Opioids and the social and political pathology of our body politic


Our Hypothesis


The devastating opioid epidemic is a manifestation of the social and political pathology that has corrupted the nation. The many explanations for the initiation and continued use of opioids for each individual victim of the epidemic, the general forces contributing to the epidemic as well as the barriers to effectively addressing the challenges reflect the personal, social, political dynamics that shape our politics. Federal, state and local government efforts underway to treat the epidemic are a positive step however limited. Unintended consequences impact on the government and stakeholders. The public conversation that 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. We believe that the symptoms associated with opioid use and the societal response to the challenge offer an opportunity to focus on a complex issue and as such more broadly to explore the political system, its limitations and most importantly, examine the potential for citizen involvement in their political ecosystem. 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. It is clear that there are many “citizen” focused interventions that can stem from various symptoms of the epidemic.


Our democracy is a fragile, complex political system made of easily corruptible, intricate web of institutions, interest groups, individual leaders and associated elites, and citizens that are connected to each other in countless ways. Every attempt to influence some aspect of this complex system produces a ripple of other reactions – some may be predictable, but many are not. This can make it difficult to anticipate what will happen when we intervene to try to make our democracy work better. The interconnected and complex challenges of pain and its optimal treatment/management, opioid use disorders and its fatal consequences, and the “failed” War on Drugs provides an excellent framework to test a citizen-centric approach to address the problems facing our nation. It 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, social and economic factors, social determinants, public policy, systemic realities. 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. Federal, state and local government efforts underway to treat the epidemic are a positive step however limited. Unintended consequences impact on the government and stakeholders.


We explore the possibility of enhanced democracy through meaningful citizens engaged within their political ecosystem. We believe and hope that in addition to making an impact on the Pain Opioid Epidemic, the process offers a much-needed change to the current political dialogue and reframes the challenges we face as a nation. The Opioid Case Presentation 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. 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. 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. 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.


Rather than continue to explore the policy “treatment” for the epidemic, we seek to use the complexity of this social challenge to demonstrate a different “radical” approach that is motivated by the belief that citizens engaged politically can contribute to solutions. We explore the possibility of enhanced democracy through meaningful citizens engaged within their political ecosystem. We believe and hope that in addition to making an impact on the Pain Opioid Epidemic, the process offers a much-needed change to the current political dialogue and reframes the challenges we face as a nation. The Opioid Case Presentation 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.


Framing the opportunity

The challenges associated with the pain opioid crisis provide an excellent backdrop to explore the potential for expanding the understanding of the role of the citizen in American Democracy. In particular, I will examine the governmental process associated with the development of the guidelines to shed light on the complexity of rulemaking as it winds through the governmental legislative, executive and bureaucracies and ultimately for individuals impacted by the decision. The interrelated challenges of chronic pain and opioid-related overdoses will be utilized to propose an expanded framework for citizen-oriented problem-solving in our democracy. Additionally, I will utilize theories of citizenship as formulated by Professor Danielle Allen to expand on work about citizen participation. The article will conclude with suggestions to more effectively incorporate citizen input into governmental policymaking and implementation. This creative aspect of democratic disagreement can also be a source of institutional dynamism, provoking parties to relentlessly probe the deficiencies of government and to argue for institutional improvements. A conversation about the opioid epidemic can provide a forum for considering the role of corporations within the political ecosystem.


Learning from past experience addressing the challenges of pain and opioid use, a more holistic, coordinated approach that embraces and leverages and builds on an understanding of the complexity of the social and political ecosystem, the various biological challenges to engage stakeholders in a democratic, citizen-oriented manner is needed. The possibility of leveraging the bipartisan and the public focus to 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 who will face a world challenged with increasing social divisions. The general considerations are framed in a citizen-oriented focus and suggest an activity for reclaiming the citizen role in the political ecosystem. To build on the experience of the opioid crisis, there is also a need for bottom-up policies to help economically devastated communities create new opportunities and maintain their members’ trust in the market economy. The way congress conducts a hearing, the role of experts in the political process, public opinion, CSPAN for the digital age.


A plan to move forward

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.


Additionally, it is clear that there are many “citizen” focused interventions that can stem from 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 build a framework that examines 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 conversation, take a deeper dive into the various stakeholders associated with the epidemic contextualized within 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.


Tracking Federal Funding to Combat the Opioid Crisis


Considerable attention has focused on the drivers of the opioid epidemic. However, less attention has been paid to whether the federal investments to address the issue are being effectively targeted to the communities most affected and to those with the highest overdose deaths. An effective response requires policymakers to know how resources are allocated and to use that information to minimize duplication and maximize the efficiency of limited resources. The federal government has not previously produced or made available a document that provides this information to the public or policymakers.

Thus, the Bipartisan Policy Center created this first-of-its-kind, comprehensive report that tracks federally funded opioid programs in the fiscal year 2017 and FY2018, and examines how these appropriated funds are being directed to address the opioid epidemic.


An invitation


We will focus on The Pain Opioid Epidemic Project starting with The Medical Case Presentation to test our hypothesis for citizen engagement (Citizenism). This week, I launched 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.


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