{"id":19340,"date":"2025-06-01T17:42:37","date_gmt":"2025-06-01T16:42:37","guid":{"rendered":"https:\/\/drugprevent.org.uk\/ppp\/?p=19340"},"modified":"2025-06-01T17:42:37","modified_gmt":"2025-06-01T16:42:37","slug":"system-dynamics-modeling-to-inform-prevention-of-opioid-overdose-and-fatality","status":"publish","type":"post","link":"https:\/\/drugprevent.org.uk\/ppp\/2025\/06\/system-dynamics-modeling-to-inform-prevention-of-opioid-overdose-and-fatality\/","title":{"rendered":"System dynamics modeling to inform  prevention of opioid overdose and fatality"},"content":{"rendered":"<h1 id=\"screen-reader-main-title\" class=\"Head u-font-serif u-h2 u-margin-s-ver\"><strong><span class=\"title-text\" style=\"font-size: 12pt;\">System dynamics modeling to inform implementation of evidence-based prevention of opioid overdose and fatality: A state-level model from the New York HEALing Communities Study<\/span><\/strong><\/h1>\n<div id=\"banner\" class=\"Banner\">\n<div class=\"wrapper truncated\">\n<div aria-live=\"polite\"><\/div>\n<div class=\"AuthorGroups\">\n<div id=\"author-group\" class=\"author-group\"><span class=\"sr-only\">Author panel:<\/span><button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0001\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Nasim S.<\/span>\u00a0<span class=\"text surname\">Sabounchi<\/span>\u00a0<\/span><span id=\"baff0001\" class=\"author-ref\"><sup>a<\/sup><\/span>\u00a0<span id=\"baff0002\" class=\"author-ref\"><sup>b<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0002\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Rachel L.<\/span>\u00a0<span class=\"text surname\">Thompson<\/span>\u00a0<\/span><span id=\"baff0001\" class=\"author-ref\"><sup>a<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0003\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Matthew R.<\/span>\u00a0<span class=\"text surname\">Lootens<\/span>\u00a0<\/span><span id=\"baff0001\" class=\"author-ref\"><sup>a<\/sup><\/span>\u00a0<span id=\"baff0002\" class=\"author-ref\"><sup>b<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0004\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">David W.<\/span>\u00a0<span class=\"text surname\">Lounsbury<\/span>\u00a0<\/span><span id=\"baff0003\" class=\"author-ref\"><sup>c<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0005\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Gary<\/span>\u00a0<span class=\"text surname\">Hirsch<\/span>\u00a0<\/span><span id=\"baff0004\" class=\"author-ref\"><sup>d<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0006\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Derek<\/span>\u00a0<span class=\"text surname\">Blevins<\/span>\u00a0<\/span><span id=\"baff0005\" class=\"author-ref\"><sup>e<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0007\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Turner C.<\/span>\u00a0<span class=\"text surname\">Canty<\/span>\u00a0<\/span><span id=\"baff0001\" class=\"author-ref\"><sup>a<\/sup><\/span>\u00a0<span id=\"baff0002\" class=\"author-ref\"><sup>b<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0008\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Nabila<\/span>\u00a0<span class=\"text surname\">El-Bassel<\/span>\u00a0<\/span><span id=\"baff0006\" class=\"author-ref\"><sup>f<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0009\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Louisa<\/span>\u00a0<span class=\"text surname\">Gilbert<\/span>\u00a0<\/span><span id=\"baff0006\" class=\"author-ref\"><sup>f<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0010\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Pedro<\/span>\u00a0<span class=\"text surname\">Mateu-Gelabert<\/span>\u00a0<\/span><span id=\"baff0007\" class=\"author-ref\"><sup>g<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0011\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Daniel J.<\/span>\u00a0<span class=\"text surname\">Feaster<\/span>\u00a0<\/span><span id=\"baff0008\" class=\"author-ref\"><sup>h<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0012\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Bruce D.