shimon waldfogel
Apr 8, 2018 · 15 min read

The Pain Opioid Epidemic Project

Introduction

The Pain Opioid Epidemic Project (Opioid Project) is an experiment in citizen engagement (Citizenism)inspired by the belief that we as citizens must engage with our fellow citizens and relevant stakeholders to achieve solutions to the challenges that face our communities and our nation. The Pain Opioid Epidemic Project (Medium) primary goal is to address the political system and the role of the citizen within it, the challenges of the system will be taken as a given and the presentation will focus on the actual aspects and problems associated with the pain opioid epidemic. In addition to 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) can lead to despair/ alienation, marginalization, hopelessness, helplessness. It sets a spotlight on the cause and offers a “treatment” citizen oriented approach to underlying challenges in the US body politic.

More directly the Opioid Project tests the hypotheses that citizens, provided with an organizing format*, information and tools can be trusted to and should be involved in solving complex social problems. The Opioid Project is informed by the recognition that despite efforts on the international, national, state and local levels and billions of dollars spent, the opioid epidemic continues to worsen. It is not for lack of motivation, data, resources, best practice that there has been little impact on the epidemic. A more complex set of biological factors, economic and political barriers and interest groups exist and must be overcome to effectively change the course of this epidemic. The challenge of pain and related opioid use requires a well formulated, coordinated effort that addresses the complexity of the pain-opioid ecosystem*, the social determents contributing to it, and the interconnection of the multiple stakeholders (government (Federal, State, Local), the medical system, nonprofits, as well as private industry, academic institutions, and social agencies).

The Opioid Project identifies current efforts to address the challenges on federal, state and local levels. Additionally it highlights barriers to comprehensive approach to address the challenge, as a way to facilitate citizen action within the Pain Opioid Ecosystem. More specifically, our goal is to provide a multi element framework that supports individuals (as citizens, patients and consumers), and social systems to achieve the right care for the right person at the right location at the right cost. It is our plan to build on the experience with the opioid project to apply the lessons to other challenges facing our society, communities and political culture. We believe that an engaged citizenry, informed, passionate and respectful, is essential not only for our democratic process, but also to achieve result that reflect the “common good” and achieve greatness for our nation.

The Opioid Project builds on the fundamental tools for representative democracy; an engaged citizenry, participating in a deliberative public dialogue process based on reliable information. It explores and challenges the healthcare system, criminal justice system and social institutions to identify and address the problems and powerful barriers that must be targeted in order to achieve our goal. It addresses the interconnected challenges that are making the status quo unsustainable, and offers a path to a brighter future for our nation. The Opioid Project recognizes that a multi-stakeholder, comprehensive public health approach to combating the nation’s prescription opioid abuse and growing synthetic opioids and heroin epidemic is crucial.

The pain opioid epidemic touches all of us to varying degrees. Some of us are struggling with a family member who is in the hell of opioid addiction, others suffer with severe pain and fear the lack of availability of opioids for relief, others are dependent on opioids prescribed for minor trauma, still others are in treatment for the disease of opioid dependence. It is up to all of us to prevent and reduce abuse, misuse, overdose and death from prescription drugs while at the same time making sure that those suffering with pain receive effective, safe evidence-based care.

Our approach recognizes that any meaningful solution must address the entire arc of the opioid ecosystem, including: the individual, social and political focus. It needs to explore prevention, recognition, diagnosis and treatment related to pain management, opioid use disorders, opioid overdoses. This includes the scientific, medical, public policy, social, economic, law enforcement, criminal justice, and related challenges.

The Opioid Project consists of a number of phases and elements that address the complexity of the Pain Opioid Ecosystem and the barriers to meaningful change. The focus of the phases is to better understand the political aspects of the epidemic and to provide solutions to the various aspects of the challenge of pain and its management, opioid use and abuse, preventing overdoses and addressing the legal and criminal justice issues associated with drug use. We provide and explore meaningful information and tools for crowd-sourcing citizen participation in the policy discussion, implementation, and accountability of stakeholders. In addition, we incorporate behavioral economic principles, digital technology, political insights, crowd-sourcing, and principles of solution journalism in our effort.

