System dynamics and related modeling of opioid use and interventions: a scoping review

Canada reported 6,601 apparent opioid toxicity deaths from April 2024 to March 2025 – averaging 18 deaths per day. The opioid crisis is a public health emergency characterized by behavioral complexity, delayed system responses, and diverse stakeholders. To address challenges like this, system dynamics modeling (SDM) simulates how parts of a system influence each other over time. By capturing feedback mechanisms, time delays, and sub-system interactions, SDM helps forecast outcomes of interventions and policies in complex settings such as opioid use disorder (OUD). This scoping review examines literature on the application of system dynamics modeling and other models that include similar features in addressing the opioid crisis. A scoping review was performed following the JBI Manual and reported using PRISMA-ScR guidelines, searching five databases from 2019 to 2025. Our review yielded 23 studies that used SDM or similar feedback-based modeling approaches. These studies include a variety of interventions (such as: various treatment options; Good Samaritan laws; and harm reduction interventions) and the most common outcome of the modeling was overdose deaths. Most of the models are based in the United States, with a few from other countries including Canada, Australia, Iran and Ukraine. The models that focused on interventions demonstrated improvement in outcomes (lower mortality, higher treatment engagement), the models that focused on qualitative understanding of the system documented interdependences. SDM supports evidence-based decisions by providing insight into the opioid crisis by mapping relationships between policies, interventions, and outcomes. However, gaps remain in modeling supervised consumption sites, long-term recovery, equity impacts, and lived experience.