<\/span>\u00a0<span class=\"text surname\">Rapkin<\/span>\u00a0<\/span><span id=\"baff0003\" class=\"author-ref\"><sup>c<\/sup><\/span><\/span><\/span><\/button>,\u00a0<button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"au0013\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Terry T.-K.<\/span>\u00a0<span class=\"text surname\">Huang<\/span>\u00a0<\/span><span id=\"baff0001\" class=\"author-ref\"><sup>a<\/sup><\/span>\u00a0<span id=\"baff0002\" class=\"author-ref\"><sup>b<\/sup><\/span><\/span><\/span><\/button><\/div>\n<\/div>\n<\/div>\n<p><button id=\"show-more-btn\" class=\"button-link u-margin-s-ver button-link-primary button-link-icon-right\" type=\"button\" data-aa-button=\"icon-expand\"><\/button><button class=\"button-link button-link-secondary button-link-icon-left button-link-has-colored-icon\" type=\"button\" aria-expanded=\"false\" aria-haspopup=\"true\"><\/button><\/div>\n<div id=\"article-identifier-links\" class=\"ArticleIdentifierLinks u-margin-xs-bottom text-xs\"><\/div>\n<section class=\"ReferencedArticles\"><\/section>\n<section class=\"ReferencedArticles\"><\/section>\n<div id=\"preview-section-abstract\">\n<div class=\"PageDivider\"><\/div>\n<div id=\"abstracts\" class=\"Abstracts u-font-serif\">\n<div id=\"abs0001\" class=\"abstract author-highlights\">\n<h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Highlights<\/h2>\n<div id=\"abss0001\">\n<div id=\"spara013\" class=\"u-margin-s-bottom\">\n<ul class=\"list\">\n<li class=\"react-xocs-list-item\"><span class=\"list-label\">\u2022<\/span>\n<div id=\"para0001\" class=\"u-margin-s-bottom\">Simulations showed fentanyl spread challenges reducing overdoses in the short run.<\/div>\n<\/li>\n<li class=\"react-xocs-list-item\"><span class=\"list-label\">\u2022<\/span>\n<div id=\"para0002\" class=\"u-margin-s-bottom\">Prevention of opioid misuse among opioid-exposed individuals should be prioritized.<\/div>\n<\/li>\n<li class=\"react-xocs-list-item\"><span class=\"list-label\">\u2022<\/span>\n<div id=\"para0003\" class=\"u-margin-s-bottom\">Combined strategies effectively reduce fatalities and OUD prevalence.<\/div>\n<\/li>\n<li class=\"react-xocs-list-item\"><span class=\"list-label\">\u2022<\/span>\n<div id=\"para0004\" class=\"u-margin-s-bottom\">Bolstering community awareness mitigates possible rise of fatalities in the future.<\/div>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"abs0002\" class=\"abstract author\">\n<h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Abstract<\/h2>\n<div id=\"abss0002\">\n<h3 id=\"cesectitle0003\" class=\"u-h4 u-margin-m-top u-margin-xs-bottom\">Background<\/h3>\n<div id=\"spara014\" class=\"u-margin-s-bottom\">As part of the New York HEALing Communities Study, we modeled the opioid epidemic in New York State (NYS) to help coalition members understand short- and long-term capacity-building needs and trade-offs in choosing the optimal mix of harm reduction, treatment, and prevention strategies.<\/div>\n<\/div>\n<div id=\"abss0003\">\n<h3 id=\"cesectitle0004\" class=\"u-h4 u-margin-m-top u-margin-xs-bottom\">Methods<\/h3>\n<div id=\"spara015\" class=\"u-margin-s-bottom\">We built and validated a system dynamics simulation model of the interdependent effects of exposure to opioids, opioid supply and overdose risk, community awareness of overdose risk, naloxone supply and use, and treatment for opioid use disorder (OUD). We simulated overdose and fatality rates, OUD prevalence, and related measures from 2012 to 2032 for the NYS population aged \u226512 and tested policy scenarios for reducing future overdose deaths.<\/div>\n<\/div>\n<div id=\"abss0004\">\n<h3 id=\"cesectitle0005\" class=\"u-h4 u-margin-m-top u-margin-xs-bottom\">Results<\/h3>\n<div id=\"spara016\" class=\"u-margin-s-bottom\">Increasing naloxone distribution by 50 % led to a 10 % decrease in overdose deaths, but only minimally reduced OUD prevalence (1 %) by 2032. Enhancing by 50 % medications for OUD (MOUD) initiations and prevention efforts each led to substantial decreases in deaths (29 % and 25 %, respectively) and OUD prevalence (27 % and 6 %) by 2032. Simultaneously increasing naloxone distribution and MOUD initiations by 50 % resulted in 38 % fewer deaths, while adding prevention efforts alongside resulted in 56 % fewer fatalities. Sensitivity analyses of the models\u2019 feedback loops demonstrated similar relative impacts.