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Dynamic Simulation of the Effect of Tamper Resistance on Opioid Misuse Outcomes

机译：动态模拟抗篡改对阿片类药物滥用结果的影响

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The objective of the study was to develop a system dynamics model of the medical use of pharmaceutical opioids, and the associated diversion and nonmedical use of these drugs. The model was used to test the impact of the a tamper resistance intervention in this complex system. The study relied on secondary data obtained from the literature and from other public sources for the period 1995 to 2008. In addition, an expert panel provided recommendations regarding model parameters and model structure. The behavior of the resulting systems-level model compared favorably with reference behavior data. After the base model was tested, logic to simulate the replacement of all opioids with tamper resistant formulations was added and the impact on overdose deaths was evaluated over a seven-year period, 2008-2015. Principal findings were that the introduction of tamper resistant formulations unexpectedly increased total overdose deaths. This was due to increased prescribing which counteracted the drop in the death rate. We conclude that it is important to choose metrics carefully, and that the system dynamics modelling approach can help to evaluate interventions intended to ameliorate the adverse outcomes in the complex system associated with treating pain with opioids.
机译：该研究的目的是制定医学用途的医学用途的系统动力学模型，以及这些药物的相关转移和非医疗使用。该模型用于测试该复杂系统中篡改阻力干预的影响。该研究依赖于1995年至2008年期间从文献和其他公共来源获得的二级数据。此外，专家小组提出了关于模型参数和模型结构的建议。由参考行为数据有利地比较了所得系统级模型的行为。在测试基础模型之后，添加了模拟用防篡改配方替代所有阿片类药物的逻辑，并在2008 - 2015年的七年期间评估了对过量死亡的影响。主要发现是引入防篡改配方意外增加了过量过量死亡。这是由于规定的规定增加，抵消了死亡率下降。我们得出结论，仔细选择度量，并且系统动态建模方法可以帮助评估旨在改善与伴有阿片类药物治疗疼痛相关的复杂系统中不良结果的干预措施。

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