TRANSFORM - Transforming the evidence base on estimating prevalence of opioid use disorder and expanded access to interventions to prevent drug related deaths: an international data linkage study - PROJECT ABSTRACT The scale of opioid harms in the US and globally requires urgent action to improve efforts to reduce such harms. Evidence on the number of people with opioid use disorder (OUD) is critical to quantify opioid agonist treatment (OAT) coverage and the scale-up required to reduce drug related deaths in the population. Administrative databases linked at the individual-level have great power to inform prevalence estimates, examine rare outcomes, and explore subgroup and context specific variations of OAT. To date, there has been relatively limited use of data linkage in US OUD and OAT research, in part reflecting challenges and concerns about ethics and feasibility. Yet many of these challenges equally exist – and have been managed – in other countries. The fragmented and particularly complex US healthcare system presents additional complications, but there are examples of US jurisdictions that have managed to overcome these. The TRANSFORM team will undertake a first of its kind multi-jurisdictional study using data linkages in the US (Rhode Island, Wisconsin, Colorado, and Massachusetts), Australia (New South Wales), and the United Kingdom (Scotland). The two non-US sites involve leading researchers globally who will be able to leverage the data and methods in those jurisdictions to apply to the four US sites and develop resources that can then be applied to other US jurisdictions. This work will generate crucial new data on the prevalence of OUD and characterize jurisdiction-specific impacts of OAT across settings and clinical contexts. Mathematical modeling will provide jurisdiction-specific information about where the greatest impacts of enhanced OAT access on mortality can be achieved, to inform practice, policy, and advocacy. Analytic code and resources for estimating prevalence, analyzing linked data, and developing jurisdiction-specific models will be made freely available. This will increase understanding of and capacity for these study designs to be implemented in other jurisdictions across the United States and globally. The overall study objective is to transform the evidence base on the prevalence of OUD and the impact of OAT as a strategy to prevent opioid harm. Specific aims include: Aim 1. Generate robust OUD prevalence estimates; Aim 2. Examine the impact of OAT on overdose and all-cause mortality in different OAT populations, treatment systems, and jurisdictions (these data will inform the statistical and population modelling in Aims 1 & 3, respectively); and Aim 3. Determine the population-level impact of existing and expanded access of OAT provision on fatal overdose and all-cause mortality among people with OUD in select jurisdictions.