<\/div>\n<\/div>\n<div id=\"abss0005\">\n<h3 id=\"cesectitle0006\" class=\"u-h4 u-margin-m-top u-margin-xs-bottom\">Conclusions<\/h3>\n<div id=\"spara017\" class=\"u-margin-s-bottom\">A combination of evidence-based strategies while also promoting prevention should be prioritized to reduce overdose fatality. Sustained community awareness and prevention efforts are needed even as overdoses and deaths decline due to the significant effects of the community awareness feedback loop on the epidemic trends.<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"preview-section-introduction\">\n<div class=\"PageDivider\"><\/div>\n<div class=\"Introduction u-font-serif u-margin-l-ver\">\n<h2 class=\"u-h4 u-margin-s-bottom\">Introduction<\/h2>\n<section id=\"sec0001\">\n<div id=\"para0009\" class=\"u-margin-s-bottom\">Although opioid-related fatalities decreased in the United States (US) and New York State (NYS) from 2022 to 2023, fatality remains high (81,083 (US) and 5,308 (NYS) in 2023) after years of unprecedented increases of fatal and non-fatal overdoses (Centers for Disease Control and Prevention, National Center for Health Statistics, 2021, 2024; National Institute on Drug Abuse, 2023). A dramatic rise in the availability of illicitly manufactured fentanyl has also been documented in the US and NYS, resulting in a more potent opioid supply (Kilmer et al., 2022; New York State Department of Health, 2023a). Intentional and unintentional exposure to fentanyl among people who use drugs has been associated with increased risk of overdose and death (Hughto et al., 2022). Fentanyl co-involved with psychostimulants, benzodiazepines, and xylazine may characterize a new wave of the opioid epidemic (Ciccarone, 2021a; Friedman &amp; Shover, 2023; Jenkins, 2021).<\/div>\n<div id=\"para0010\" class=\"u-margin-s-bottom\">In 2019, the National Institute on Drug Abuse (NIDA) funded the HEALing (Helping to End Addiction Long-term\u00ae) Communities Study (HCS), a large implementation research project designed to reduce opioid fatalities, increase access to medications for opioid use disorder (MOUD), and reduce stigma toward people on MOUD (National Institutes of Health HEAL Initiative, n.d.; The HEALing Communities Study Consortium, 2020). The HCS employed a coalition-driven intervention to inform the deployment of evidence-based practices to rapidly reduce opioid-related overdoses and fatalities in 67 highly affected communities in NYS, Kentucky, Massachusetts, and Ohio. Through a data-driven approach to community-engaged planning and action, the HCS sought to learn how to increase the reach of evidence-based harm reduction and treatment interventions (Chandler et al., 2023; Chandler et al., 2020; El-Bassel et al., 2021).<\/div>\n<div id=\"para0011\" class=\"u-margin-s-bottom\">System dynamics (SD) modeling was incorporated to support the HCS in NYS to engage community coalitions. SD models use feedback loops (i.e., closed sequences of time-dependent causal relationships) to hypothesize the endogenous drivers of a system\u2019s behavior over time (Richardson, 2011). These feedback loops are able to capture accumulation processes, nonlinearities, and time delays to gain insight into the causal nature of complex problems (Yasarcan, 2023). SD models also serve as tools to help diverse community members build a shared appreciation of why systems problems manifest and persist, how such problems can be resolved, and what can be done to mitigate unintended consequences of policies and practices (Forrester &amp; Senge, 1980; Senge &amp; Sterman, 1992). Simulation analyses can then test policy interventions and assess possible intended and unintended consequences (Sterman, 2006).