系统动力学建模为阿片类药物过量和死亡的循证预防的实施提供信息：纽约康复社区研究的州级模型

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-05-27 DOI:10.1016/j.drugpo.2025.104843

Nasim S. Sabounchi , Rachel L. Thompson , Matthew R. Lootens , David W. Lounsbury , Gary Hirsch , Derek Blevins , Turner C. Canty , Nabila El-Bassel , Louisa Gilbert , Pedro Mateu-Gelabert , Daniel J. Feaster , Bruce D. Rapkin , Terry T.-K. Huang

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引用次数: 0

摘要

作为纽约康复社区研究的一部分，我们模拟了纽约州（NYS）的阿片类药物流行，以帮助联盟成员了解短期和长期的能力建设需求以及选择减少危害、治疗和预防战略的最佳组合的权衡。方法建立并验证了阿片类药物暴露、阿片类药物供应和过量风险、社区过量风险意识、纳洛酮供应和使用以及阿片类药物使用障碍（OUD）治疗的相互作用的系统动力学模拟模型。我们模拟了2012年至2032年纽约州年龄≥12岁人口的用药过量和致死率、OUD患病率和相关措施，并测试了减少未来用药过量死亡的政策方案。结果到2032年，纳洛酮用量增加50%导致过量死亡减少10%，但仅能使OUD患病率最低限度地降低（1%）。到2032年，将OUD （OUD）启动的药物治疗和预防力度分别提高50%，导致死亡率（分别为29%和25%）和OUD患病率（27%和6%）大幅下降。同时，将纳洛酮分发和mod起始量增加50%可使死亡人数减少38%，同时增加预防工作可使死亡人数减少56%。对模型反馈回路的敏感性分析显示了类似的相对影响。结论应优先结合循证策略，同时加强预防，以降低药物过量死亡率。尽管由于社区认识反馈循环对流行病趋势的重大影响，过量用药和死亡人数有所下降，但仍需要持续的社区认识和预防努力。

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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.

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.