Medicine and Health Sciences Commons^™

System Dynamics To Investigate Opioid Use And Chiropractic Care For Chronic Musculoskeletal Pain, Marion Mcgregor, Alexandra Nielsen, Chadwick Chung, Mark Fillery, Wayne Wakeland, Silvano Mior

Systems Science Faculty Publications and Presentations

Objective: The purpose of this investigation was to create a system dynamics (SD) model, including published data and required assumptions, as a tool for future research identifying the role of chiropractic care in the management of chronic, nonmalignant pain in a Canadian population. Methods: We present an illustrative case description of how we evaluated the feasibility of conducting a large-scale clinical trial to assess the impact of chiropractic care in mitigating excessive opioid use in Canada. We applied SD modeling using current evidence and key assumptions where such evidence was lacking. Modeling outcomes were highlighted to determine which potential …

A Systems Approach To Stress, Stressors And Resilience In Humans, Barry S. Oken, Irina Chamine, Wayne W. Wakeland

Systems Science Faculty Publications and Presentations

The paper focuses on the biology of stress and resilience and their biomarkers in humans from the system science perspective. A stressor pushes the physiological system away from its baseline state towards a lower utility state. The physiological system may return towards the original state in one attractor basin but may be shifted to a state in another, lower utility attractor basin. While some physiological changes induced by stressors may benefit health, there is often a chronic wear and tear cost due to implementing changes to enable the return of the system to its baseline state and maintain itself in …

Dynamic Modeling Of Nonmedical Opioid Initiation: Epidemic And Access, Alexandra Nielsen, Teresa D. Schmidt, Dennis Mccarty, Wayne W. Wakeland

Systems Science Faculty Publications and Presentations

We report development of a systems level dynamic model of initiation and nonmedical use of pharmaceutical opioids in the US. The model calibrated to 1995-2005 National Survey of Drug Use and Health (NSDUH) data, predicts 2006-2011 data well. Preliminary findings indicate that interventions which reduce the perceived attractiveness of opioids for recreational use may be able to reduce initiation and nonmedical use most significantly, while supply restriction effected through drug take back days and prescribing changes may have more modest effects. We argue that system dynamics is an effective approach for evaluating potential interventions to this complex system where the …

Data On The Diversion, Nonmedical Use And Adverse Outcomes Associated With Pharmaceutical Opioids, Amanuel Zimam, Teresa D. Schmidt, Alexandra Nielsen, Wayne W. Wakeland

Systems Science Faculty Publications and Presentations

Background: Recent increases in the nonmedical use of pharmaceutical opioids and the adverse outcomes associated with them have stimulated a large amount of research and data collection on this public health problem. Systematic organization of the available data sources is needed to facilitate ongoing research, analysis, and evaluation.

Method: A list of keywords associated with diversion, nonmedical use, and adverse outcomes of pharmaceutical opioid use generated 94 peer-reviewed academic articles and a number of governmental and nongovernmental sources. All sources were in English, contained quantitative data, and were published between January 1995 and April 2012. A list of 20 topics …

System Dynamics Modeling Of Medical Use, Nonmedical Use And Diversion Of Prescription Opioid Analgesics, Wayne Wakeland, Alexandra Nielsen, Teresa D. Schmidt

Systems Science Faculty Publications and Presentations

The objective of the study was to develop a system dynamics model of the medical use of pharmaceutical opioids to treat pain, and the associated diversion and nonmedical use of these drugs. The model was used to test the impact of simulated interventions 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 (R2=.95). After the base model …

A System Dynamics Model Of Pharmaceutical Opioids: Medical Use, Diversion, And Nonmedical Use, Teresa Schmidt, Wayne Wakeland, J. David Haddox

Systems Science Faculty Publications and Presentations

A dramatic rise in the nonmedical of pharmaceutical opioids has presented the United States with a substantial public health problem. Nonmedical use of prescription pain relievers has become increasingly prevalent in the US over the last two decades, and diversion of medicines obtained by prescription is assumed to be a major source of supply for nonmedical opioid use. Policymakers striving to protect population health by ameliorating the adverse outcomes of nonmedical use of opioid analgesics could benefit from a systems-level model which reflects the complexity of the system and incorporates the full range of available data. To address this need, …

Key Data Gaps For Understanding Trends In Prescription Opioid Analgesic Abuse And Diversion Among Chronic Pain Patients And Nonmedical Users, Wayne W. Wakeland, John Fitzgerald, Aaron Gilson, J. David Haddox, Jack Homer, Lewis Lee, Louis Macovsky, Dennis Mccarty, Teresa D. Schmidt, Lynn Webster

Systems Science Faculty Publications and Presentations

Population dynamics of medical and nonmedical prescription opioid usage and adverse outcomes were modeled. Critical parameter values were determined by their amount of influence on model behavior. Results suggest that closing these data gaps would help researchers to better identify ways to reduce the risk of adverse outcomes.