Modeling the Impact of Simulated Educational Interventions on the Use and Abuse of Pharmaceutical Opioids in the United States

Abstract

Three educational interventions were simulated in a system dynamics model of the medical use, trafficking, and nonmedical use of pharmaceutical opioids. The study relied on secondary data obtained in the literature for the period of 1995 to 2008 as well as expert panel recommendations regarding model parameters and structure. The behavior of the resulting systems-level model was tested for fit against reference behavior data. After the base model was tested, logic to represent three educational interventions was added and the impact of each intervention on simulated overdose deaths was evaluated over a 7-year evaluation period, 2008 to 2015. Principal findings were that a prescriber education intervention not only reduced total overdose deaths in the model but also reduced the total number of persons who receive opioid analgesic therapy, medical user education not only reduced overdose deaths among medical users but also resulted in increased deaths from nonmedical use, and a “popularity” intervention sharply reduced overdose deaths among nonmedical users while having no effect on medical use. System dynamics modeling shows promise for evaluating potential interventions to ameliorate the adverse outcomes associated with the complex system surrounding the use of opioid analgesics to treat pain.

Dynamic model of nonmedical opioid use trajectories and potential policy interventions

“…Trafficked means a “dealer” is involved and drugs are paid for with money or trade. Trafficked supply availability is an exogenous input to the model that was derived from a dynamic model of medical POA use and trafficking (55), and is consistent with anecdotal evidence reported in the popular press (e.g. 56).…”

Key Data Gaps Regarding the Public Health Issues Associated with Opioid Analgesics

“…The creation of a system dynamics model of opioid analgesic use and abuse by Wakeland and colleagues 16 led to the identification of 12 gaps in available data. The model features the population dynamics of: (1) opioid analgesic treatment for CNMP, (2) medical use and abuse of opioid analgesics, (3) diversion of opioid analgesics for nonmedical use, (4) initiation of and frequency of nonmedical use among non-patients, and (5) the associated overdose deaths.…”

“…16 System dynamics is a computer simulation methodology that describes a system in terms of stocks and flows which are governed by differential equations. 17,18 The system dynamics method is particularly well-suited for studying health care systems, 19 and has been successfully applied to public health phenomena such as the evaluation of policy options concerning cocaine prevalence 20,21 and health care reform.…”

The Proliferation of Dosage Thresholds in Opioid Prescribing Policies and Their Potential to Increase Pain and Opioid-Related Mortality:

“…In light of the paucity of empirical research evaluating the efficacy of threshold models and their outcomes, coupled with the realization that politics has been known to trump science , perhaps the current political solution is somewhere in the middle where thresholds are placed in advisory guidelines instead of mandatory rules, the concerns are addressed, and the actual impacts of these models are determined. In the interim, however, educational interventions to reduce pain and unintentional overdose currently exist and can be effective . After all, prescriber education remains a key component in federal efforts , and even the Washington model recognizes the value of education by exempting physicians from the mandatory pain consult requirement if the prescriber has taken continuing medical education (CME) in pain management .…”