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Spence C, Kurz ME, Sharkey TC, Miller BL. Scoping Literature Review of Disease Modeling of the Opioid Crisis. J Psychoactive Drugs 2024:1-14. [PMID: 38909286 DOI: 10.1080/02791072.2024.2367617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/28/2024] [Indexed: 06/24/2024]
Abstract
Opioid misuse continues to cause significant harm. To investigate current research, we conducted a scoping literature review of disease spread models of opioid misuse from January 2000 to December 2022. In total, 85 studies were identified and examined for the opioids modeled, model type, data sources used and model calibration and validation. Most of the studies (58%, 49) only modeled heroin; the next largest categories were prescription opioids and unspecified opioids which accounted for 9% (8) each. Most models were theoretical compartmental models (57) or applied compartmental models (21). Previously published research was the most used data source (38), and a majority of the model validation involved the researchers setting initial conditions to verify theoretical results (30). To represent typical opioid use more accurately, multiple opioids need to be incorporated into the disease spread models, and applying different modeling techniques may allow other insights into opioid misuse spread.
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Affiliation(s)
- Chelsea Spence
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Mary E Kurz
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Thomas C Sharkey
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Bryan Lee Miller
- Department of Sociology, Anthropology and Criminal Justice, Clemson University, Clemson, SC, USA
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Wang W, Lu S, Tang H, Wang B, Sun C, Zheng P, Bai Y, Lu Z, Kang Y. A Scoping Review of Drug Epidemic Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042017. [PMID: 35206206 PMCID: PMC8872096 DOI: 10.3390/ijerph19042017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023]
Abstract
The phenomenon of drug epidemics has been a global issue in the past decades, causing enormous damages to the physical and mental health of drug users and social well-being. Despite great efforts to curb drug epidemics at the governmental or social level, the total number of drug users has still been on the rise in recent years, along with illicit production and trafficking around the world. Inspired by dynamical epidemic models of infectious disease, a flourishment of promising results has been observed in the exploration of drug epidemic models. In this review, we aim to provide a scoping review of all existing drug epidemic modeling studies, and it has been shown that most studies focused on analyses of theoretical behaviors of the model systems, lacking emphasis on practical applications in real settings. We found that the drug epidemic models were characterized by a longer time scale, no incubation period, no significant prevention vaccines interfered, and population specificity. This review could assist policymakers and public health workers in gaining deeper insights into modeling tools, and help modelers improve their works, thus narrowing gaps between mathematical epidemiology and public health studies.
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Affiliation(s)
- Wei Wang
- Institute of Environmental Information, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; (W.W.); (B.W.); (C.S.)
| | - Sifen Lu
- Precision Medicine Key Laboratory of Sichuan Province and Precision Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Haoxiang Tang
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China;
| | - Biao Wang
- Institute of Environmental Information, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; (W.W.); (B.W.); (C.S.)
| | - Caiping Sun
- Institute of Environmental Information, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; (W.W.); (B.W.); (C.S.)
| | - Pai Zheng
- Department of Occupational and Environmental Health Science, School of Public Health, Peking University, Beijing 100871, China;
| | - Yi Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100871, China;
| | - Zuhong Lu
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China;
| | - Yulin Kang
- Institute of Environmental Information, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; (W.W.); (B.W.); (C.S.)
- Correspondence:
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Cerdá M, Jalali MS, Hamilton AD, DiGennaro C, Hyder A, Santaella-Tenorio J, Kaur N, Wang C, Keyes KM. A Systematic Review of Simulation Models to Track and Address the Opioid Crisis. Epidemiol Rev 2021; 43:147-165. [PMID: 34791110 DOI: 10.1093/epirev/mxab013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 01/04/2023] Open
Abstract
The opioid overdose crisis is driven by an intersecting set of social, structural, and economic forces. Simulation models offer a tool to help us understand and address this complex, dynamic, and nonlinear social phenomenon. We conducted a systematic review of the literature on simulation models of opioid use and overdose up to September 2019. We extracted modeling types, target populations, interventions, and findings. Further, we created a database of model parameters used for model calibration, and evaluated study transparency and reproducibility. Of the 1,398 articles screened, we identified 88 eligible articles. The most frequent types of models were compartmental (36%), Markov (20%), system dynamics (16%), and Agent-Based models (16%). Over a third evaluated intervention cost-effectiveness (40%), and another third (39%) focused on treatment and harm reduction services for people with opioid use disorder (OUD). More than half (61%) discussed calibrating their models to empirical data, and 31% discussed validation approaches used in their modeling process. From the 63 studies that provided model parameters, we extracted the data sources on opioid use, OUD, OUD treatment, cessation/relapse, emergency medical services, and mortality parameters. This database offers a tool that future modelers can use to identify potential model inputs and evaluate comparability of their models to prior work. Future applications of simulation models to this field should actively tackle key methodological challenges, including the potential for bias in the choice of parameter inputs, investment in model calibration and validation, and transparency in the assumptions and mechanics of simulation models to facilitate reproducibility.
