PDF(Pubmed)
Abstract：
For the past two decades, the USA has been embroiled in a growing prescription drug epidemic. The ripples of this epidemic have been especially apparent in the state of Maine, which has fought hard to mitigate the damage caused by addiction to pharmaceutical and illicit opioids. In this study, we construct a mathematical model of the opioid epidemic incorporating novel features important to better understanding opioid abuse dynamics. These features include demographic differences in population susceptibility, general transmission expressions, and combined consideration of pharmaceutical opioid and heroin abuse. We demonstrate the usefulness of this model by calibrating it with data for the state of Maine. Model calibration is accompanied by sensitivity and uncertainty analysis to quantify potential error in parameter estimates and forecasts. The model is analyzed to determine the mechanisms most influential to the number of opioid abusers and to find effective ways of controlling opioid abuse prevalence. We found that the mechanisms most influential to the overall number of abusers in Maine are those involved in illicit pharmaceutical opioid abuse transmission. Consequently, preventative strategies that controlled for illicit transmission were more effective over alternative approaches, such as treatment. These results are presented with the hope of helping to inform public policy as to the most effective means of intervention.
摘要：
在过去的二十年里，美国已经卷入了日益增长的处方药流行之中。这种流行病的涟漪在缅因州尤为明显，努力减轻药物和非法阿片类药物成瘾造成的损害。在这项研究中,我们构建了阿片类药物流行的数学模型,该模型包含了对更好地理解阿片类药物滥用动态非常重要的新特征.这些特征包括人口易感性的人口统计学差异，一般传输表达式，以及药物阿片类药物和海洛因滥用的综合考虑。我们通过用缅因州的数据对其进行校准来证明该模型的有用性。模型校准伴随着敏感性和不确定性分析，以量化参数估计和预测中的潜在误差。对模型进行了分析，以确定对阿片类药物滥用者数量影响最大的机制，并找到控制阿片类药物滥用流行的有效方法。我们发现，对缅因州滥用者总数影响最大的机制是那些参与非法药物阿片类药物滥用传播的机制。因此,控制非法传播的预防策略比替代方法更有效，比如治疗。提出这些结果的希望有助于为公共政策提供最有效的干预手段。
