A Farewell to (H)arms
Enlisting Silicon Valley to help fight America’s opioid epidemic
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by Jason Smith
Recently Facebook founder and CEO Mark Zuckerberg sat down for an interview at the University of Kansas to discuss his observations on the American political and social landscape following his visits to all 50 states. When asked what stood out to him most, if there was some kind of unifying theme, he responded that one thing did indeed stand out, glaring back at him regardless of where he found himself: the opioid epidemic.
The biggest surprise by far has been the extent of the opioid issues. And it is really saddening to see… Now, I do think that the opioid crisis is starting to get more attention. From my perspective and what I saw this year, it’s still getting nowhere near the attention that it needs… It’s not going to happen overnight, and I think the issue will likely get worse before it gets better, but if we do the right things as a country — and more often actually at the state level — there is a road map for how we can improve this situation.
https://www.youtube.com/watch?v=MG5slQLfNXI
Over the past year I’ve watched the community over at Addiction Unscripted utilize the tools offered by Facebook to strengthen the bonds of meaningful dialogue to produce happiness from misery. AU’s use of Facebook to foster online communities that then strengthen real-world communities, has been incredible to watch.
The word “addiction” spent most of the last century on the “Shit We Don’t Discuss in Public” list. The word was used to verbally paint ominous societal portraits of the worst parts of ourselves, huddled in dark corners wrapped in our vices with dirty faces and filthy fingernails.
By sharing their experiences, addicts provided support for one another, and look at the result — they turned “addiction” into something from which strength could be drawn by others, that assists anyone drowning in life by using their own life as a flotation device until that individual is strong enough to swim on their own.
Addicts have banded together, and it’s beautiful to watch. The political response, however, has been less inspiring. The reason? The “system” in place to prevent, treat, and fight the opioid epidemic is no system at all, and it’s spelling doom and death to those caught up in the grips.
Like dying of thirst in the middle of the ocean
Last summer, I was at a book signing in Northern California where I was scheduled for the entire evening, and I was excited. I’ve always enjoyed hearing others share their stories, or describe how they took something I wrote and used it in a way I never considered when I wrote it.
But this day was different.
There was a line across the room of parents of dead children, and children of dead parents. Some had family members still in the grips of addiction, some were noticeably in the grips as they stood before me. After waiting patiently, a woman approached the table, towing an eight year old little girl behind her. The woman told me she wanted to buy my book for the little girl, who she introduced as her niece. The woman then began explaining how her sister — the little girl’s mother — had died of a heroin overdose two months earlier, so she was buying the book for the girl, hoping it would help. She said she didn’t know what else to do.
I didn’t what to say to her. My book isn’t that book. I’m certainly no recovery expert. Shit, I’m hanging by a thread myself most days. so if you want answers, I don’t know what to tell ya. I have my story, but if you’re looking for someone to tell you what to do, I ain’t that guy. Plus, I’m fairly certain there’s some shit in that book that most people would deem unsuitable for an eight year old.
But what was I supposed to tell her? “No, don’t buy it?” “OK, buy it, but don’t expect too much?” Shit man, I don’t know. Yet all night long, this was what I saw and heard. One person after another, asking me what they should do to get their heroin-addicted teenage daughter to stop putting a needle in her arm, what I thought they should do to get their dad to go into treatment because he’s living on the streets, what I thought little Mikey here, whose big brother, his hero, his best friend, his everything, overdosed on Xanax and heroin six months ago, and he hasn’t been himself since. He’s withdrawn, he stopped playing sports, his grades took a nosedive, and they wanted to know what I thought they should do to help him.
There I was neck-deep in this addiction-recovery thing, connected, networked, familiar with the various treatment options, the array of models and philosophies, the costs. I’d read the studies, compared the data, I knew which treatments were showing promise, which were outdated, and yet when asked point-blank by a mother whose eyes welled with tears because she knew her kid was going to die, “Where can I go for help?,” I had nothin’.
Nothin’.
I just looked at her, frozen and speechless, because the truth was, I didn’t have a goddamn clue what to tell her.
I left early, about half way through, because I felt sick. It was so fucking heavy and I’m not equipped to deal emotionally with that. I sat in my car in the parking lot and stared into the night sky. Angry. Frustrated. Hurt. Confused. I stopped writing for a full year after that experience. I just couldn’t bring myself to do it.
