The opioid epidemic started at the turn of the century, continues to have a devastating impact on many individuals and communities throughout the United States. The statistics are overwhelming. The personal stories are heart-breaking. According to the CDC, between 1999 and 2017 more than 400,000 people have died from a drug overdose, becoming a leading cause of injury and death in the United States. In 2017, around 68% of the more than 70,200 drug overdose deaths involved an opioid. Countless more individuals have suffered severe medical, social, psychological and legal problems associated with opioid use. In addition to the toll on individuals, the opioid epidemic has impacted rural, suburban and urban communities, rich and poor, republican and democratic, all racial grouping. In the same period, the “War on Drugs,” waged against illegal drug users has had devastating consequence on individuals, their families and communities. Efforts by government to stem drug use has militarized local police forces, and has introduced more vehicles for government intrusion into the private life of citizens. Individuals suffering with pain, have been forced to forgo treatment that has helped them function. Most tragically, many of the opioid overdoses leading to the user’s death and serious morbidity are preventable. Many of the social consequences were predictable and avoidable. And perhaps most importantly, the political, social and economic conditions that contribute to the epidemic rarely addressed.
During the past decade I have followed the many efforts by the federal, state and local government, the media, academicians, book authors, non profits, citizen groups, health care institutions, experts, law enforcement and stakeholders of all sorts to address the challenges associated with opioids. It is not for the absence of awareness of the challenge of lack of narratives and theories to explain the roots and persistence of the epidemics devastation. Nor is the response lacking a scientific understanding of addiction, the political will to legislate, litigate, incarcerated, fund, the response to the epidemic. It is not due to an absence of a physical barrier with Mexico, data, resources, emerging best practice. In the past few years, congress passed in a bipartisan manner legislation to address the challenges related to opioid use, allocating billions of dollars to various initiatives. Thousands of legal cases against the manufacturers of pharmaceutical opioid products and the distributors are presently taking place in various venues around the country. The stated goal for the lawsuits is to have these companies compensate and pay for their actions “treat” the consequences of the defendants on communities throughout the country.
The public conversation has evolved during this period however has been limited in its scope, missing a valuable opportunity for meaningful political activity. Groups focused on addiction, pain, restorative justice.
In many ways the opioid epidemic has come to highlight the pathology of our current political moment and represents the many underlying challenges faced by the body politic of the United states. I have come to realize that without a comprehensive understanding of the interconnected and complex bio-psycho-socio-political challenges of opioid use/ abuse and the related complex factors that fermented and now maintain this epidemic, the pathology within our body politic, the current efforts stemming from the SUPPORT Act and the implementation of recommendations made by the President’s Commission on Combating Drug Addiction and the Opioid Crisis, including funding allocations by the federal and state governments, the billions of dollars that states and local governments stand to “win” to help “fight” the epidemic, the promises made by presidential candidates, will have similar outcomes to all the trillions in taxpayer dollars that has been “spent” over the past 2 decades with continued OD death and destruction in communities.
Most importantly, I have come to believe that the opioid epidemic is a symptom of and thus provides an opportunity to examine the larger disease of the US political system. Systematically examining the underlying pathology provides a framework to better understand our representative democracy and its institutions and the complex political process that defines our political system. Such a process may introduce ideas and tools to reclaim the role of the citizen within the political ecosystem. At this time of political polarization, lack of trust in government, the opioid epidemic offers an opportunity to learn about how our government functions and how it gets corrupted in order to suggest strategies for citizens to be active in holding public servants accountable to carry out their duties. The possibility of leveraging the bipartisanism and the public focus into better understanding the challenges facing our society, nation and to consider strategies to enhance our institutions and address the challenges facing our current and future citizens entering a world challenged with increasing social and economic divisions.
For starters, 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. Exploring the opioid crisis with a complexity lens, allows for a more comprehensive approach that includes identifying and addressing the many factors that lead to and sustain the opioid crisis, including the political corruption, the corporate decision making, social determinants, public policy, systemic realities. These efforts must be informed by the economic, social, cultural, political and spiritual factors that are the breeding ground for drug use and addiction are known to sustain and amplify the epidemic. The approach must address the complexity associated with the opioid problem by focusing on the entire opioid ecosystem and target and hold accountable the various stakeholders.
More specifically it requires that we provide meaningful solutions and ways to manifest them that address the entire pain opioid ecosystem. The social determinants, amplified the social, cultural changes facing increasing number of Americans and leading to “death of despair” play a crucial role. Solutions must address the challenges of pain management, opioid use disorders, opioid overdoses, public policy, law enforcement, criminal justice.
Federal, state and local governmental efforts underway to treat the epidemic are a positive step however limited. Unintended consequences impact on the government and stakeholders.
An approach that is based on the interconnected and complex bio-psycho-socio-political challenges of opioid use/ abuse provides an excellent framework to test a “citizen centric” approach to address the problems facing our nation.
Additionally, it is clear that there are many “citizen” focused interventions that can stem various symptoms of the epidemic. The challenge we face is providing a process that will achieve the best outcome with acceptable unintended consequences. Providing the right citizen engagement tools and framework, citizens, patients, consumers, healthcare professionals, public servants and politicians, working together can achieve great results addressing the challenges facing our nation.
We need a pragmatic approach that is solution focused. Rather than continuing to explore strategies within the bipolar criminal justice (the “war on drugs”) and public health frameworks, we need a comprehensive strategy that addresses the interconnected challenges the epidemic poses. Working together we can find solutions that provide accepted outcomes for clearly defined goals that improve the health and well being of all Americans at a cost we can afford.
This week, I launch a series of articles and related materials that use a more complex narrative to provide a framework to understand the challenges, embrace the opportunities and combat the barriers that have given birth to and stymied meaningful treatment of the opioid epidemic. Additionally, it will contextualize the personal experience of individuals suffering with pain and the clinicians seeking to treat them, and the institutions that regulate the relationship. Most importantly, the series leverages the multitude of issues evoked by the opioid epidemic and its management, to create a framework that tests an approach with a mission to enhance the role of citizens in our evolving democracy. The overall goal is to use the opioid crisis as a case study to better understand the political and social forces in our society and to better address the challenges facing our body politic. The process will lead to a crowd sourced document that reflects the case presentation approach, a tool for increased citizen engagement.
The declared objectives of the effort are:
Provide a narrative that is more nuanced and complex, utilizing data and information focusing on potential solutions
Provide a framework for citizen opinion and communication (Citizen assemblies)
Provide tools to enhance the role of the citizen as part of the body politic and interface with government at all levels. The 2020 elections
Provide tools and information for personal involvement
Educate about the constitutional framework and government corruption
Offer an alternative way for citizen public opinion to address societal complexity
For the next six months (July 14th 2019 to December 2019) we will focus on The Pain Opioid Epidemic Project starting with Medical Case Presentation to test our hypothesis for citizen engagement. We examine the various stakeholders associated with the epidemic and highlight the potential for citizen action, interest groups, citizen groups, individuals, non governmental regulators, as well as public officials to impact the opioid/pain epidemic. We review some of the narratives that have shaped the efforts to address the opioid related challenges and shape the current conversationWe take a deeper dive into the various stakeholders associated with the epidemic contextualized with in the larger social, cultural and political landscape. The effort will leverage aspects of the opioid epidemic to better understand the corruption of the body politic. Additionally, the potential for citizen action, interest groups, citizen groups, individuals, non governmental regulators, as well as public officials to impact the opioid/pain epidemic and more effective government with be highlighted. .