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The Pain and Opioid Epidemic Medical Case Presentation

Saturday, July 13, 2019

Invite 

 

In order to demonstrate to potential for the use of the framework, an experiment, The Pain Opioid Epidemic Project will be suggested and the readers invited to take part in order to manifest an experiment in citizen engagement to address one of our current “national emergencies”.  Using the Medical Case Presentation for deliberative dialogue to address the challenges facing the United States body politic. Putting the Pain Opioid Medical Case Presentation into Practice Article is an abbreviated presentation of The Pain Opioid Epidemic Case Presentation An experiment in Citizen Engagement. It is our goal to have an ongoing crowdsourced case conference that addresses the ongoing challenges associated with the pain opioid epidemic.  To learn more about the project, our strategic plan,  plan for further activities contact us

 

Introduciton 

 

The Medical Case Presentation: The Pain Opioid Epidemic  (The Opioid Case) builds on an understanding of the complexity of the political ecosystem that has evolved from the constitutional DNA. It will particularly focus on exploring various political, social and other institutions and processes from the citizen perspective. More specifically, keeping with the medical case presentation framework, the article suggests a citizen based tool box to engage with the relevant stakeholders that are relevant to the the emergence and evolving devastation of the opioid epidemic. Suggestions are made to utilize the process and these tools to address other complex problems facing out country.

 

The role of the citizen within the pain opioid epidemic is than used as a case study to better understand the complexity of the ecosystem and to introduce a framework for citizen engagement.

 

An understanding of the complexity of the political ecosystem that has evolved from the constitutional DNA is essential for the exploration of the various political, social and other institutions and processes from the citizen perspective. The role of the citizen within the pain opioid epidemic is then used as a case study to better understand the complexity of the ecosystem and to introduce a framework for citizen engagement. More specifically, keeping with the medical case presentation framework, the article suggests a citizen-based tool box to engage with the relevant stakeholders that are central to the emergence and evolving devastation of the opioid epidemic.  The role and utilizing digital technology as a toxin as well as potential treatment are made. Specific remedies for the reality of citizenship participation in the political process are reviewed. Suggestions are made to utilize the process and these tools to address other complex problems facing out country.

 

Background

 

The opioid epidemic continues to have a devastating impact on many individuals and communities throughout the United States. The statistics are overwhelming. The personal stories are heartbreaking. The financial cost staggering. In many ways the opioid epidemic has come to highlight and act as a symptoms for many underlying challenges faced by the United states. We believe that the symptoms associated with opioid use and the societal response to the challenge offer a focused but complex issue that can provide a way to explore the political system, its limitations and most importantly, examine the potential for citizen involvement in their ecosystem. The Opioid Case  serves to test the proposition that with the proper framework and easy to use citizen-oriented tools, we can more effectively collaborate to address complex problems.

 

The epidemic has been attributed to many of the social challenges facing Americans and lead to marginalization, alienation, despair and sense of hopelessness. It has often been stated and research appears to bear out that a major driver of the epidemic are societal changes, alienation and hopelessness experienced by many citizens. Rates of opioid abuse, addiction, and fatal overdose rise along with unemployment and other social determinants.In this medical case presentation  we use the complexity of the opioid epidemic to highlight the potential for the use of the medical case presentation to inform citizens and provide tools to engage within the political ecosystem.

 

The Putting the Pain Opioid Medical Case Presentation into Practice

 

The Medical Case Presentation is an essential framework for a focused disciplined approach to addressing medical problems. Healthcare professionals use the Medical Case Presentation to identify, analyze, develop, implement and monitor a solution based “treatment plan” for medical problems. When used effectively, it allows healthcare professionals to communicate and share information among varied clinical disciplines to develop testable hypotheses for simple and complex problems. The framework allows for clearly identifying problems and providing objective data to support the diagnosis and “treatment plan.” The Medical Case Presentation is uniquely positioned to address systematic changes over time. Through progress notes addressing specific problems, we’ll be able to adapt to new issues to clearly identify problems and potential solutions.  

 

The Opioid Case effort is measured in terms of specific outcomes associated with the social and political challenges and consequences of the opioid epidemic, a major focus of this project is to model the framework of the medical case presentation as a tool to enhance citizen participation and engagement in the political ecosystem. The approach addresses the complexity associated with the opioid problem by focusing on the entire opioid ecosystem and holding accountable the various stakeholders. We believe that the majority of Americans are pragmatic problem solvers and are eager to address tough issues in a solution-driven nonpartisan framework; the Opioid Case Presentation demonstrates how to approach a difficult problem.

