Team Holarchy- Opioid Epidemic Transition Design 51702
Introduction
Hello! Welcome to Team Holarchy’s Medium Page
We are here to map the complexity of the Opioid Crisis in Pittsburgh.
Meet the team!
Ekta
Ekta is a Masters student in Interaction Design with a background in Computer Science Engineering. Her work is focused on leveraging technology with a backbone of good design and research to build products and systems that change lives for the better.
Michelle
Michelle Cedeno is currently an MA at Carnegie Mellon University. Her background is in Neuroscience and Film. She argues that both science and design help bring humanity front and center, make us care, and create answers that resonate with our values. Her work broadly addresses narratives between the interplay of neuroscience and speculative design.
David
David is a Master of Integrated Innovation for Products & Services student at CMU, focusing on User Research, Experience Design, and Storytelling. As a media arts background, he is passionate about using storytelling to create enjoyable and inspiring experiences for the users and the audience.
Patrick
Pat is a senior undergraduate student in the Tepper School of Business, majoring in Marketing with a minor in Media Design. He believes marketing is about effectively providing and communicating solutions to the end-user. One key aspect of communicating this information is the reasoning and importance behind the need for change, and he believes Transition Design involves better educating people about the scope and extent of a problem and the necessity of ideating and implementing a proper, long-term solution.
Jo
Jo Zhouzheng is a Master of Integrated Innovation for Products & Services student at CMU, focusing on interaction design and service design. Before CMU, she worked as an analyst at a technology company based in NYC. This professional experience before her career switch has equipped her with a critical mind, which allows her to put the design in the larger business and social context. As an advocate of human-centered design, she believes that it is the deeply rooted humanness and care of others that makes design meaningful.
Sofía
Sofia is a Ph.D. student in Transition Design with a background in graphic design. Her research focuses on the role of design and designers within the Mexican public service as catalysts of change.
Together we strive to tackle Pittsburgh’s opioid crisis and intervene in a meaningful system levels way to ultimately develop a holistic solution.
Research Methods and Research Methodology in approaching Opioids
The opioid crisis is a complex, wicked problem that has been developing for decades; Many systems are interwoven that add to this entangled web. The misuse of addiction to opioids is a serious national crisis that affects public health, social and economic welfare, and etc…
Approaching this multidimensional issue as a team, we first wanted to be thorough with our research and understand the broad scope of how the issue originated and became so vast in scope. Individual secondary research was taken upon each team member. Each one of the team had an area of interest on the topic and first began researching from there. For example, Michelle has a research background and wanted to learn more about the connection between opioids and pharmaceutical companies. In addition, Ekta wanted to do more research on mass media and opioids, while Sofía was interested in border control and government policy. Patrick’s corporate growth and business angle highlighted issues of illicit sales on the dark web and other markets as well as the hidden corporate agendas big companies have when selling their products. Jo went deeper with pharmaceuticals and mental health and David gave a very holistic and historical account of the history of the opioid plant and medicinal qualities.
This first exercise in exploratory research proved that our team’s prior knowledge, skillset, and cultural diversity helped facilitate a range of topics that feed into the opioid epidemic. It was important for us to learn as much as possible of the situation so we were knowledgeable about how things related. Presenting our ideas together helped us devise a system to be better organized. This dynamic helped kickstart information processing.
Our first meeting consisted of us presenting the ideas we researched. We had many lines of overlap but a general understanding. Already our group saw how big our problem could get; the intricacies of problems, consequences, and stakeholders were so many that we had a challenge to accurately map how each one was related.
Thus iterating, color coding and creating a hierarchical system helped us find a method that really was conducive in shaping and mapping this wicked problem.
Mapping a Wicked Problem
After scoping the wicked problem, we zoomed out to look for connecting commonalities between different issues and categorized them. Such categorization and hierarchy allowed the team to look at the interrelation among the multiple issues from a systemic lens. The opioid epidemic issue was broken down into the following five sub-issues: IT, social, economic, governance, and environmental issues.
Infrastructure/Technology Issues
We identified the mass media propaganda and poor opioid record tracking system as two major wicked problems. Under mass media propaganda, problems have resulted from easy access to opioid through personal devices and false advertisement through different media channels. Mass media propaganda from the pharmaceutical industry made the medical community and patients overlook the addictive effect of opioid medication possible. Access to digital devices and the internet made it possible for pharma to target specific doctors and patients.
Social Issues
We identified three major problems. First, the lack of education for physicians, patients and the demographics affected by opioid could result in opioid misuse. Second, mental health issues are indirectly related to overdose and addiction of any sorts. Third, the values and mindset of the people could incentivize the illegal opioid trade. For example, some people might choose to use natural opioid, while others might choose synthetic opioid that could result in overdose.