<\/div>\n<div id=\"para0012\" class=\"u-margin-s-bottom\">Prior publications have described SD models of earlier waves of the US opioid and non-opioid drug epidemics (Levin et al., 1972, 1975; Homer, 1993, 1997; Wakeland et al., 2011, 2013, 2015, 2016; Homer &amp; Wakeland, 2021; Lim et al., 2022; Stringfellow et al., 2022; Sabounchi et al., 2023). The earliest model examined the 1970s heroin epidemic in a New York City neighborhood characterized by high rates of youth heroin use (Levin et al., 1972, 1975). This model included feedback loops capturing the heroin supply, community education, policing, and incarceration, among others. Though not calibrated to historical data, the model suggested that a comprehensive set of policy interventions were needed to curb the epidemic. Another early illicit drug model studied the US cocaine epidemic of the 1970s and 1980s (Homer, 1993, 1997). A key feedback loop of this model showed how the popularity of cocaine drove an increase in its use. By highlighting time delays and gaps in data reporting of drug use, the model pushed back against the then-current idea that drug seizure policies were effective at reducing cocaine use prevalence.<\/div>\n<div id=\"para0013\" class=\"u-margin-s-bottom\">More recently, Wakeland et al (2011, 2013, 2015, 2016) modeled excessive opioid prescribing practices in the US and the diversion of pharmaceutical opioids to the illicit market through 2011. An update extended the model\u2019s boundary to include the effects of fentanyl in the illicit drug supply after 2013 (Homer &amp; Wakeland, 2021). Another update incorporated additional structures for MOUD, naloxone use, supply-side changes on prescription opioids, and the perceived risk of overdose fatality (Lim et al., 2022; Stringfellow et al., 2022).<\/div>\n<div id=\"para0014\" class=\"u-margin-s-bottom\">Building upon these earlier SD models and adding additional structures identified in our preparatory qualitative modeling of the opioid epidemic (Sabounchi et al., 2023), we present here an opioid SD model built to support implementation of the HCS in NYS and the short- and long-term effects of simulated strategies around opioid overdose education and naloxone distribution (OEND) and MOUD.<\/div>\n<\/section>\n<\/div>\n<\/div>\n<div class=\"hor-line-top u-padding-m-bottom u-padding-m-top u-text-center u-position-relative inserted-access-block\"><\/div>\n<div id=\"preview-section-snippets\">\n<div class=\"Snippets u-font-serif\">\n<h2 class=\"u-h4 u-margin-l-ver\">Section snippets<\/h2>\n<section>\n<section id=\"sec0002\">\n<section id=\"sec0003\">\n<h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Model development<\/h2>\n<div id=\"para0015\" class=\"u-margin-s-bottom\">We developed and validated an SD model that simulated opioid overdose and fatality trends of the NYS population aged \u226512 years from 2012 through 2023 and their potential evolution to 2032. We iteratively revised the model\u2019s structure in consultation with subject-matter experts, county staff and coalition members, and literature review, while also comparing simulated output to opioid-related historical data series (Table 1). This iterative model building process helped to ensure sufficient<\/div>\n<\/section>\n<\/section>\n<\/section>\n<section>\n<section id=\"sec0008\">\n<section id=\"sec0009\">\n<h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Base run<\/h2>\n<div id=\"para0042\" class=\"u-margin-s-bottom\">Fig. 2 shows selected base run results and the fit to available NYS time series data. The base run showed an increasing trend in the number of annual opioid overdose deaths with a peak of 3,111 in 2017 and a second peak of 5,383 deaths in 2022, followed by a continuous decline to 4,189 in 2032 (Fig. 2A). Annual overdose-related ED visits and hospitalizations (Fig. 2B) and naloxone administrations by emergency medical services and law enforcement (Fig. 2C) showed similar trends. Naloxone<\/div>\n<\/section>\n<\/section>\n<\/section>\n<section>\n<section id=\"sec0015\">\n<h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Discussion<\/h2>\n<div id=\"para0056\" class=\"u-margin-s-bottom\">We have presented a generalized opioid SD model structure that captures the main drivers of the opioid epidemic including the effects of fentanyl and the COVID-19 pandemic. When calibrated to NYS, the model replicated historical trends in opioid-specific overdose and fatality from 2012 to 2023 and generated plausible projected trends of key variables through 2032.