                                      

The Opioid Case is central to The Pain Opioid Epidemic Project. Using the Medical Case Presentation as an organizing structure, the Opioid Case creates a framework for a citizen-oriented approach to the challenges facing us in the Body Politic of the United States. In the coming months, the Opioid Case  offers a dynamic, interactive, collaborative process that engages our fellow citizens to address the opioid-related challenges confronting us as individuals, members of our community and citizens of the nation. The Opioid Case Presentation provides a vehicle for citizens to collaborate, identify, analyze, develop, implement and monitor a solution based “treatment plan” for medical problems.

 

The Opioid Case utilizes digital technology through blogs, surveys, newsletters and crowdsourcing to provide wide access for many individuals and the democratization of information with real world facts rather than rhetoric to serve as a potent platform to build on the ideas and energy of many to make the process as useful and productive as it can be. The various sections of the opioid epidemic case will be presented over a period of weeks and ongoing discussion will be encouraged. Short and long term goals and plans will be developed and monitored.

 

I limit my focus to the following aspects of the medical case presentation: the values (vision), symptoms, history of the present condition, current treatment, review of systems, data and information, diagnosis, treatment plan and progress notes for the challenges of the “body politic. Additionally, The Medical Case Presentation includes multiple features to engage citizens. Similar to the diagnostic and treatment tools in the hands of medical clinicians, these features can be thought of as the toolbox for citizenship. In order to demonstrate to potential for the use of the framework, an experiment, The Pain Opioid Epidemic Project will be suggested and the readers invited to take part in order to manifest an experiment in citizen engagement to address one of our current “national emergencies”.

 

Disclaimer

 

Our efforts are not intended to duplicate the extensive, multi-prong approach undertaken by the many stakeholders addressing the pain opioid epidemic. We seek to explore the potential for and facilitate citizen participation. In order to do so, we address the problems associated with the opioid epidemic and the ecosystem in which it exists. We build on an understanding of the complexity of the problem itself, the potential provided by information and communication technologies (ICT) and insights from behavioral economics to address the challenge.

 

The medical case presentation is a collaborative process consisting of the following general sections:

 

Chief Complaint:

Symptom of a larger pathology. Opioids — primarily prescription painkillers, synthetic opioids, Fentanyl, and heroin — were factors in more than 60,000 deaths across the U.S. in 2016, and opioid overdoses have more than quadrupled since 2000, according to the U.S. Centers for Disease Control and Prevention, now surpassing traffic accidents in the number of deaths caused by injury in the United States. As the use and abuse of opioids, including prescription opioids, heroin and synthetic opioids continues to have a devastating effect on individuals, families, public health and safety in communities across the United States, it is clear that a different approach to the problem is necessary. In addition numerous unintended consequences have emerged, leading to further distress for individuals, organizations and communities. Despite efforts on the international, national, state and local levels, billions of dollars spent, hundred of thousands of citizens incarcerated, the opioid epidemic continues to worsen.

 

History of the Present Condition:

The History of Present Condition section addresses the problem in more detail providing a timeline and associated systems and impact of the problem presented. Despite efforts on the international, national, state and local levels, billions of dollars spent, hundred of thousands of citizens incarcerated, the opioid epidemic continues to worsen.

 

Current Treatment:

The Opioid Project identifies current efforts to address the challenges on federal, state and local levels. Additionally it highlights barriers to comprehensive approach to address the challenge, as a way to facilitate citizen action within the Pain Opioid Ecosystem.

 

This section will explore the current best practice for citizen engagement in general and related to pain opioid in particular including pain management, addiction treatment, and response to overdose. There are various programs and organizations dedicated to address the opioid epidemic. The efforts lack the effectiveness needed to treat this deadly disease. The treatment consists of efforts by multiple stakeholders on the federal, state and local levels and include prevention, treatment, law enforcement, scientific efforts.

 

Review of Systems:

Using an ecosystem framework, the review of systems section will examine the various stakeholders, and describe their interests, motivation, resources and prior input into addressing the challenge of opioid use.

Highlights the pathology that occurs in the political ecosystem provides a user-friendly tool to better understand and engage with the various relevant stakeholders. The ecosystem view assists citizens in developing a richer understanding of the social and political systems affecting their lives. The citizen can learn about their representatives, organizations and other relevant influences on their local, state and federal (or global) systems and more easily engage with them. My Political Ecosystem: This easy-to-use tool provides a snapshot of the political system where citizens can learn about their representatives, organizations and other relevant aspects of their local, state and federal (or global) systems. In order to actively participate in our politics, we need to be informed about political and public institutions, our representatives and other government officials.

 

Data and information:

Data is crucial for an objective presentation of a given medical situation, not just to help the diagnosis, but also to decide on a course of treatment and monitor results. The challenge with data is to agree upon what is important and relevant. Data is not an opinion; it is usually reproducible and verifiable. Data is a tool for more informed decision making about, not a decision itself. The challenge is to present the information in a simplified manner that allows for utilization into the decision-making.

