prescription renewal for individuals with SOUD, %/month | 94% |
| Estimated annual decline in opioid prescriptions from 2018-2019 | 8.9% |
| Probability of individuals with iatrogenic SOUD continuing use of opioids after acute pain treatment | 50% |
| Probability that chronic pain opioid user without SOUD wants to get prescription renewed, %/month | 99% |
| Probability that an opioid user is able to get renewal for chronic pain prescription if they choose, %/month | 98% |
| Use Disorder | |
| Probability of developing SHUD for non-opioid users with no pain | 0.002% |
| Probability of iatrogenic SOUD with opioid prescription, %/month | 0.20% |
| Probability of a non-medical user developing SOUD from diverted pills, %/month | 7% |
| Baseline rate of escalation to SHUD from SOUD without Rx, %/month | 4% |
| Probability of escalation to SHUD if there are not diverted pills for SOUD without Rx | 75%-60% |
| SOUD prevalence among population with opioid prescription for chronic pain | 7% |
| Percent of SHUD population who escalated from SOUD | 80% |
| Number of pain-free nonusers a prescription holder diverts opioids to, #/month | 0.01 |
| Proportionality factory relating SOUD without Rx population able to be sustained by diverted pills to lagged number of prescription holders | 0.02 |
| Treatment and desistance | |
| Percent of SOUD population enrolled in pharmacotherapy | 13%-26% |
| Percent of SHUD population enrolled in pharmacotherapy | 16%-32% |
| Rate of SOUD with Rx enrollment in pharmacotherapy, %/month | 0.5%-1% |
| Rate of SOUD without Rx enrollment in pharmacotherapy, %/month | 2%-4% |
| Rate of SHUD enrollment in pharmacotherapy, %/month | 2%-4% |
| Rate of drop out from pharmacotherapy for SOUD, %/month | 5% |
| Rate of drop out from pharmacotherapy for SHUD, %/month | 14% |
| Rate of desistance from SOUD in pharmacotherapy, %/month | 1.0% |
| Baseline rate of desistance from SOUD without pharmacotherapy, %/month | 0.5% |
| Rate of desistance from SHUD in pharmacotherapy, %/month | 0.5% |
| Rate of desistance from SHUD not in pharmacotherapy, %/month | 0.25% |
| Probability of enrollment in pharmacotherapy if there are not diverted pills for SOUD without Rx | 15%-30% |
| Probability of desistance if there are not diverted pills for SOUD without Rx | 10% |
| Mortality | |
| Mortality rate for the general population, %/month | 0.07% |
| Mortality rate for SOUD not in pharmacotherapy %/month | 0.23% |
| Mortality rate for SHUD not in pharmacotherapy %/month | 0.54% |
| Mortality rate for SOUD in pharmacotherapy %/month | 0.13% |
| Mortality rate for SHUD in pharmacotherapy %/month | 0.30% |
| Overdose mortality for person with SHUD, not in pharmacotherapy, %/month | 0.43% |
| Overdose mortality for person with SOUD, not in pharmacotherapy, %/month | 0.15% |
| Infection-related mortality for person with SHUD, not in pharmacotherapy, %/month | 0.03% |
| 1-month relative risk of use disorder-related mortality in vs. out of pharmacotherapy for person with severe use disorder | 0.50 |
| Utility values | |
| Pain-free nonuser | 1 |
| Chronic pain nonuser | 0.85 |
| Acute pain nonuser | 0.88 |
| Acute pain with Rx | 0.94 |
| Chronic pain with Rx | 0.85 |
| SOUD not in pharmacotherapy | 0.83 |
| SOUD in pharmacotherapy | 0.92 |
| SHUD not in pharmacotherapy | 0.80 |
| SHUD in pharmacotherapy | 0.90 |
| Dead | 0 |
Abbreviations: Rx = prescription; SHUD = severe heroin use disorder; SOUD = severe opioid use disorder
1
Sources for all parameter values are provided in the Supplement.
2
Where a range is shown for a value, the parameter takes on the first value from January 2020 to December 2020, then the value changes linearly from the first value to the second value over the time period January 2021 to June 2022, and then the parameter has the second value over the remainder of the modeled time horizon.