There was help over here, and people dying over here, and nothing connecting the two.
There were resources. There were services. There were assessments. It wasn’t a lack of information that was the problem. The problem was then, just as it is now, that a systemic infrastructure doesn’t exist. There’s nowhere to send someone who needs help.
And what-the-fuck good is help, if there’s no door in?
In war, logistics beats strategy every time.
When you picture Operation Overlord, aka D-Day, when allied forces stormed the the beaches of Normandy, I’m guessing you picture something like the scene here. What you see in the photo is overwhelming force, as wave after wave of young men from all over the world attempt to gain an Allied foothold on mainland Europe.
However, that’s just what you see in the small sliver of time captured in the photograph. What you don’t see are the two years of preparation and planning it took to design, construct, implement, and supply such a massive undertaking. You don’t see the construction of naval bases, warehouses, industrial and housing facilities, and hospital space.
By the fifth day, 326,547 troops had come ashore. That’s roughly the entire population of Anaheim. Think of the people behind the scenes that kept them fed and supplied with the 105,000 tons it required. Or the 54,000 vehicles sent across the channel, including gas, parts, tires, oil, mechanics.
In 1943 Eisenhower realized the existing allied command structure was hindering their ability to achieve the objectives they set out for. Germany had the advantage of being a single country with a single command center, where the allies were a collection of different nations, with differing opinion on how to win the war. First chance he got in ’43, Eisenhower scrapped the whole existing structure and built a new one. He knew that the logistical operation leading up to the invasion would be the deciding factor of whether or not the operation was successful. None of it mattered — not the number of troops, or planes, or supplies, not the war strategy or collecting of intelligence — it was all for nothing if there wasn’t a system in place to plug it all into once they landed on the beaches of Normandy.
This photo, minus the infrastructure, would be a massacre. A slaughter. But with the unseen systemic logistical infrastructure,where information and resources between battalions flowed seamlessly, and operational procedures were clearly defined — it’s D-Day.
There’s a thin line between chaos and victory, and it’s called logistics. Unfortunately, substance abuse treatment in the United States is far from being on the side of victory.
Systems don’t fail. People fail at building systems.
When a system fails — meaning it produces anything other than the desired result— then it’s because that system was in some way designed to fail.
Systems do what they’re designed to do. They do what what we tell them.
Systems don’t fail. People fail at building systems, and the system to treat and prevent substance abuse is producing precisely the result it was designed to produce.
In 2015, 52,000 people died from drug overdoses.
In 2016, that number rose to 64,000.
That’s more than any year at the height of the AIDS epidemic.
That’s more Americans dead in 2016 alone, than over the 20 year duration of the Vietnam conflict.
But here’s the kicker — those aren’t the real numbers.
I’ll repeat that — those are not the real numbers of drug overdoses in this country.
They’re a best-guess estimate.
There isn’t a system in place to accurately track overdose deaths in the United States, data, one might assume, the bureaucrats might want to see. Year-to-year, that information could be used to extrapolate which programs are working, where they’re working, and for whom.
Think of teen pregnancy: districts nationwide that restricted sex education to abstinence-only had the highest teen pregnancy rates. This was raw data, collected.
Data doesn’t tell us why or how. That’s not its job. That’s our job, to interpret, to hypothesize, to compare. But we can’t do a damn thing if we don’t have accurate data. Minus the data, the debate over the teaching of abstinence-only sex education is a moral one, steeped in traditional values of parents and grandparents who want a system to cater to a society they wish existed, as opposed to the one that actually exists.
Data takes the debate over abstinence-only sex ed and removes it from the arena of biblical morality, and puts it where it belongs — into reality.
When it comes to drug overdoses, however, we don’t have accurate data. If we don’t even know how many overdoses are occurring each year, in each state, across the country, then upon what information are they currently basing the decisions they’re making? How do they know how much to spend? How do they know where to spend it? Are they even using collected, quantifiable, real data at all?
Billions of dollars are being spent to fund a system for substance abuse prevention and treatment, despite none of the decision-makers having a clear understanding of how many people are dying each year from the very problem they claim they’re preventing and treating.