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Affiliation(s)
- Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | | | - Ava D Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Ayaz Hyder
- Division of Environmental Health Sciences, College of Public Health, and Translational Data Analytics Institute, The Ohio State University, Columbus, Ohio
| | - Julian Santaella-Tenorio
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Navdep Kaur
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Christina Wang
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Marks C, Borquez A, Jain S, Sun X, Strathdee SA, Garfein RS, Milloy MJ, DeBeck K, Cepeda JA, Werb D, Martin NK. Opioid agonist treatment scale-up and the initiation of injection drug use: A dynamic modeling analysis. PLoS Med 2019; 16:e1002973. [PMID: 31770373 PMCID: PMC6879119 DOI: 10.1371/journal.pmed.1002973] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/18/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Injection drug use (IDU) is associated with multiple health harms. The vast majority of IDU initiation events (in which injection-naïve persons first adopt IDU) are assisted by a person who injects drugs (PWID), and as such, IDU could be considered as a dynamic behavioral transmission process. Data suggest that opioid agonist treatment (OAT) enrollment is associated with a reduced likelihood of assisting with IDU initiation. We assessed the association between recent OAT enrollment and assisting IDU initiation across several North American settings and used dynamic modeling to project the potential population-level impact of OAT scale-up within the PWID population on IDU initiation. METHODS AND FINDINGS We employed data from a prospective multicohort study of PWID in 3 settings (Vancouver, Canada [n = 1,737]; San Diego, United States [n = 346]; and Tijuana, Mexico [n = 532]) from 2014 to 2017. Site-specific modified Poisson regression models were constructed to assess the association between recent (past 6 month) OAT enrollment and history of ever having assisted an IDU initiation with recently assisting IDU initiation. Findings were then pooled using linear mixed-effects techniques. A dynamic transmission model of IDU among the general population was developed, stratified by known factors associated with assisting IDU initiation and relevant drug use behaviors. The model was parameterized to a generic North American setting (approximately 1% PWID) and used to estimate the impact of increasing OAT coverage among PWID from baseline (approximately 21%) to 40%, 50%, and 60% on annual IDU initiation incidence and corresponding PWID population size across a decade. From Vancouver, San Diego, and Tijuana, respectively, 4.5%, 5.2%, and 4.3% of participants reported recently assisting an IDU initiation, and 49.4%, 19.7%, and 2.1% reported recent enrollment in OAT. Recent OAT enrollment was significantly associated with a 45% lower likelihood of providing recent IDU initiation assistance among PWID (relative risk [RR] 0.55 [95% CI 0.36-0.84], p = 0.006) compared to those not recently on OAT. Our dynamic model predicts a baseline mean of 1,067 (2.5%-97.5% interval [95% I 490-2,082]) annual IDU initiations per 1,000,000 individuals, of which 886 (95% I 406-1,750) are assisted by PWID. Based on our observed statistical associations, our dynamic model predicts that increasing OAT coverage from approximately 21% to 40%, 50%, or 60% among PWID could reduce annual IDU initiations by 11.5% (95% I 2.4-21.7), 17.3% (95% I 5.6-29.4), and 22.8% (95% I 8.1-36.8) and reduce the PWID population size by 5.4% (95% I 0.1-12.0), 8.2% (95% I 2.2-16.9), and 10.9% (95% I 3.2-21.8) relative to baseline, respectively, in a decade. Less impact occurs when the protective effect of OAT is diminished, when a greater proportion of IDU initiations are unassisted by PWID, and when average IDU career length is longer. The study's main limitations are uncertainty in the causal pathway between OAT enrollment and assisting with IDU initiation and the use of a simplified model of IDU initiation. CONCLUSIONS In addition to its known benefits on preventing HIV, hepatitis C virus (HCV), and overdose among PWID, our modeling suggests that OAT scale-up may also reduce the number of IDU initiations and PWID population size.
