Abstract for: A System Dynamics Model of Opioid Use for Chronic Non-Malignant Pain Incorporating Complementary and Alternative Care

The liberal prescription of opioids for chronic non-malignant pain has resulted in an alarming rate of its utilization and subsequent abuse. Large pragmatic, population-based studies of policy change to manage challenging and complex clinical situations such as this are extremely costly and time consuming. A system dynamics model was created to demonstrate the impact of complementary and alternative care (chiropractic care) on the escalating problem of opioid use for chronic non-cancer pain. Modeling provided data to anticipate constraints, to illustrate key leverage points for intervention and to guide future pragmatic research. Primary outcome variables used to test the dynamic hypotheses were: number of patients addicted to opioids and number of opioid-related deaths. Policy implementation was allowed to occur in the year 2000, and the results were analyzed for a 15 year period of policy retention (2015). Significant positive change was most apparent where chiropractic care was included early in the course treatment for pain. Pragmatic clinical trials of system-wide effects remain a difficult undertaking. System dynamics modeling illustrated assumptions and feedbacks to guide further investigation.