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

对美国阿片类药物和海洛因流行病的模型知情理解和缓解

• 批准号: 9587080
• 负责人: JAMES C BENNEYAN
• 金额: $ 23.55万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9587080
• 关键词: Abate; Academy; Address; Advisory Committees; Advocate; Affect; Agreement; Area; Behavior; Behavioral; Biological Models; Cessation of life; Cities; Complex; County; Data; Data Aggregation; Dependence; Development; Differential Equation; Drug Modelings; Drug usage; Effectiveness of Interventions; Emergency Situation; Engineering; Ensure; Epidemic; Etiology; Event; Experimental Designs; Feedback; Fentanyl; Financial cost; Goals; Health; Health Care Costs; Health Services Accessibility; Heroin; Heterogeneity; Human; Individual; Influenza; Institutional Review Boards; Interdisciplinary Study; Intervention; Knowledge; Law Enforcement; Lead; Link; Logistic Models; Maine; Medicine; Modeling; Monitor; Naloxone; Opioid; Outcome; Overdose; Pain management; Patients; Persons; Pharmaceutical Preparations; Phase; Police; Policies; Policy Making; Policy Research; Primary Health Care; Process; Provider; Readiness; Recovery; Relapse; Research; Resource Allocation; Science; Services; Severities; Social Work; Societies; Substance abuse problem; Surgeon; System; Testing; Time; Uncertainty; United States Agency for Healthcare Research and Quality; United States National Institutes of Health; United States Public Health Service; Urine; Validation; Work; addiction; base; behavioral health; care systems; disparity reduction; effective intervention; experimental study; improved; insight; model development; mortality; opioid epidemic; opioid mortality; programs; public health intervention; social; socioeconomic disparity; treatment adherence; treatment services

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.

项目概要 该提案旨在开发、验证和应用阿片类药物-海洛因流行病的系统工程模型 帮助评估、告知和优化有效政策，以缓解这一日益严重的问题。正如所强调的 美国卫生局局长、卫生与公共服务部长和特朗普总统，这一复杂的流行病 影响着社会的几乎所有阶层，影响深远的社会（380 万非法用户）、金融（785 亿美元）、 和健康（每年 420,000 例用药过量和 33,000 例死亡）影响，以及重大的区域和社会经济影响 差异。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 年以来死亡率急剧上升， 并且没有减弱的迹象。尽管这场危机十分严重，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，滥用就会开始并 传播、寻求和提供治疗、物质供应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院、美国国立卫生研究院的提倡 健康、医疗保健研究和质量机构以及其他机构帮助解决此类复杂问题，但 尚未应用于阿片类药物流行。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（起始、依赖、治疗）和试点的 TEMS 工程模型 它们在多种设置中的使用以保证鲁棒性。具体目标包括：（1）开发并验证初步系统 每个阶段的动态、基于代理、容量优化和离散事件物流模型； (2)反面 使用这些模型进行管道试点分析来识别见解和结构关系，快速生成和测试 假设，并估计干预措施的有效性和后果； (3)概括和扩展结果 除了最初的试点应用之外，还包括确定更大的技术和政策研究议程。 总体目标是使用设想的模型来获取有关因果关系和动态的知识 每个阶段，然后调查并提供有效的干预措施、资源分配和政策。尽管 计划的工作将主要基于模型，拟议的工程师-临床医生研究小组将依赖于反馈 来自多元化利益相关者咨询委员会（包括行为健康、初级保健、成瘾 来自多个州和护理系统的治疗、药物滥用和政策专家）来验证 建立模型并探索可行的干预策略。预期结果包括：（1）经过验证的预 划线、滥用传播和治疗模型在多种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的适用性； (2) 有用的见解、解释性假设 ses，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。