Abstract for: System Dynamics Modeling to Inform Effective implementation of Evidence Based Practices to Prevent Opioid Overdose and Overdose

As part of the New York State HEALing Communities Study (NY HCS) to address the opioid crisis, we have constructed a system dynamics model of the opioid epidemic in NY that generalizes to the state and to the participating NY communities (N=16). Our goal is to understand the dynamic structures that can explain historical trends of several time series relating to opioid morbidity and mortality in NY. We report on comparative simulation analyses to help stakeholders develop a deeper understanding of short- and long-term capacity building needs and trade-offs in choosing the optimal mix of Opioid Overdose Education & Naloxone Distribution (OEND), Medications for Opioid Use Disorder (MOUD), and Safer Prescribing and Dispensing Practices (SPDP) strategies to their given communities’ capacities and barriers. Our analysis shows: (1) a combination of evidence-based strategies has the most impact; (2) linkage strategies for MOUD need to be combined with treatment retention strategies; (3) naloxone distribution has limited impact if not combined with strategies to improve bystander availability; (4) strategies that promote prevention in opioid misusers should be an important priority; and (5) given the associated effects of the COVID-19 pandemic and fentanyl supply, reversing overdose death rates is challenging, even with expanded implementation of strategies.