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Affiliation(s)
- Charles Marks
- SDSU-UCSD Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, California, United States of America
- The School of Social Work, San Diego State University, San Diego, California, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Sonia Jain
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Xiaoying Sun
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Richard S. Garfein
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States of America
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
- School of Public Policy, Simon Fraser University, Vancouver, Canada
| | - Javier A. Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States of America
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Sharareh N, Sabounchi SS, McFarland M, Hess R. Evidence of Modeling Impact in Development of Policies for Controlling the Opioid Epidemic and Improving Public Health: A Scoping Review. Subst Abuse 2019; 13:1178221819866211. [PMID: 31447562 PMCID: PMC6689912 DOI: 10.1177/1178221819866211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Opioid addiction and overdose rates are reaching unprecedented levels in the U.S., with around 47,736 overdose deaths in 2017. Many stakeholders affect the opioid epidemic, including government entities, healthcare providers and policymakers, and opioid users. Simulation and conceptual modeling can help us understand the dynamics of the opioid epidemic by simplifying the real world and informing policymakers about different health interventions that could reduce the deaths caused by opioid overdose in the United States every year. OBJECTIVES To conduct a scoping review of simulation and conceptual models that propose policies capable of controlling the opioid epidemic. We demonstrate the strengths and limitations of these models and provide a framework for further improvement of future decision support tools. METHODS Using the methodology of a scoping review, we identified articles published after 2000 from eight electronic databases to map the literature that uses simulation and conceptual modeling in developing public health policies to address the opioid epidemic. RESULTS We reviewed 472 papers of which 14 were appropriate for inclusion. Each used either system dynamics simulation modeling, mathematical modeling, conceptual modeling, or agent-based modeling. All included studies tested and proposed strategies to improve health outcomes related to the opioid epidemic. Factors considered in the models included physicians prescribing opioids, trafficking, users recruiting new users, and doctor shopping; no model investigated the impact of age and spatial factors on the dynamics of the epidemic. Key findings from these studies were (1) prevention of opioid initiation is better than treatment of opioid addiction, (2) the analysis of an intervention's impact should include both benefits and harms, and (3) interventions with short-term benefits might have a counterproductive impact on the epidemic in long run. CONCLUSIONS While most studies examined the role of prescription opioids and trafficking on this epidemic, the transition of patients from prescription opioid use to nonprescription use including heroin and synthetic opioids such as fentanyl impacts the system significantly and results in an epidemic with quite different characteristics than what it had a decade ago. We recommend including the impact of age and geographic location on the opioid epidemic using modeling methods.
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Affiliation(s)
- Nasser Sharareh
- Health System Innovation and Research Division, Population Health Sciences Department, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Shabnam S Sabounchi
- College of Community and Public Affairs, the State University of New York at Binghamton, Binghamton, NY, USA
| | - Mary McFarland
- Eccles Health Science Library, University of Utah, Salt Lake City, UT, USA
| | - Rachel Hess
- Health System Innovation and Research Division, Population Health Sciences Department, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Santoro M, Triolo L, Rossi C. Drug user dynamics: A compartmental model of drug users for scenario analyses. DRUGS-EDUCATION PREVENTION AND POLICY 2013. [DOI: 10.3109/09687637.2012.750274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gillespie J, McClean S, Scotney B, Garg L, Barton M, Fullerton K. Costing hospital resources for stroke patients using phase-type models. Health Care Manag Sci 2011; 14:279-91. [PMID: 21695521 DOI: 10.1007/s10729-011-9170-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 06/06/2011] [Indexed: 11/30/2022]
Abstract
Optimising resources in healthcare facilities is essential for departments to cope with the growing population's requirements. An aspect of such performance modelling involves investigating length of stay, which is a key performance indicator. Stroke disease costs the United Kingdom economy seven billion pounds a year and stroke patients are known to occupy long periods of time in acute and long term beds in hospital as well as requiring support from social services. This may be viewed as an inefficient use of resources. Thrombolysis is a therapy which uses a clot-dispersing drug which is known to decrease the institutionalisation of eligible stroke patients if administered 3 h after incident but it is costly to administer to patients. In this paper we model the cost of treating stroke patients within a healthcare facility using a mixture of Coxian phase type model with multiple absorbing states. We also discuss the potential benefits of increasing the usage of thrombolysis and if these benefits balance the expense of administering the drug.