That data doesn’t exist because there’s no system in place nationwide to force states or counties or hospitals to report overdose deaths. Compare California to South Carolina? Shit, we can’t even compare Orange County to San Diego County, because each county does its own thing. Each hospital does its own thing. Imagine a map like the teen pregnancy map, where instead of sex ed, we could see states that fund primarily 12-step based recovery vs. states that utilize medicated withdrawal programs vs. states that use medication assisted maintenance programs.
Such an ability would allow for new and progressive approaches in the treatment of addiction across all 50 states because each state could then rely upon the findings of previous studies, regardless of where they were conducted, and pick up where those studies left off. If a particular program showed a high rate of success in certain populations but not others, that could potentially provide an insight into the influence of environmental and genetic factors on compulsive behavior, something that doesn’t currently exist.
If data is deemed unreliable, however, that means it must be re-collected so that its unreliability doesn’t contaminate the rest of the study. In legal-speak, it’s ‘Fruit of the Poisonous Tree,’ and in the US, there isn’t any fruit that hasn’t been poisoned.
The failure to collect basic data like causes of death produces a disincentive for innovative approaches in treating substance abuse, because it’s simply too expensive to conduct studies that can’t build off of the work of previous studies. California can’t look to South Carolina, because they collect data differently than we do. It creates an incentive, however, to keep doing what we’re doing because anything else would be too expensive. It’s cheaper to stick with what we know, than it is to break new ground, even if what we know isn’t working.
Some county hospitals here in California record overdose deaths, while others do not. Read that sentence again and let it really sink in.
Some hospitals and public health departments face political pressure by county boards of supervisors to not record overdose deaths out of fear the publicity will have a negative impact on the community’s reputation and home values.
Others are encouraged to over-report their numbers because they know that an increase in overdoses will trigger emergency federal and state funding, which is true. It’s also a concept — hey, so uhh… what we’re doing isn’t working, so we’re gonna need double the dollar amount you gave us last time so we can double the number of people it’s not working for — that’s so illogical, so counter-intuitive, and so mind-fuckingly stupid, that every county Health and Human Services department across the country should have to recite the italicized sentence above out-loud at the beginning of every meeting they conduct, at least once a day, like kids do the pledge of allegiance in elementary school. They should be forced to hear the system they designed described out-loud.
In an interview I conducted recently with William Ruzzamenti, director of California’s Central Valley High-Intensity Drug Trafficking Area, he told me that he suspects the actual number of overdose deaths to be double the number being reported.
I personally know three people who I grew up with just in my small community of Auburn, California, whose deaths will not be counted in the 2017 statistics. One choked to death after nodding out on heroin while eating, which was nowhere on the official cause of death. Another was pulled out of a motel, her body in shock from a bacterial infection from using dirty and old needles. Her cause of death did not mention drug use. The third died of liver cancer at the age of 38, the result of years of painkiller abuse and effects of acetaminophen. His cause of death did did not mention drug use.
So if I know three people personally, just in my tiny circle, how many are really out there?
How someone died, especially in a hospital, should be like that first question on Who Wants to be a Millionaire. If you can’t get that shit right, your ass should be home playing Candyland.
And when the bureaucrats tell you that it’s just not possible to collect data across state lines, or between systems, or when they tell you that it just doesn’t work that way, that it’s just not that easy, that change just takes time, and you just don’t understand, that’s when you tell them that they should just go find another fucking job, one that just doesn’t require problem solving, since critical thinking is obviously just not their thing. Their intellectual laziness is killing people. “The system doesn’t work that way” is not a valid justification to continue doing something. It is valid justification to change the damn system.
When they tell you that the system isn’t built to do whatever it is you’re asking, then tell them good. That’s the first sign it might just work.
If the system can’t get this right, then what are its chances of accurately collecting the data necessary to assess programs and models, so we can determine whether or not something should continue to receive public funding? How can we find innovative approaches if we can’t assess outcomes?
And can somebody please tell me: What in the hell data are they currently using to determine what programs to fund?
This is the very best the current system can offer, so don’t let them tell you the system isn’t working, because they’ll try.
The system is so termite-infested, in so many places, at so many levels, that one must question whether it’s salvageable at all. Perhaps at this point, the responsible, adult thing to do is leave the stove on, go out of town for the weekend, and get ready to file an insurance claim.
