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Modeling the Impact of Simulated Educational Interventions on the Use and Abuse of Pharmaceutical Opioids in the United States: A Report on Initial Efforts
Health Education & Behavior (2013)
  • Wayne W. Wakeland, Portland State University
  • Alexandra Nielsen, Portland State University
  • Teresa Schmidt, Portland State University
  • Dennis McCarty, Oregon Health & Science University
  • Lynn R. Webster, Oregon Health & Science University
  • John Fitzgerald
  • J. David Haddox, Tufts University
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.
A dramatic rise in the nonmedical use of pharmaceutical opioids has presented the United States with a substantial public health problem (Compton & Volkow, 2006). Despite the increasing prevalence of negative outcomes, such as fatal and nonfatal overdoses, nonmedical use of pharmaceutical opioids remains largely unabated by current policies and regulations (Fishman, Papazian, Gonzalez, Riches, & Gilson, 2004). Resistance to policy interventions likely stems from the complexity of the medical and nonmedical use of pharmaceutical opioids, as interactions among prescribers, pharmacists, persons obtaining opioids for medical or nonmedical use, opioid traffickers, and public health advocates result in chains of causal relationships and instances of information feedback in the system.
This article presents a system dynamics (SD) model of the U.S. opioid-related complex system. This model is designed to foster a more complete understanding of how medical use, trafficking, and nonmedical use are interrelated, and to identify points of high leverage for educational interventions on the epidemic of nonmedical use. Three potential interventions are simulated, relative costs and benefits are estimated, and possible counterintuitive downstream effects are highlighted. The term opioids is used to mean pharmaceutically manufactured opioid (morphine-like) medicines, most of which are indicated for use as analgesics, and does not include heroin or other illicit opioid drug substances.
Keywords
  • Alcohol and substance abuse,
  • Dynamic modeling,
  • Modeling and simulation,
  • Nonlinear dynamics,
  • Substance use,
  • Systems science
Publication Date
October, 2013
DOI
10.1177/1090198113492767
Citation Information
Wayne W. Wakeland, Alexandra Nielsen, Teresa Schmidt, Dennis McCarty, et al.. "Modeling the Impact of Simulated Educational Interventions on the Use and Abuse of Pharmaceutical Opioids in the United States: A Report on Initial Efforts" Health Education & Behavior Vol. 40 Iss. 1 (2013)
Available at: http://works.bepress.com/wayne_wakeland/39/