Abstract for: A dynamic modeling analysis of the opioid use disorder cascade of care in New York State

Cascade of Care (CoC) models are useful tools to inform policymaking to improve access to evidence-based treatment for opioid use disorder (OUD). In this study, we expand upon previous OUD CoC frameworks by utilizing a previously built system dynamics simulation model of the opioid epidemic in New York State. The model captures the dynamics of opioid misuse and OUD, opioid supply, social influence, and provision of treatment and was originally built using a variety of information sources, including surveillance data, expert opinion, and published works. We performed experiments with this model to evaluate the impact of various interventions on the OUD CoC over a 20-year period (2012-2032). The simulated interventions include increasing initiation and retention rates of medication for opioid use disorder (MOUD), increasing OUD identification, and intensifying prevention efforts. Simulations revealed gaps in the OUD CoC, including substantial shortages in OUD diagnosis, MOUD initiation and retention, and individuals achieving remission. Policy analyses indicate that a combination of robust interventions targeting multiple points along the OUD CoC is needed to effectively reduce gaps in provision of OUD treatment. Prevention strategies were particularly vital to reduce the number of individuals at risk for developing OUD, lowering the demand for MOUD treatment.