We’re asking the government to get us out of a mess they created, using the mess itself as the tool with which they’re going to dig us out?
If we are all waiting for them to fix this for us, then very simply:
We. Are. Fucked.
Excuse the language, but there’s no other way to put it that’s as succinct and accurate.
But then again, maybe we don’t need to wait for them. In fact, perhaps we have before us a unique opportunity to institute the type of wholesale systemic change that only a crisis like the current one could permit.
The bad news is, we have a very, very big problem.
The good news is, it might just be big enough to take a radical approach.
Tapping into America’s greatest natural resource: American Hustle.
American ingenuity is unparalleled historically. Look at the start-ups, small businesses, entrepreneurs, angel investors. We are a nation of inventors, with a portfolio ranging from the Lunar Module to the Used Car Salesman. We hustle. We’ve never been a people to blindly accept the status quo, just because. If we think there’s a better way to do something, we’ll try it. We change the world because there’s nothing good on TV. Facebook was created in a dorm room. Other civilizations would have kept an advent like the World Wide Web to themselves, for personal gain. Not America. We gave it away, wrote some code to accept Visa and MasterCard, and introduced the world to the Cam Model.
We identify problems, we form solutions, and we bet our life-savings on them. Sometimes it works, sometimes it doesn’t, but when we check-out of this life, at least we can say we tried.
That audaciously brooding self-confidence in Thomas Jefferson’s voice as you read through Declaration of Independence is the slow jam we were conceived to. It’s belief in the individual right, but a faith in the wisdom of collective experience. And to win the war against the opioid epidemic, this is the collective experience into which we’re going to need to tap if we’re going to have a fighting chance.
What do you think Facebook would look and feel like if it were run by people who run your local Department of Motor Vehicles? How appealing would the landing page be? How clunky would the whole operation feel? What would the UX be like, how often would it update to keep up with the ever-changing needs of its users?
Mind you, this is the same DMV who’s held onto the crowd-management system of cramming as many people into a room at once as possible, then forcing them to stare at a middle school basketball scoreboard while they wait for their number to be called. Maybe I’m just a dreamer, but I can’t help but wonder if there’s a better way.
What would happen this holiday season if Amazon were taken over and operated by the good folks at the VA? How long would your order take to ship? God forbid you need a return. What month do you think you’d have to order your Christmas gifts by, to receive before December 25?
Think what Medium would look like, if instead of Ev Wiliams, it had Betsy Devos at the head.
Twitter, eBay, Apple, just think where they’d be today if Silicon Valley was run like any one of these bureaucratic agencies?
My guess is 2018 would be the year of the floppy disc. Not the small square one, no, no, slow down there time traveller. I’m talking big, black, actually-floppy-Oregon Trail floppy disc.
You think I’m lying?
In 2017, the system in Placer County, California to take residents who’ve been approved for county funding for inpatient care, and get them into a bed in a treatment center, is to hand them a piece of paper — mind you, they’re more than likely entering the early stages of withdrawal, so patience won’t be a strength — and telling them to go home, and call the numbers on the sheet every morning until a bed opens up.
Seriously. I’m not making that up.
I just ran a homeless shelter for 18 months, and I worked alongside some of their best people, who were incredibly talented and passionate and completely neutered by a system designed to amputate their spirit and feed the machine.
That phone-in system is not only in Placer County, but in many counties across the country. A 2013 study found that the average national wait time with this system is 30 days. I saw it take as long as 47 days.
A 2007 study found that nationally 50% of those approved for county funding to get help never make it to treatment. The primary reason, according to the study, is the ineptitude of the phone-in system.
This is the bed management system found on the front lines of this epidemic.
Phone numbers.
The system used by the counties to place addicts into beds so they won’t die, is the same one radio stations use to give away concert tickets.
Once again, call me naive, but I think there might be a better system out there.
But as dystopian as whatever you pictured when you imagined the DMV folks running Facebook, or the VA running Amazon — now flip it.
What if we enlisted the minds behind this century’s greatest innovations to help us design a better system?