Research and provide relevant data needed for rational discussion of the problem.

 

Diagnosis:

Discuss the various options available, the barriers to action and the consequences of each action or inaction. A complex set of barriers exist that stymie effectively treating the course of this epidemic. In order to have an impact on the various aspects of the opioid epidemic it is essential to better understand and address the various drivers of the epidemic and their consequences. More specifically it will require providing meaningful solutions and ways to manifest them that address the entire Pain Opioid Ecosystem, including: pain management, opioid use disorders, opioid overdoses, public policy, law enforcement, criminal justice and related challenges.

 

Problem list:

The problem list includes the various challenges identified needing to be addressed including:

 

Vision: Establish a vision for the individual, community, nation and the international community

 

Humanizing the Epidemic:

Focusing on the individual suffering with pain and addiction & confronting stigma associated with their condition

 

Social Determinants of the Opioid Epidemic:

Social determinants such as poor housing conditions are often accompanied by neighborhood-level conditions that limit access to health care, risk-reduction information, and treatment alternatives, which are protective resources and can disrupt behaviors that ultimately lead to opioid addiction.

 

Opioid Supply Reduction:

Reducing the supply of non medical opioids and preventing the initiation and misuse of nonmedical opioid use

 

Pain Disorders:

Appropriate acute and chronic pain management and medical use of opioids

 

Opioid Use Disorder:

Prevented, properly diagnosed and properly treated Best practice, scientifically informed addiction prevention, abuse and dependence treatment

 

Harm Reduction:

Preventing and reducing harm associated with opioid use, including eliminating overdose mortality and morbidity associated with opioid use

 

“The War on Drugs”:

A criminal justice system that reflects scientific understanding of opioid use and targets criminal elements associated with the pain-opioid epidemic.

 

Treatment Plan:

 

The Treatment Plan outlines a multifactorial, action process targeting specific challenges that we have identified. The action plan is divided into time segments that reflect different levels of urgency as well as psychological understanding to maximize the probability of achieving the identified goals. We believe that offering a time frame with clearly defined and measurable outcomes is an antidote to the crisis environment that leads to poor choices and worsening of the problems. Although this division is helpful, many of the actions take place at different stages of the process. For example, the efforts to create a vision for the healthcare system will be an ongoing process. Specific challenges in addressing the Pain-Opioid ecosystem will be described along with the policy options to remedy them.

 

Formulate an action plan based on measurable outcomes, transparency, accountability and informed consent. The citizen activist agenda addresses the identified challenges and powerful barriers that have stymied prior efforts at addressing the medical and social challenges of pain and addiction. The particular items that are specifically listed below are treated utilizing an action plan for citizen engagement.

 

The treatment plan of the Opioid Case offers a comprehensive, multi-prong, multistage action plan that is​​ divided into immediate, short and long term actions. The treatment plan format allows us to engage in a healthy deliberative political process toward our vision:

 

  • By September 2020, every individual who experiences pain (acute and chronic) has access to and is able to receive evidence based, best practice informed treatment that improves their well-being in outcomes that matter for them.

  • By September 2020 there are no reported deaths of opioid overdose, serious medical harm associated with opioid use are reported in the US.

  • By September 2020 the official approach to opioid addiction and dependence is informed by a public health related then criminal justice approach.

  • By September 2020 individuals suffering with opioid use disorders have access to affordable, evidence based treatment.

We believe that together, following a treatment plan, we can solve the Pain Opioid Epidemic and build a system that we can be proud of, and change the political culture that has been so destructive.

 

The Checklist:

Being a citizen is challenging and complex. Checklists have been used to improve outcomes in various fields. We introduce the checklists to facilitate taking action and interacting with various stakeholders. Developing a checklist is a continuous process.

 

Citizen Brief:

A complete Citizen Brief provides a vision for an issue, reframes the problem, provides data, and discusses the various issues and proposals available. These actions can be personal, social or political, Citizen Brief is associated with an activist agenda to address the identified challenges and powerful barriers that stymie efforts to confront social challenges. The particular items in the Brief are linked to an action plan for citizen engagement.

 

Progress Notes:

Apply the action plan, monitor outcomes and update the action plan

Ongoing collection and analysis of population and individual data associated with the Opioid Epidemic. The data will feature The Opioid Epidemic Case Presentation Progress Notes and occasional Clinical Case Conference focusing on individual situation.

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The Pain Opioid Epidemic Case Presentation  Active is a Google document for crowdsourcing a comprehensive approach to address the Pain Opioid challenge.

 

 

Contact Us for access to the document and to become part of the effort. 

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