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. The political theater riveting. The impact is experienced regardless of class, geography, gender, religious background, in other words its a unifying tragedy.
During the three decades I have practiced as a psychiatrist the most difficult and challenging individuals I encountered suffered with intractable chronic pain, opioid substance use disorders and people who lost a child, sibling, parent or friend to opioid overdose. As a physician I have encountered parents who lost children to unintentional opioid overdoses, I have treated individuals who become suicidal due to persistent excruciating chronic pain. Additionally, I have seen the suffering of people who experience chronic pain and require opioid medications but must now face increasing obstacles to to increasing scrutiny and regulations. Individuals who got embroiled in the legal system for experimenting or using drugs with substances.
But just as important as a citizen I have watches as tens of thousands of people become statistics in what has become to be the number one public health crisis facing our society. recognize the importance of public policy to stem this problem. At the same time, it is clear that the various strategies from the War of Drugs to the more recent pivot to a more public health approach have failed to stem the epidemic. I have realized that we, as citizens and medical stakeholders can do more to address this challenge. I realize that as a profession physicians and other medical stakeholders can and must do more to address this problem.
During this period 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 clear to me that 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.
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.
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. The epidemic can also serve as an opportunity to examine the divisions within our political system and learn how to address the challenges we face. The limitations (failure) of government (federal, state and local) to regulate potential dangerous substances. The limited focus of interest groups on maximizing their profits or protecting their turf. The failure of the medical community to accept responsibility that comes with the ability to prescribe dangerous drugs and their reluctance to engage in addressing social challenges that contribute to patient’s well being. The inadequacy of the media to provide the public deep, contextualized information that can impact the course of the epidemic, often resorting to sensationalization of the victims of epidemic. Furthermore, opioid dependence has been linked in various populations to growing desperation, alienation, marginalization and hopelessness experienced by many citizens due to changing economic conditions.
After participating in multiple events local and national events, reading numerous articles, studying white papers, task force reports, watching congressional and hearings and executive branch meetings, I have come to realize that citizens must play an informed, active role in addressing the complex, wicked problem of the opioid epidemic. I developed The Pain Opioid Project as a vehicle for citizen involvement. The goal is to develop a treatment plan to be used by citizens to address the related challenges of pain management, opioid use, dependence, addiction, abuse, overdose and the "War on Drugs" and its consequences. Using the experience with the Pain Opioid Challenge, we will address other symptoms of the US body Politic in the coming year.
While government may contribute some solutions to addressing the problem, it is up to all of us to prevent and reduce abuse, misuse, overdose and death from prescription drugs. We need a multi-pronged, coordinated strategy that is informed by a public health focus to combatting the nation’s prescription opioid abuse and growing heroin epidemic. A crucial part must be played by the citizens in their communities who must lead the way locally and nationally. The complexity involved the individual in their internal biological and psychological environment interactions with their social political environment. In the past years we have witnessed advances in understanding of pain and addiction. These have been translated to guidelines, business opportunities, and at times clinical practice however it has not filtered to clinicians.
I have come to believe that what is required is an understanding of the complexity and challenges associated with the pain-opioid ecosystem system for the individual, communities, health care institutions and government. To be successful, we need to come up with strategies that address the underlying causes of the addiction, the barriers and challenges of pain and opioid use, a more holistic, coordinated approach that embraces and leverages the complexity of social and political ecosystem, the various biological challenges, and engages the stakeholders. The challenge of pain-opioid use required a well formulated, coordinated effort that addresses the complexity of the opioid-pain ecosystem as well as leverages an understanding of the institutional challenges that must be understood and overcome. Additionally, it is clear that there are many interventions that can stem various “symptoms” of the epidemic”. Additionally, reframing the challenges and plan into a hopeful framework for better understanding the societal challenges and potential for addressing them in our divisive, partisan body politic.
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.
The challenge we face is providing a process that will achieve the best outcome with acceptable “unintended consequences”. The treatment plan is motivated by and is testing the belief that given the right tools and framework, private citizens, patients, consumers, healthcare professionals, public servants and politicians, working together can achieve great results addressing the opioid epidemic and related challenges facing our nation. The treatment plan offers a modular approach that can be easily used to address particular aspects of the Pain- Opioid Epidemic for the individual, community, social agencies and the government. The particular items are linked to an action plan for citizen engagement.
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 part three 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.
For the past 30 years, I have been confronted with the opioid epidemic in my clinical experience as a psychiatrist treating individuals suffering with chronic pain who consider or have attempted suicide, individuals in the hell of addiction after starting with an opioid prescribed by a physician for a minor injury, parents who have lost a child to an opioid overdose, children who have lost parents to the law enforcement, legal world. These are very challenging encounters, complicated by a health care system within the larger society that is not responsive to the needs of these populations. What is most disturbing is that there is a lot that can be done to treat this growing epidemic. It has become clear to me that to address the challenges of pain and opioid abuse and overdose I would need to explore and address as an engaged citizen with the complexity of the Pain Opioid Ecosystem.
Public support for the federal government addressing the opioid epidemic has received unusual bipartisan support. Yet, efforts to date that have offered limited solutions have failed to stem the devastation. It is necessary to understand the interconnected and complex bio-psycho-socio-political challenges of opioid use/ abuse. Viewing the entire opioid ecosystem and addressing the interconnected elements provide an excellent framework to test a “citizen centric” approach to address problems facing our nation. More specifically, the challenge of pain opioid epidemic is best understood from the complexity/ ecosystem lens. Exploring and understanding the pain opioid ecosystem, the various stakeholders, their interaction and the dynamics driving and maintaining the various issues provides potential “solutions” at the various levels of the complex ecosystem.
Like the symptoms associated with opioid use and the pain management, the Opioid Project focuses on the underlying “symptoms of the diseases of the US political system”. These symptoms are an epiphenomena for a more virulent if not “mortal disease” of the US body politic. The environment that maintains the veracity of the symptom is the political/ economic reality (Democracy-Capitalism) that leads to despair/ alienation, marginalization, hopelessness, helplessness. In order to fully understand the pathology and provide treatment the following must be considered:
The ease with which the governmental power tramples civil liberties.
The limitations (failure) of government (federal, state and local) to regulate potential dangerous substances.
The unintended consequences of thoughtless corrupt governmental action.
The limited focus of interest groups on maximizing their profits or protecting their turf. The failure of the medical community to accept responsibility that comes with the ability to prescribe dangerous drugs and their reluctance to engage in addressing social challenges that contribute to patient’s well being.
The inadequacy of the media to provide the public deep, contextualized information that can impact the course of the epidemic, often resorting to sensationalization of the victims of the epidemic.
Over the past few decades the devastation of the Opioid Crisis has continued, coinciding with millions of Americans are suffering with pain disorders and more and more impacted by the consequences of efforts to address the opioid crisis. As a psychiatrist in clinical practice, I experience the urgency of addressing the challenges of pain management in context of the opioid epidemic. I have come across numerous guidelines, position papers, legislations etc all in an effort to address this issue. I have had to comply with ever increasing regulations and procedures associated with response by policy makers and regulars.
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.
The Pain Opioid Project as a vehicle for citizen involvement. (More detailed overview of the project here).
I invite us to consider the possibility that we the people can make a difference.
Check out the Pain Opioid Epidemic Case Presentation.