What if we asked the men and women behind the scenes who took Apple, Amazon, Facebook, and made them run more smoothly, more efficiently, more cost effectively, and asked them join this fight? To help us design a better way to do the things, because the current system is collapsing under its own weight.
How long do you think it would take Ev Williams Mark Zuckerberg to re-design that phone-in bed-management system? To scrap the whole thing, and build new one, complete with risk assessment, cost-benefit analysis, with built in data collection, wait time assessment, the whole thing?
The study I referenced that found 50% of those approved for treatment never get to treatment — that was published in 2007.
It’s 2017. A full decade has passed, and we’re still using a system that’s been proven to fail 50% of the time.
Coincidentally, 2007 was the year of the very first iPhone. While Placer County has done nothing to fix their system, here is a shot of the iPhone over the same time period. This is how often Apple was willing to assess and evaluate their product, then fix what needed to be fixed to meet a shifting demand over the same time period.
Do you think the engineers at Amazon would find it acceptable if 50% of what they sold failed to be delivered?
Ask yourself why the current system does find it acceptable, and why Amazon would not. Because that answer is the cultural shift we need help learning to embrace.
I’m not suggesting privatization. I’m suggesting we can’t even begin conversations about what might work best when we don’t have a system in place that’s capable of tracking the data we need to start the conversation.
What I’m asking for is the open sharing of ideas to benefit the collective good. I’m not suggesting Google open up a detox on its Mountainview campus. I’m suggesting we invite the Mountainview Campus team down to shadow a detox facility, then share what they see. How can they offer what they’ve mastered in their industry, to us so we can get a hold on this thing? How can we use their systems to meet our needs? How did they create a functioning workplace culture, that embraced new ideas?
Picture Amazon making available a team of executives to county Health and Human Services senior staff for two weeks, who shadow, observe, and watch. And after that week, they sit deliver their findings, and work toward fixing what’s broken.
- I’m calling on captains of 21st Century American industry to help us win this war.
- I’m calling on policy makers and elected officials to lean heavily on their senior staff to make this happen, because you know as well as I do how reluctant they’ll be.
- I’m calling for a third party non-profit to handle the interaction, so that government doesn’t just add a layer of bureaucracy and so there’s no appearance of conflict of interest for financial gain by anyone participating.
To leaders in these industries, I’m sure you’ve learned lessons the hard way, I’m sure you have a wealth of resources at your disposal , some of which I’m hoping you’re willing to share to save lives. Nothing proprietary, I’m talking systems, ideas, culture. Help the leaders in our community be better for the good of the whole.
We saw American industry mobilize to fight wars before. In 1941, America produced three million cars. But from 1942–1945, it produced 139. Why? Because Chrysler was busying making warplane fuselages. General Motors was busy producing engines, guns, trucks and tanks. The US Government turned to Ford Motor Company and their famously efficient assembly lines which dated back to the Model-T, to take their existing infrastructure, for producing cars which required 15,000 parts, and scale it up to produce B-24 Liberator Long Range Bombers, which had 1.5 million parts.
And you know what?
It fucking worked.
If we did it then, we can do it now, and shame on us for not thinking of this sooner.
I don’t know what it should look like exactly, or who it should include, but I do know something needs to change, and the system isn’t going to change itself.
Does this sound like a crazy idea?
Shit yeah, it does. But maybe that’s not such a bad thing.
My call is to Silicon Valley, to the leaders of business and industry across the country who feel like they something they’ve created, improved, replaced, something in a way that’s unique and efficient and can be retrofitted into the fight against the drug epidemic on some level, somewhere. It could be leadership, structure, hiring, seminars, culture, growth, planting the next round of leaders, presenting seminars on new advances in medicated withdrawal, literally if you have something of value to offer, then offer it.
Think of it as your civic duty during wartime. Or, if you need dollars and cents, I can tell you for a fact that whatever your company sells, if you have a generation of opiate addicts, their money isn’t going to be spent on whatever you’re selling, unless you’re selling a high, and that’s one area the government has got you beat.
You guys — Ev Williams Mark Zuckerberg jeff bezos et. al., we need you. My generation needs you. I’m only 38, and I’m getting burnt out on funerals.
Any sucker can can change the world once.
Who’s willing to try for a second time?
Contact the author here: authorjasonsmith@gmail.com
