Model-Informed Understanding and Mitigation of the U.S. Opioid and Heroin Epidemic

项目总结 本提案旨在开发、验证和应用阿片类海洛因流行的系统工程模型。 帮助评估、告知和优化有效的政策，以缓解这一日益严重的问题。中突出显示的 美国卫生部长、卫生与公共服务部部长和特朗普总统，这一复杂的流行病 正在影响到社会的几乎所有阶层，深刻的社会影响(380万非法使用者)、金融(785亿美元)、 和健康(每年420,000人过量和33,000人死亡)的影响，以及重大的区域和社会经济影响 差距。自1999年以来，与阿片类药物相关的死亡人数增加了四倍多，自2010年以来死亡率大幅上升， 而且没有减弱的迹象。尽管这场危机规模巨大，但有效的战略仍然难以捉摸，而且往往 没有充分解决处方发生的内在相互作用和动态，滥用开始和 传播、寻求和提供治疗，以及物质的可获得性和市场力量影响行为。 系统科学模型越来越受到美国国家医学科学院、美国国立卫生研究院 Health，Agency for Healthcare Research and Quality，以及其他机构帮助解决这些复杂的问题，但有 尚未应用于阿片类药物的流行。为了解决这一差距，拟议的研究旨在开发系统- 药物使用连续体每个阶段(开始、依赖、治疗)和试点的TEM工程模型 它们在多个设置中使用，以实现健壮性。具体目标包括：(1)开发和验证初步系统 每个阶段的动态、基于代理、能力优化和离散事件物流模型；(2) 风管试点分析使用这些模型来识别洞察力和结构关系，快速生成和测试 假设，并估计干预的有效性和后果；以及(3)概括和扩展结果 除了最初的试点应用，包括确定更大的技术和政策研究议程。 主要目标是使用设想的模型来获得关于因果关系和动力学的知识 每个阶段，然后调查并通报有效的干预措施、资源分配和政策。而当 计划中的工作将主要基于模型，拟议的工程师-临床医生研究团队将依赖于Feed- 从一个不同的利益相关者咨询委员会回来(包括行为健康、初级保健、成瘾 治疗、药物滥用和来自几个州和护理系统的政策专家)来验证 开发模型，探索可行的干预策略。预期结果包括：(1)经过验证的预先 划片、滥用传播和处理模式，在多个环境和规模中表现出稳健性，如 以及对其他多物质现象的更广泛适用性；以及(2)有用的见解、解释性假设-- 以及对可能对阿片类药物流行产生有意义影响的拟议政策和干预措施的分析。

PROJECT SUMMARY This proposal aims to develop, validate, and apply systems engineering models of the opioid-heroin epidemic to help evaluate, inform, and optimize effective policies to mitigate this growing problem. As highlighted by the U.S. Surgeon General, Secretary of Health and Human Services, and President Trump, this complex epidemic is affecting nearly all strata of the society, with profound social (3.8 million illicit users), financial ($78.5 billion), and health (420,000 overdoses and 33,000 deaths / year) impacts, and significant regional and socioeconomic disparities. Opioid-related deaths have more than quadrupled since 1999, at sharply higher rates since 2010, and with no indication of abating. Despite the enormity of this crisis, effective strategies remain elusive, often insufficiently addressing the inherent interactions and dynamics by which prescribing occurs, abuse begins and spreads, treatment is sought and provided, and substance availability and market forces affect behaviors. System science models are increasingly advocated by the National Academy of Medicine, National Institutes of Health, Agency for Healthcare Research and Quality, and others to help solve such complex issues, but have not yet been applied to the opioids epidemic. To address this gap, the proposed research aims to develop sys- tems engineering models at each phase of the drug use continuum (initiation, dependency, treatment) and pilot their use in multiple settings for robustness. Specific aims include: (1) develop and validate preliminary system dynamics, agent-based, capacity optimization, and discrete event logistics models across each phase; (2) con- duct pilot analysis using these models to identify insights and structural relationships, rapidly generate and test hypotheses, and estimate intervention effectiveness and consequences; and (3) generalize and expand results beyond the initial pilot applications, including identification of a larger technical and policy research agenda. The overarching objective is to use the envisioned models to gain knowledge about causality and dynamics for each phase, and to then investigate and inform effective interventions, resource allocations, and policies. While the planned work will be largely model-based, the proposed engineer-clinician research team will rely on feed- back from a diverse stakeholder advisory committee (comprising of behavioral health, primary care, addiction treatment, substance abuse, and policy experts drawing from several states and care systems) to validate the developed models and explore feasible intervention strategies. Anticipated outcomes include: (1) validated pre- scribing, abuse spread, and treatment models with demonstrated robustness in multiple settings and scales as well as broader applicability to other multi-substance phenomena; and (2) useful insights, explanatory hypothe- ses, and analysis of proposed polices and interventions that can meaningfully impact the opioid epidemic.