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Affiliation(s)
- Jennifer Gillespie
- School of Computing and Information Engineering, University of Ulster, Coleraine Campus, South Building, Coleraine, Northern Ireland, UK.
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Scribner R, Ackleh AS, Fitzpatrick BG, Jacquez G, Thibodeaux JJ, Rommel R, Simonsen N. A systems approach to college drinking: development of a deterministic model for testing alcohol control policies. J Stud Alcohol Drugs 2010; 70:805-21. [PMID: 19737506 DOI: 10.15288/jsad.2009.70.805] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The misuse and abuse of alcohol among college students remain persistent problems. Using a systems approach to understand the dynamics of student drinking behavior and thus forecasting the impact of campus policy to address the problem represents a novel approach. Toward this end, the successful development of a predictive mathematical model of college drinking would represent a significant advance for prevention efforts. METHOD A deterministic, compartmental model of college drinking was developed, incorporating three processes: (1) individual factors, (2) social interactions, and (3) social norms. The model quantifies these processes in terms of the movement of students between drinking compartments characterized by five styles of college drinking: abstainers, light drinkers, moderate drinkers, problem drinkers, and heavy episodic drinkers. Predictions from the model were first compared with actual campus-level data and then used to predict the effects of several simulated interventions to address heavy episodic drinking. RESULTS First, the model provides a reasonable fit of actual drinking styles of students attending Social Norms Marketing Research Project campuses varying by "wetness" and by drinking styles of matriculating students. Second, the model predicts that a combination of simulated interventions targeting heavy episodic drinkers at a moderately "dry" campus would extinguish heavy episodic drinkers, replacing them with light and moderate drinkers. Instituting the same combination of simulated interventions at a moderately "wet" campus would result in only a moderate reduction in heavy episodic drinkers (i.e., 50% to 35%). CONCLUSIONS A simple, five-state compartmental model adequately predicted the actual drinking patterns of students from a variety of campuses surveyed in the Social Norms Marketing Research Project study. The model predicted the impact on drinking patterns of several simulated interventions to address heavy episodic drinking on various types of campuses.
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Galea S, Hall C, Kaplan GA. Social epidemiology and complex system dynamic modelling as applied to health behaviour and drug use research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 20:209-16. [PMID: 18930649 DOI: 10.1016/j.drugpo.2008.08.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Revised: 07/23/2008] [Accepted: 08/09/2008] [Indexed: 11/24/2022]
Abstract
A social epidemiologic perspective considers factors at multiple levels of influence (e.g., social networks, neighbourhoods, states) that may individually or jointly affect health and health behaviour. This provides a useful lens through which to understand the production of health behaviours in general, and drug use in particular. However, the analytic models that are commonly applied in population health sciences limit the inference we are able to draw about the determination of health behaviour by factors, likely interrelated, across levels of influence. Complex system dynamic modelling techniques may be useful in enabling the adoption of a social epidemiologic approach in health behaviour and drug use research. We provide an example of a model that aims to incorporate factors at multiple levels of influence in understanding drug dependence. We conclude with suggestions about future directions in the field and how such models may serve as virtual laboratories for policy experiments aimed at improving health behaviour.
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Affiliation(s)
- Sandro Galea
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.
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Caulkins JP. Implications of Inertia for Assessing Drug Control Policy: Why Upstream Interventions May Not Receive Due Credit. ACTA ACUST UNITED AC 2008. [DOI: 10.1177/009145090803500208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An empirically-derived model of national drug initiation is combined with a compartment model of trends in illicit drug use parameterized for Australia. Numbers of initiates seem to oscillate over time but with fluctuations whose aptitude diminishes over time. Lags and interpersonal variation in drug use careers smooth those oscillations for measures of problem use and total drug-related social cost, so even abrupt changes in initiation barely ripple the trajectory of drug-related social cost. Hence, the benefits of interventions that successfully disrupt initiation may be “hidden in plain sight” by being spread broadly over time so that they leave only the faintest finger-print detectable by before-and-after comparison. Thus, the absence of clear drops in drug-related problems does not imply that an upstream ntervention such as prevention or supply disruption did not produce substantial social benefits. More generally, drug use and related problems are often perceived of as stubborn, even intractable. Some of that perception stems from real limitations in the effectiveness of drug-control interventions. However, inertia inherent in the evolution of drug use can make even cost-effective interventions appear weak (and detrimental interventions appear benign).
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