Construction of a county-town-village three-level drug distribution system in county-level medical consortia: A palliative care opioid analgesic model from Huzhou city, Zhejiang province, China

Background: In county-level and rural regions of China, access to opioid analgesics for palliative care is constrained by centralized dispensing, fragmented drug distribution systems and limited patient mobility. Although county-level medical consortia have strengthened healthcare integration, an evidence-informed framework for the decentralized yet regulated distribution of controlled medicines remains insufficiently developed. Objectives: This study aimed to develop and evaluate, through simulation-based policy modeling, a County–Town–Village (CTV) three-level drug distribution framework for opioid analgesics within county-level medical consortia using Zhejiang Province as a conceptual case study. Methods: A simulation-based comparative policy analysis was performed using structured simulated data representing 12 modeled county-level medical consortia (six intervention and six comparison counties) over a simulated 12-month period. Simulation inputs were generated from plausible county-level healthcare characteristics, opioid prescribing patterns, travel distances and pharmaceutical governance indicators. Difference-in-differences (DiD) analysis was applied to compare projected outcomes between simulated scenarios, including medication access time, travel distance, continuity of opioid use, documentation completeness, adverse drug event reporting and diversion-risk indicators. Results: The modeled intervention projected shorter medication access time (DiD = −3.0 days; p < 0.001), reduced travel distance (DiD = −24.9 km/month; p < 0.001), improved continuity of opioid use (70.8% to 84.9%; DiD = +12.7 percentage points; p < 0.001) and greater documentation completeness (61.3% to 88.9%; p < 0.001). Simulated adverse drug event reporting increased (5.9 to 8.4 per 100 patient-months; p = 0.012), whereas diversion-risk indicators remained unchanged (1.8% vs. 1.9%; p = 0.74). Conclusion: This simulation-based policy evaluation suggests that the proposed three-level distribution framework may improve access, continuity and pharmaceutical governance of opioid analgesics while maintaining regulatory oversight under modeled conditions. Because these findings are simulation-derived rather than empirically observed, prospective real-world implementation studies are required before policy adoption.