By Iris Smith, Ph.D.
In 2021, drug overdoses accounted for an estimated 108,000 U.S. deaths. Between July 2019 and July 2021, median monthly overdose deaths among adolescents 10-19 years old increased 109%. Opioids accounted for 90% of those deaths, with 83.9% involving illicitly manufactured fentanyl and 24.5% involving the use of counterfeit pills. However. only 35% of decedents had an opioid use history and 40% had a history of mental health issues.[1] Adolescent opioid use is influenced by multiple interacting forces including the socio-economic environment, government policies, law enforcement, and political will. Identifying the sources of influence, their relationship and interactions with drug use and distribution patterns from a systems level perspective may be useful in crafting prevention approaches.
Systems thinking involves taking a holistic approach to prevention, focusing on how different components of a system are interconnected. The Systems Thinking for Health Framework (STFH) proposed by Thelan et al. (2023) suggests a way to view complex systems and apply systems thinking. STFH assumes that all systems are both dynamic and complex with many interacting components. It provides an operational guide for application consisting of 6 steps:
One example of system’s thinking comes from a recent scoping review of law enforcement drug seizures and overdose mortality indicating that seizures of fentanyl and other synthetic opioids were consistently associated with increased overdose mortality across studies reviewed. Potential explanations for the relationship between seizures and overdoses included: interruptions in individuals’ opioid tolerance levels after the arrest of their supplier, forcing them to use a less trusted source or unsafe locations or use methods; and the underlying characteristics or composition of the drug supply at any given time or place. Seizures of the most lethal drugs and those most often involved in overdoses had the strongest association with overdoses.[3]
One study reviewed found that 93% of the year to year variance in Ohio’s drug overdose deaths across ten years could be estimated by using drug seizure and drug death data to estimate the “lethality” of different drugs and subsequently applying a lethality index along with the number of seizures of each substance as a proxy for the relative representation of different drugs in the street supply.[4] The association between seizures and overdoses may operate through multiple pathways. For example, drug markets may respond to drug control measures by supplying increasingly potent substances that increase overdose risks, especially in the absence of sufficient demand-reduction measures.5 Using systems thinking to identify the multiple “drivers” of the opioid crisis and how they interact can lead to more effective strategies for prevention.
Cano M, Timmons P, Madeline Hooten M, Sweeney K, Sehun O (2024). A Scoping Review of Law Enforcement Drug Seizures and Overdose Mortality in the United States. International Journal of Drug Policy 124; pg. 104321.
Lang J, Mendenhall E,Koon AD (2023). Disentangling Opioids-Related Overdose Syndemics: A Scoping Review; International Journal of Drug Policy; https://doi.org/10.1016/drugpo./2023/104152
Sharma G, Chakole S, Prasad R, Wanjari MB, Sharma R. (2023). A Review on Preventing Tragedy: Strategies to Combat the Devastating Effects of Adolescent Drug Overdoses. Cureus 15(5): e39132. DOI 10.7759/cureus.39132
Slesnick, N., Brakenhoff, B., Bunger, A., Chavez, L., Cuthbertson, C., Famelia, R., Feng, X., Fitzpatrick, M., Ford, J., Hatsu, I., Holowacz, E., Jaderlund, S., Kelleher, K., Luthy, E., Mallory, A., Martin, J., Pizzulo, A., Stone-Sabali, S., Yilmazer, T., Wu, Q., … Zhang, J. (2023). Lessons Learned from Housing First, Rapid Rehousing Trials with Youth Experiencing Homelessness. Addiction Science & Cinical Practice, 18(1), 58. https://doi.org/10.1186/s13722-023-00413-x PMCID: PMID: 37775777
Tanz LJ, Dinwiddie AT, Mattson CL, O’Donnell J, Davis NL. Drug Overdose Deaths Among Persons Aged 10–19 Years — United States, July 2019–December 2021. MMWR Morb Mortal Wkly Rep 2022;71:1576–1582. DOI: http://dx.doi.org/10.15585/mmwr.mm7150a2
Thelen J, Sant Fruchtman C, Bilal M,et al. Development of the Systems Thinking for Health Actions framework: a literature review and a case study. BMJ Global Health 2023;8:e010191 . doi:10.1136/bmjgh-2022-010191
[1] Tanz LJ, Dinwiddie AT, Mattson CL, O’Donnell J, Davis NL. Drug Overdose Deaths Among Persons Aged 10–19 Years — United States, July 2019–December 2021. MMWR Morb Mortal Wkly Rep 2022;71:1576–1582. DOI: http://dx.doi.org/10.15585/mmwr.mm7150a2
[2] Thelen J, Sant Fruchtman C, Bilal M,et al. Development of the Systems Thinking for Health Actions framework: a literature review and a case study. BMJ Global Health 2023;8:e010191 . doi:10.1136/bmjgh-2022-010191
[3] Hall, O. E., Hall, O. T., Eadie, J. L., Teater, J., Gay, J., Kim, M., Cauchon, D., & Noonan, R. K. (2021). Street-drug lethality index: A novel methodology for predicting unintentional drug overdose fatalities in population research. Drug and Alcohol Dependence, 221, Article 108637. https://doi.org/10.1016/j. drugalcdep.2021.108637
[4] Cano M, Timmons P, Madeline Hooten M, Sweeney K, Sehun O (2024). A Scoping Review of Law Enforcement Drug Seizures and Overdose Mortality in the United States. International Journal of Drug Policy 124; pg. 104321.
