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. 2025 Aug:142:104843.
doi: 10.1016/j.drugpo.2025.104843. Epub 2025 May 27.

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

Nasim S Sabounchi  1 , Rachel L Thompson  2 , Matthew R Lootens  3 , David W Lounsbury  4 , Gary Hirsch  5 , Derek Blevins  6 , Turner C Canty  3 , Nabila El-Bassel  7 , Louisa Gilbert  7 , Pedro Mateu-Gelabert  8 , Daniel J Feaster  9 , Bruce D Rapkin  4 , Terry T-K Huang  3
Affiliations

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

Nasim S Sabounchi et al. Int J Drug Policy. 2025 Aug.

Abstract

Background: 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.

Methods: 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 ≥12 and tested policy scenarios for reducing future overdose deaths.

Results: 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' feedback loops demonstrated similar relative impacts.

Conclusions: 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.

Keywords: Community-engaged intervention; Evidence-based practices; Harm reduction; Implementation research; Medications for opioid use disorder; Naloxone; Opioid use disorder; Policy analysis; System dynamics modeling.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nasim S. Sabounchi reports financial support was provided by National Institutes of Health. David W. Lounsbury reports financial support was provided by National Institutes of Health. Nabila El-Bassel reports financial support was provided by National Institutes of Health. Louisa Gilbert reports financial support was provided by National Institutes of Health. Daniel J. Feaster reports financial support was provided by National Institutes of Health. Bruce D. Rapkin reports financial support was provided by National Institutes of Health. Terry T.-K. Huang reports financial support was provided by National Institutes of Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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