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Comment & Response
November 2017

Factors to Consider for Reducing US Opioid-Related Deaths: Looking Beyond Access—Reply: Factors to Consider for Reducing US Opioid-Related Deaths—Reply

Author Affiliations
  • 1Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
  • 2Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
JAMA Psychiatry. 2017;74(11):1171-1172. doi:10.1001/jamapsychiatry.2017.2431

In Reply We thank Desai et al for commenting on our article1 reporting trends in heroin use and heroin use disorder in the United States and for noting their findings that while access to opioid-dependency medication (ODM) increased in Massachusetts from 2010 to 2016 through greater numbers of ODM prescribers, opioid-related deaths rose even faster. Clearly, increasing the number of available ODM prescribers is only 1 of many factors that must be addressed to solve the opioid epidemic. We agree with Desai et al that despite the benefits of ODM among those receiving it, rates of opioid-related deaths are not likely to decrease if the incidence and prevalence of heroin use and other opioids (eg, fentanyl and even stronger synthetic opioids) continue to rise. Further, we note that prescribers are usually limited in the number of patients to whom they can offer ODM, so an increase in prescribers does not necessarily translate into a sharp increase in the number of patients receiving ODM. Moreover, only a minority of patients with opioid use disorder seek treatment because of stigma, beliefs that they do not need treatment, or structural barriers/accessibility to seek treatment after being treated for an opioid overdose.2 Of those who do, many drop out.3

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