<\/div>\n<div id=\"para0057\" class=\"u-margin-s-bottom\">The model also serves as a unique analytical tool to facilitate an understanding of the underlying dynamics of the opioid epidemic<\/div>\n<\/section>\n<\/section>\n<section>\n<section id=\"sec0016\">\n<h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Limitations<\/h2>\n<div id=\"para0065\" class=\"u-margin-s-bottom\">Limited data availability led to higher uncertainty in calibrated parameters related to the opioid supply, exposure to opioids, and community awareness model sectors. Known limitations and uncertainty in the number of individuals using illicit opioids reported in national surveillance data (e.g., National Survey on Drug Use and Health) may have led to an underestimation of opioid use prevalence.<\/div>\n<div id=\"para0066\" class=\"u-margin-s-bottom\">Our model does not explicitly inform questions or policies around health equity due to limited<\/div>\n<\/section>\n<\/section>\n<section>\n<section id=\"sec0017\">\n<h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Conclusions<\/h2>\n<div id=\"para0067\" class=\"u-margin-s-bottom\">Our model has revealed important insights about likely trajectories in NYS opioid overdose fatality rates, which have worsened with the COVID-19 pandemic and a growing supply of cheaper, more lethal illicit synthetic opioids. Simulated policies that simultaneously build capacity for OEND and MOUD and foster efforts around community awareness and prevention were shown to be most effective over time. Simulated results indicated a clear challenge in substantially reducing overdose death rates in<\/div>\n<\/section>\n<\/section>\n<section>\n<section id=\"sec0017a\"><\/section>\n<\/section>\n<section>\n<section id=\"coi0001\">\n<div id=\"para0077\" class=\"u-margin-s-bottom\"><\/div>\n<\/section>\n<\/section>\n<section>\n<section id=\"ack0001\">\n<h2 id=\"cesectitle0026\" class=\"u-h4 u-margin-l-top u-margin-xs-bottom\">Acknowledgements<\/h2>\n<div id=\"para0078\" class=\"u-margin-s-bottom\">This research was supported by the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration through the NIH HEAL (Helping to End Addiction Long-term\u00ae) Initiative under award number UM1DA049415 (ClinicalTrials.gov Identifier: NCT04111939). This study protocol (Pro00038088) was approved by Advarra Inc., the HEALing Communities Study single Institutional Review Board. We wish to acknowledge the participation of the HEALing Communities Study communities,<\/div>\n<\/section>\n<div><\/div>\n<div><\/div>\n<div><span style=\"font-size: 14pt;\"><strong>Source:\u00a0 https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0955395925001434<\/strong><\/span><\/div>\n<\/section>\n<\/div>\n<\/div>\n<div class=\"Tail\"><\/div>\n<div id=\"preview-section-references\">\n<div class=\"paginatedReferences u-font-serif\"><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>System dynamics modeling to inform implementation of evidence-based prevention of opioid overdose and fatality: A state-level model from the New York HEALing Communities Study Author panel:Nasim S.\u00a0Sabounchi\u00a0a\u00a0b,\u00a0Rachel L.\u00a0Thompson\u00a0a,\u00a0Matthew R.\u00a0Lootens\u00a0a\u00a0b,\u00a0David W.\u00a0Lounsbury\u00a0c,\u00a0Gary\u00a0Hirsch\u00a0d,\u00a0Derek\u00a0Blevins\u00a0e,\u00a0Turner C.\u00a0Canty\u00a0a\u00a0b,\u00a0Nabila\u00a0El-Bassel\u00a0f,\u00a0Louisa\u00a0Gilbert\u00a0f,\u00a0Pedro\u00a0Mateu-Gelabert\u00a0g,\u00a0Daniel J.\u00a0Feaster\u00a0h,\u00a0Bruce D.\u00a0Rapkin\u00a0c,\u00a0Terry T.-K.\u00a0Huang\u00a0a\u00a0b Highlights \u2022 Simulations showed fentanyl spread challenges reducing overdoses in the short run. \u2022 Prevention of opioid misuse among opioid-exposed individuals [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68,135,40,19],"tags":[],"class_list":["post-19340","post","type-post","status-publish","format-standard","hentry","category-drug-use-various-effects","category-opioids","category-prevention-research","category-usa"],"_links":{"self":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/19340","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/comments?post=19340"}],"version-history":[{"count":0,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/19340\/revisions"}],"wp:attachment":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/media?parent=19340"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/categories?post=19340"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/tags?post=19340"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}