title: System dynamics modeling as a potentially useful tool in analyzing mitigation strategies to reduce overdose deaths associated with pharmaceutical opioid treatment of chronic pain.
abstract: OBJECTIVE
  To illustrate a system-level, simulation-based approach for evaluating mitigation strategies to address the dramatic rise in abuse, addiction, and overdose deaths associated with the use of pharmaceutical opioid analgesics to treat chronic pain. SIMULATED INTERVENTIONS: Making available drug formulations with increased tamper-resistance, prescriber education programs, and programs that reduce rates of medical user-related abuse and addiction. SIMULATED OUTCOME MEASURE: Number of overdose deaths of medical users of pharmaceutical opioid analgesics, including those who abuse or have become addicted.
  
  
  METHODS
  A demonstration system dynamics model is developed, tested, and used to evaluate the impact of candidate mitigation strategies on the outcome measures.
  
  
  RESULTS
  Tamper-resistant drug products will likely reduce overdose death rates but may not reduce overall deaths if there is increased prescribing. Prescriber education would likely reduce deaths through a reduction in patient access to pharmaceutical opioid analgesics.
  
  
  CONCLUSIONS
  The system dynamics approach may have potential for opioid-related policy evaluation. However, metrics must be carefully selected, and trade-offs may be involved. For example, it may be difficult to limit negative outcomes associated with pharmaceutical opioids without adversely affecting chronic pain patients' access to pharmaceutical treatment. Ultimately, a combination of metrics and value judgments will be needed to properly evaluate mitigation strategies.
authors.affiliation: Portland State University, Systems Science Graduate Program, Portland, Oregon 97207, USA. wakeland@pdx.edu
authors.forename: Wayne
authors.initials: W
authors.lastname: Wakeland
authors.forename: Teresa
authors.initials: T
authors.lastname: Schmidt
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Gilson
authors.forename: J David
authors.initials: JD
authors.lastname: Haddox
authors.forename: Lynn R
authors.initials: LR
authors.lastname: Webster
mesh_terms: D000701:Analgesics, Opioid / Q000506:poisoning* / Q000627:therapeutic use*; D002908:Chronic Disease; D062787:Drug Overdose / Q000401:mortality*; D004502:Education, Medical, Continuing; D006801:Humans; D008962:Models, Theoretical; D010146:Pain / Q000188:drug therapy*; D019966:Substance-Related Disorders
chemical_list: D000701:Analgesics, Opioid