Burden of overdoses among persons with opioid use disorder in the United States, 2025-2028: a simulation modeling study.

Abstract

Despite recent declines in fatal overdoses in the United States, the overdose crisis remains a persistent public health challenge. We modeled hypothetical scenarios of short-term increases or decreases in opioid-involved overdose rates among individuals with opioid use disorder (OUD) and estimated overdose-related outcomes, costs, and prevention efforts to counteract potential increases in fatal overdoses. We updated a previously validated simulation model of the US population with OUD using 2021-2024 data. Fatal and nonfatal overdoses, individuals with OUD and in remission, and estimated economic costs were projected between 2025 and 2028 under baseline conditions and hypothetical scenarios assuming annual 5% increases or decreases in fatal overdose rates. We quantified prevention efforts to counteract increases in overdose across four prevention strategies aimed at improving access to medications for OUD (MOUD) and reducing fatal overdose. The baseline scenario estimated 97,000 fatal and 3.4 million nonfatal opioid-involved overdoses among individuals with OUD, and an economic burden of $3.94 trillion between 2025 and 2028. Assuming decreased fatal overdose rates, we estimated 14.1% fewer fatal overdoses, and $202 billion in reduced economic burden. Conversely, assuming fatal overdose rates increased, we estimated an additional 16.5% fatal overdoses and $236 billion in economic burden. Model simulations estimated increasing annual MOUD initiation to 62.6% and naloxone administration to 14.2% could independently prevent additional lives lost. The economic burden of overdose and OUD highlights the importance of continued investments in overdose prevention. Increased prevention efforts, such as naloxone use and increased MOUD initiation, could help counteract potential increases in fatal overdose rates. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.