The treatment plan provides a comprehensive, multi-stakeholder and multi-phase road map for citizen involvement in their political ecosystem, locally and nationally. Our goal is to provide a framework, a platform of sorts, to tackle an epidemic that has claimed many lives. It is our plan to build on the experience with the Opioid Project to apply the lessons to other challenges facing our society, communities, and political culture. Using the Opioid Project as a framework we invite fellow citizens to join our efforts. To explore the possibility that utilizing a citizen oriented toolbox, supported by meaningful information and tools, and a process that facilitates engagement with various levels of societal and political stakeholders, we can have a positive impact on difficult, complex challenges facing our nation.


Goal

The Opioid Project is an ambitious multi-phase undertaking that has as its goals the following:

  • to achieve best practice outcomes for individuals within the pain opioid ecosystem*.
  • to provide a citizen centric, solution oriented, bio-psycho-social-spiritual-political informed treatment plan for the related challenges of pain management, Opioid Use Disorders (including dependence, addiction abuse, and overdose), and the challenges associated with the war on drugs.
  • to provide a citizen focused approach to address social and political challenges that engages citizens in order to reclaim the role of the citizen in the political system.

Vision

The Opioid Project engages with fellow citizens and relevant stakeholders in formulating an agreed upon vision about optimal care for the individual suffering with pain and opioid related challenges. The vision is translated into measurable outcomes that are monitored. The Opioid Project guiding vision:

By September 2019 there are no reported deaths of opioid overdose reported in the US.

By September 2019 the official approach to opioid use, dependence and addiction is informed by the principles and spirit of public health instead of a criminal justice approach.

By September 2019 individuals suffering with opioid use disorders have access to affordable, evidence based treatment.

By September 2019 “The War on Drugs” will be officially over globally, nationally, and locally.

By September 2020, every individual who experiences pain has access to and is able to receive evidence based, best practice informed treatment that improves their well-being in outcomes that matter for them.

Review our vision for optimal care: (Work in progress)

The individual suffering with opioid use disorder/ addiction. Help us refine the vision for the individual suffering with opioid use disorders.

Vision of Optimal Care for the individual suffering with opioid use disorder/ addiction What is your vision? (Medium)

Vision of Optimal Pain Management of the individual suffering with pain.Help us refine the vision for the individual suffering with pain

Providing care for the individual suffering with opioid use disorder/ addiction within the hospital and the healthcare system (Google Doc Draft) (Web site )

Pain disorders: Appropriate acute and chronic pain management and medical use of opioids (Google Docs)

Vision of healthy communities: Review our vision for a optimal healthcare system.


The Opioid Project consists of a number of elements for empowering individuals to address the challenges of pain management, opioid addiction, dependence, abuse, and overdose. Here are a number of the elements:

The Pain Opioid Epidemic Case Presentation and Treatment Plan

The Citizen Brief

The Checklist Manifesto

Ecosystem and Stakeholder Watch Through The Complexity Lens

The County Based Pain Opioid Epidemic Platform

Optimal Care: The Pain Opioid Best Practice, Evidence-based Inventory and Database

Citizen Toolbox for the 21st Century: Taking personal, social and political action

Real Time Monitoring The Pain Opioid Epidemic and its Consequences

The Pain Opioid Epidemic: Solutions through Technology

Crowd-sourcing & collaboration: The Liberty Bell Challenge


The Pain Opioid Epidemic Case Presentation (Pain Opioid Case) and Treatment Plan

The Pain Opioid Case is a framework for a citizen oriented approach to the challenges facing us in the body politics of the United States. Using the Medical Case Presentation as an organizing structure, the Pain Opioid Case offers a dynamic, interactive, collaborative process that engages our fellow citizens to address the opioid related challenges confronting us as individuals, members of our community and citizens of the nation. It provides a vehicle for citizens to collaborate, identify, analyze, develop, implement and monitor a solution-based “treatment plan” for medical problems. In addition, the Pain Opioid Case 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. While the Pain Opioid Case effort is measured in terms of predetermined outcomes associated with the Opioid Epidemic and the social and political challenge of the consequences of the Opioid Epidemic, a major focus of this process is to examine the framework of the Case Presentation as a tool to enhance citizen participation and engagement in the “political ecosystem”.