Social issues are tightly linked to governance and economic issues: accessible health care, social stereotyping, the liberty to choose alternative methods of treating chronic pain, go hand in hand with a system that favors the growth and profit of private pharmaceutical companies.
Environmental Issues
We identified water pollution and global warming as two major issues. The consumption of opioids pollute the water systems through human discharges in the sewage system, impacting the aquatic life. Fish near sewage outpours have been observed with diminished reflexes and unhealthy conditions. Currently, most poppy flowers, opioids’ raw ingredient, are grown in tropical areas, making transportation and the transactionality of the product a high pollutant one.
Governance Issues
The governance root was an especially interesting web of interconnections. The way our team divided this subcategory was branching all the consequences off of Ideology. As a team, we decided that Ideology was the foundational cause of this root problem. Ideology, as it means, is the integrated assertions, theories, and aims that constitute a sociopolitical program. In the government specifically working in a capitalist regime with a two-party system, many politicians and citizens have their own ideology. From ideology stems Neoliberalism, national discourse, and educational institutions and family. From Neoliberalism, which favors free-market capitalism and growth, we connected healthcare which connects to public rehab centers to private rehab centers. We made the connection of private rehab centers to corporate growth because we believe rehab centers intentionally want more people to enter their facilities. Nationalist discourse is a concept of modern governance that aims at transforming social inequalities into a source of national identity. This conversation leads to border control and cartels and how opioids are sold illegally. Thus governance is a huge interesting web of consequences that directly relate to the opioid crisis in Pittsburgh.
Economic Issues
We identified globalization, capitalism, job loss and the desire to grow economy as four major issues. First, globalization and capitalism could incentivize the sales of illegal trade of opioid and “Dark Web’. The social crisis resulted from the opioid consumption could lead to job loss. Third, the corporate growth, especially the need for expansion and an increase in profits drove the pharmaceutical industry to push the medical community to over-prescribe painkillers than needed, directly resulted in widespread opioid addiction.
The fundamental drive of the opioid epidemic lies in globalization and its economic consequences. The opioid epidemic has occurred in three waves. The first wave began in 1991 when deaths involving opioids began to rise following a sharp increase in the prescribing of opioid medications for the treatment of pain. The increase in opioid prescriptions was influenced by reassurances given to prescribers by pharmaceutical companies and medical societies claiming that the risk of addiction to prescription opioids was very low. Communities, where opioids were readily available and prescribed liberally, were the first places to experience increased opioid abuse and diversion (the transfer of opioids from the individual for whom they were prescribed, to others, which is illegal).
The second wave of the opioid epidemic started around 2010. As efforts to decrease opioid prescribing began to take effect, prescription opioids were made harder to obtain. Addicts turned to heroin, which leads to a rapid increase in deaths from heroin abuse.
The third wave is due to an increase in deaths related to synthetic opioids such as fentanyl. The increase in fentanyl deaths has been linked to illicitly manufactured fentanyl used to replace other drugs of abuse.
The corporate growth, especially the need for expansion and increase in profits drove the pharmaceutical industry to indirectly intervene the opioid prescribing patterns through lobbying and advocacy groups. These efforts include sending sales representatives dozens of times per year to visit prolific prescribers, halt measures to restrict opioid overprescribing.
These efforts directly resulted in overprescription of opioid by the medical community and exacerbated opioid epidemic. Patients who become an addicted turn to the illegal market for illicitly manufactured drugs. Increasing demand from the illegal market directly leads to an increased poppy growth rate which in turn is connected with the environmental consequences we identified.
Stakeholders
From there, our team listed all potential stakeholders involved in the opioids crisis. Stakeholders such as the government, hospitals, rehab centers, pharmaceutical companies, the addicts themselves, and many others. We wanted to select stakeholders that had very clear and uniform fears and desires before mapping potential conflicting or synergistic relationships.
One of the obvious stakeholders would have been the addicts themselves. But addicts can be of
different kinds, legal addicts, illegal addicts, addicts willing to seek help and those not willing to do so, etc. So we decided to go a bit unconventional and take the family and friends of the addicts as our primary stakeholders. The family and friends of the addicts will always want the wellbeing of the addict. They would always want the addict to overcome their addiction as soon as possible.
