System dynamics modeling to inform implementation of evidence-based prevention of opioid overdose and fatality: A state-level model from the New York HEALing Communities Study.

BACKGROUND

As part of the New York HEALing Communities Study, we modeled the opioid epidemic in New York State (NYS) to help coalition members understand short- and long-term capacity-building needs and trade-offs in choosing the optimal mix of harm reduction, treatment, and prevention strategies.

METHODS

We built and validated a system dynamics simulation model of the interdependent effects of exposure to opioids, opioid supply and overdose risk, community awareness of overdose risk, naloxone supply and use, and treatment for opioid use disorder (OUD). We simulated overdose and fatality rates, OUD prevalence, and related measures from 2012 to 2032 for the NYS population aged ≥12 and tested policy scenarios for reducing future overdose deaths.

RESULTS

Increasing naloxone distribution by 50 % led to a 10 % decrease in overdose deaths, but only minimally reduced OUD prevalence (1 %) by 2032. Enhancing by 50 % medications for OUD (MOUD) initiations and prevention efforts each led to substantial decreases in deaths (29 % and 25 %, respectively) and OUD prevalence (27 % and 6 %) by 2032. Simultaneously increasing naloxone distribution and MOUD initiations by 50 % resulted in 38 % fewer deaths, while adding prevention efforts alongside resulted in 56 % fewer fatalities. Sensitivity analyses of the models' feedback loops demonstrated similar relative impacts.

CONCLUSIONS

A combination of evidence-based strategies while also promoting prevention should be prioritized to reduce overdose fatality. Sustained community awareness and prevention efforts are needed even as overdoses and deaths decline due to the significant effects of the community awareness feedback loop on the epidemic trends.