{
  "_status": "superseded",
  "_superseded_by": "instrument-v7.json",
  "_note": "Historical record only. Do not use for review or registration.",
  "model_version": "v6-design-2026-07-23",
  "status": "specification_not_scored_or_validated",
  "legacy_model": "v5",
  "principle": "Separate outcome estimands from causal and contextual risk modifiers; do not aggregate unlike denominators by default.",
  "required_context": [
    "region_and_year",
    "substance_or_formulation",
    "pharmaceutical_or_illicit_supply",
    "dose_or_potency_range",
    "route",
    "frequency",
    "duration",
    "co_use",
    "target_population",
    "setting_and_supervision"
  ],
  "views": [
    {
      "id": "episode",
      "question": "What is the expected serious harm from one defined episode?",
      "denominator": "100000 episodes",
      "outcomes": [
        "acute_medical",
        "acute_behavioral_psychiatric"
      ]
    },
    {
      "id": "regular_use",
      "question": "What is the expected health loss from a defined pattern of regular use?",
      "denominator": "1000 user_years",
      "outcomes": [
        "chronic_physical",
        "chronic_psychiatric_cognitive",
        "external_harm_per_user_year"
      ],
      "modifiers": [
        "use_disorder_probability",
        "physical_dependence_probability",
        "withdrawal_hazard_conditional_on_dependence"
      ]
    },
    {
      "id": "population_burden",
      "question": "What total burden does this scenario cause in a named population and year?",
      "denominator": "region_year",
      "outcomes": [
        "deaths",
        "dalys",
        "victim_harm",
        "economic_cost"
      ],
      "prevalence_included": true
    }
  ],
  "outcome_domains": {
    "acute_medical": "Serious medical event per episode, including poisoning, overdose, cardiovascular event, hyperthermia, seizure, or other emergency.",
    "acute_behavioral_psychiatric": "Serious accident, violence, self-harm, dangerous disorientation, or psychiatric event requiring care per episode.",
    "chronic_physical": "Physical morbidity and mortality attributable to the defined use pattern per user-year.",
    "chronic_psychiatric_cognitive": "Persistent psychiatric or cognitive morbidity attributable to the defined use pattern per user-year.",
    "external_harm_per_user_year": "Harm experienced by other people per user-year, using a consistent denominator across scenarios."
  },
  "modifiers": {
    "use_disorder_probability": "Probability of DSM/ICD substance use disorder within a stated exposure window.",
    "physical_dependence_probability": "Probability of physiological dependence at the defined dose, frequency, and duration.",
    "withdrawal_hazard_conditional_on_dependence": "Ordinal medical hazard of abrupt cessation among people who are physically dependent.",
    "supply_uncertainty": "Probability and consequence of adulteration, substitution, or potency variance.",
    "route": "Route-specific bioavailability, onset, reinforcement, and complication profile.",
    "co_use": "Interaction effects with specified co-used substances.",
    "setting": "Supervision, environment, equipment, and access to emergency care."
  },
  "scoring_rules": [
    "Use natural units before any value transformation.",
    "Define value-function anchors before converting to 0-100.",
    "Record missing evidence as missing, never as zero.",
    "Use ordinal bands when evidence supports rank but not interval distance.",
    "Estimate uncertainty from empirical intervals, model uncertainty, and independent expert disagreement.",
    "Check criteria for non-overlap and preferential independence before additive aggregation.",
    "Use swing weights, not equal slider positions interpreted as neutral.",
    "Do not publish a universal overall rank by default."
  ],
  "validation_requirements": [
    "preregistered_protocol",
    "systematic_evidence_review",
    "multidisciplinary_independent_scoring",
    "inter_rater_reliability",
    "content_validity_review",
    "construct_validity_hypotheses",
    "external_holdout_validation",
    "second_panel_replication",
    "temporal_and_geographic_transportability_tests"
  ]
}