Hope and Desires
1. Addiction as a disease should be better managed by the authorities
2. Easy access to good quality and affordable healthcare for the addict
3. Knowledge of alternative treatment options rather than consuming opioids
4. Faster recovery of the addict
5. Lower cost of recovery treatment
6. Better education to understand the side effects of using opioids
Fears and Concerns
1. The addiction results in a fatal outcome
2. The addict get access to more illegal drugs
3. The addict gets meted out harsher treatment due to racial stereotyping and racism
4. The addict drains all the family savings to meet his addiction needs
5. The addict becomes an emotional burden to the family
6. If the family does not know how to deal with addiction they feel helpless
7. If the addict does not want to change, the friends and family feel helpless
8. Fear that the addict will not be able to earn for the family or contribute to family
savings, especially if the addict is the sole breadwinner of the family
9. Other members of the family or other friends pick up the addiction from the addict
10. The addict becomes violent or hurts his loved ones in an inebriated state or to obtain resources for buying drugs
Other stakeholders we chose were the pharmaceutical companies that research and produce medications for those in need. Since these are usually big corporations, one of their main concerns is to generate profits. In order to do this, they need to come up with new and innovative drugs to combat life-threatening issues. A hidden agenda that they might have is their desire to make sure that their customers don’t find out about the increasing risks of taking opioids or other painkilling medication since customers are more likely to stop purchasing these medications once they realize the dangers surrounding taking opioid drugs.
The final stakeholder we identified were policy-makers. Their hope and desires were quite diverse in regards to other stakeholders, mainly due to their ideological grounding. Some of the desires we described were in line with improving access to health care, to rehab and mental health facilities and public institutions, as well as making visible the rise of opioid consumption nationally. Yet, the other avenue of hopes and desires derived from a nationalist ideological stance: regulation of opioids trade, tracking users and sales, as well as protecting the entrance points of illegal opioids. Their fears mainly befell in the ripple effects the opioid crisis may have, incrementing or exacerbating other wicked problems like poverty, homelessness, crime, illegal sales points (physical and digital, e.g. the dark web) and an increase in unemployment and high mortality rates.
Finally, we speculated their worst fears would materialize in a social uprisal or active public scrutiny. This would imply a demand from civil society in accountability and transparency in public bids and contracts with pharmaceutical companies, as well as enforcement of already existing regulations.
Interconnections
When we started mapping the stakeholders, we found several interconnections and relationships between the stakeholders. These relations could be both positive and negative.
- Increase in the unemployment rate (policy makers) and racial stereotyping causes addicts to lose jobs and not be able to contribute to their family finances. (family and friends)
- Addiction and stereotyping further lead to loss of jobs (policymakers) which further hampers the inability of an addict to contribute to family finances. (family and friends)
- Making public healthcare affordable (policymakers) will enable more families to access treatment for their family member who is addicted (family and friends)
- A better rise in visibility of misuse of opioids (policymakers) will lead to people being better educated about the harmful effects of opioids and avoiding their use in the first place (friends and family). This will also help addicts see the harmful effects of opioid consumption and start treatment at the earliest.
- The faster they recover (family and friends), the better the overall national public health (policymakers)
- The rise of visibility on the use of opioids (policymakers) will also help people look for alternative treatment methods (family and friends) other than relying on opioids.
- Pharmaceutical companies are scared of the increased sale of illegal drugs in the black market (pharma companies). This concern is shared by the family and friends of the addict, as they were the addict to have lesser access to such drugs (family and friends).
- However if the pharmaceutical company is involved in the trade of illegal drugs and sells drugs illegally in the black market (pharma companies), they would want the people to have more access to such illegal drugs, which stand in conflict with the expectations of the family and friends of the addicts (family and friends).
- Lower cost of treatment (policymakers, family and friends) means declining profits for the pharmaceutical companies (pharma).
- While the lawmakers would not want an uprising or social protest (policy makers), neither would the pharmaceutical companies (pharma), because such a protest would taint their public image and cause negative publicity. And in the medical market, trust is important for business.
- Both clean business pharmaceutical companies (pharma), as well as policymakers, want to curb the growth of illegal drugs on the dark web.
- Pharmaceutical companies want to innovate and introduce new medicines (pharma) which will further help in providing alternatives for opioids (family and friends) and cause an improvement in public health. (policymakers)
- Pharmaceutical companies would want lesser public awareness about the dangers of opioids which stands in conflict with the policymaker’s desire to improve education about the dangers of opioids.
- Better tracking and control of opioid users by the government (policy makers) would result in dipping profits for the pharmaceutical companies (pharma).
- Policy makers require funding to function, so they raise the sales tax on the sale of pharmaceutical products, which decreases the profits of the pharma companies.
