System Dynamics Modeling of Medical Use, Nonmedical Use and Diversion of Prescription Opioid Analgesics

The objective of the study was to develop a system dynamics model of the medical use of pharmaceutical opioids to treat pain, and the associated diversion and nonmedical use of these drugs. The model was used to test the impact of simulated interventions in this complex system. The study relied on secondary data obtained from the literature and from other public sources for the period 1995 to 2008. In addition, an expert panel provided recommendations regarding model parameters and model structure. The behavior of the resulting systems level model compared favorably with reference behavior data (R2=.95). After the base model was tested, logic to simulate the interventions was added and the impact on overdose deaths was evaluated over a seven-year period, 2008-2015. Principal findings were that a prescriber education intervention reduced total overdose deaths, while reducing the number of persons treated with opioid analgesics. A “popularity” intervention sharply reduced nonmedical overdoses. We conclude that the system dynamics modeling approach shows promise for evaluating potential policy interventions to ameliorate the adverse outcomes associated with the complex system surrounding the use of opioid analgesics to treat pain