Abstract for: Using System Dynamics Modeling to Compare County-Level Responses to the Opioid Crisis in the New York HEALing Communities Study

Despite recent declines, opioid overdose remains a leading cause of death among U.S. adults, with substantial variation across communities. To better understand these differences and support tailored interventions, we developed and validated a system dynamics model for the New York HEALing Communities Study. The model supports data-driven decision-making and planning for evidence-based strategies, including naloxone distribution, and medication for opioid use disorder (OUD) treatment, while accounting for differences in local context and historical capacity. We developed a comprehensive system dynamics model of the opioid crisis across 16 counties, capturing opioid exposure, supply, overdose risk, community awareness, naloxone use, and MOUD treatment. The model was calibrated using county-specific demographic and health data and informed by stakeholder input. Simulation results revealed substantial variation in overdose death rates from 2012–2032. Comparative analyses identified the key system structures and feedback mechanisms driving county-specific differences in overdose outcomes. County outcomes differed based on key factors such as community awareness and opioid supply-to-demand ratios. Performance measures, including MOUD treatment coverage and overdose-to-OUD prevalence ratios, helped explain county-specific success in reducing OUD prevalence, overdoses, and deaths. Simulations showed that counties implementing combinations of evidence-based practices achieved better long-term outcomes. Results also demonstrated that intervention effects may be delayed, with outcomes sometimes worsening before improving when strong OUD trends already exist. Simulation analyses revealed the system structures and feedback loops underlying historical opioid morbidity and mortality trends across 16 communities in the New York HEALing Communities Study. The validated model serves as a virtual laboratory for understanding local differences in the opioid crisis, community responses, and intervention effectiveness. It provides a valuable tool for strategic planning, helping community decision-makers evaluate future trends and identify interventions that can reduce opioid overdoses and fatalities.