Reflection
Overall, this exercise was a great way to collaborate and share ideas. our team’s dynamic is a wonderful mixture that adds to the different perspectives one can take on this wicked problem. Mapping out both stakeholders and roots and consequences gave us a great foundational background on how best to continue researching this multidimensional problem.
February 11, 2018, Mindset and Posture
Analyzing the opioid crisis through the lens of this week’s three readings (Mary Clarke “Framing the Problem”, Alan Drengson “Shifting Paradigms: From Technocrat to Planetary Person”, Freya Mathews “Post Materialism”), we were able to narrow in on 3 relevant points that directly apply to the Opioid Epidemic in Pittsburgh :
1- Framing the wicked problem as a net/network instead of a “billiard balls” metaphor: instead of looking at the problem as different stakeholders who interact with each other unpredictably, we see the problems as a neurological net in which purposefully or not, stakeholders and actors are affecting each other constantly.
2- Technocratic approach to the problem: this approach has led to a quantitative focus of the problems instead of trying to approximate it from a humanitarian/qualitative perspective. This has been strategically used by pharmaceutical companies’ to amplify and give weight to their interests. This way of managing the problem impacts the way health and patients are managed, in a general sense.
3- Materialist/Modern principles: the vision of healthcare in the United States has led to approaching health in a functional/utilitarian point of view that has extracted the human factor to the epidemic in opioids abuse. We need to shift that paradigm to a post-materialist society in which everyone’s’ interests (human and non-human) are taken into account without affecting our natural resources.
February 18 World View and Opioids Recap
Worldviews are the pillars in which socio-cultural paradigms stand on. In the West, there is a perception that the neoliberal capitalist framework is the only possibility to tackle common problems. A rigid scientific approach to our social structures, as shown through Fritjof Capra’s text “The Newtonian World Machine” and George Ritzer “The McDonaldization of Society”, has historically permeated and shifted our living paradigm from a holistic to a mechanistic one. Our present worldview sees the universe as a linear scientific system, governed by the laws of physics, mathematics, and chemistry. As humans, we have a need to understand, make sense and grasp the world’s natural and social phenomena. These natural laws can be used to predict and determine the behavior of the individual parts of a system which in turn run socio-political entities like the government and our institutions. This places humans in control of nature to create useful things to improve humanity. Ultimately a mechanistic worldview sees growth and capitalism as a power, limited only by our imaginations and our technological sophistication. This implies that the goal of a mechanistic worldview focuses on the success of the individual; and even though we have come to understand much of nature through science, instead of just trying to accept, recognize and tolerate it, we have had the imperative need to dominate and tame it.
In contrast, the goal of the ecological worldview is the continued well-being and healthy functioning of the whole. An ecological worldview sees humans as part of a larger community of life; part of nature with a contributive role to play in the health and evolution of the living systems. This ecological framework reminded our team of Eastern philosophies such as Daoism and their ancient knowledge which emphasized the importance to follow nature’s patterns. These belief sets forced us to ask the question: how do we change our current world order into an ecological worldview? A new framework for humanity that aligns with the way nature works and the values that drive it is therefore needed. To create this alternative story and to move towards a more ecological worldview throughout all human systems, we need a shift in values.
In relation to the opioid crisis in Pittsburgh, the mechanistic view starts from the way doctors are pressured from pharma companies to prescribe opioids as a one size fits all solution and the hard governmental response to drug trafficking. The opioid epidemic from the stance of different stakeholders is constantly reinforcing a worldview where humans are trapped in work routines and consumeristic goals that have neglected health, positioned a person’s well-being as an indulgence rather than a right. The holistic view is considering the interdependence of addiction and how it affects pharmaceutical companies, local businesses, family and friends, and policymakers at all government levels. When considering the issue from an ecological view, we begin to ask deeper questions, such as: where does the raw material use to make opioids come from? how is it made? who makes it? and, how does it affect our environment when used?. For example, research has already shown that opioids, use and unused, make their way into our water systems and end up affecting the wildlife that resides in these waters. As we shift away from anthropocentric (human-centered) values and towards more ecocentric (earth-centered) values, we shift away from selfishness and towards selflessness.
Keeping the values of an ecological worldview in mind as we tackle the opioid problematic would include: understanding the wholeness and interconnections of the system, working with many relationships and stakeholders, and knowing that the world is constantly changing. Actions that might propel the ecological framework are the reflection that takes into consideration all stakeholder interests and the impact of actions on all system levels, collaborative processes which necessitate negotiation and partnership with all interested parties including nature and to focus on the wellbeing, education, and nourishment on a whole world level. This will ultimately lead towards a self-sufficient and ecocentric paradigm.