The Medical Case Presentation (BLOG)


The Treatment Plan

The treatment plan starts with a recognition of a clearly defined goal for the treatment of the opioid epidemic. The treatment plan outlines a multi-factorial, citizen based action process that targets the various elements and aspects of the pain-opioid ecosystem. Specific challenges in addressing the pain-opioid ecosystem are described along with the policy options to remedy them.

The Treatment Plan is divided into time segments that reflect different levels of urgency as well as psychological understanding to maximize the probability of achieving the identified goals. We believe that offering a time frame with clearly defined and measurable outcomes is an antidote to the crisis environment that leads to poor choices and worsening of the problems. Although this division is helpful, many of the actions take place at different stages of the process. For example, the efforts to create a vision for optimal care will be an ongoing process.


Citizen Briefs

The citizen brief is central to reclaiming the role of the citizen in the body politics. It is a stand-alone document addressing a particular societal challenge, i.e the opioid epidemic. The citizen brief is utilized to establish a framework for a citizen oriented treatment plan that provides a comprehensive, multi stakeholder and multi-phase road map for citizen involvement in their political ecosystem. It is best used as part of The Medical Case Presentation. The complete citizen brief provides a vision for the issue re-frames a problem, provides data, discusses the various issues and proposes actions that can be undertaken by the citizen to address the problem. These actions can be personal, social or political. The Citizen Brief is uniquely positioned to address systematic changes over time. The “Citizen Brief”* can be understood as framework to a process to summon our fellow citizens to address the challenges confronting us as individuals, our communities and our nation. In addition to providing a framework for engagement it includes multiple features to achieve the goals. Divided into sections that contribute information to create an impression and more clearly define the problems and potential solutions.

About the Citizen Brief (Medium)

Vision: Establish a vision for the individual, community, nation and the international community

Humanizing the epidemic: Focusing on the individual suffering with pain and addiction and confronting stigma associated with their condition

Social Determinants of the opioid epidemic: Social determinants such as poor housing conditions are often accompanied by neighborhood-level conditions that limit access to health care, risk-reduction information, and treatment alternatives, which are protective resources and can disrupt behaviors that ultimately lead to opioid addiction.

Opioid supply reduction: Reducing the supply of non-medical opioids and preventing the initiation and misuse of non-medical opioid use

Pain disorders: Appropriate acute and chronic pain management and medical use of opioids

Opioid use disorder: Prevented, properly diagnosed and properly treated. Best practice, scientifically informed addiction prevention, and abuse and dependence treatment

Harm reduction: Preventing and reducing harm associated with opioid use, including eliminating overdose mortality and morbidity associated with opioid use

“The War on Drugs”: A criminal justice system that reflects scientific understanding of opioid use and targets criminal elements associated with the pain-opioid epidemic.


The Checklist Manifesto

Being a citizen is challenging and complex. Checklists have been used to improve outcomes in various fields. We introduce the checklists to facilitate taking action and interact with various stakeholders. Developing a checklist is a continuous process. The various checklists will be made public and improved upon as we go along with the Pain- Opioid Epidemic Project. The Checklist Library is linked to the Pain- Opioid Ecosystem and the citizen toolbox.

Opioid Checklist: (Pain Opioid Project checklist) CDC opioid checklist


Ecosystem and Stakeholder Watch Through The Complexity Lens

The Patient in the Pain Opioid Ecosystem

Pain Opioid Ecosystem

The Pain Opioid Ecosystem (Kumo) provides an overview of the various stakeholders, rules and environment that impacts on the complexity of the challenges associated with the Pain Opioid Epidemic.

Along with the section on stakeholders, the Ecosystem features people and organizations who are tasked with creating legislation, scientific research, law enforcement, and treatment approach to confront the epidemic. The Pain Opioid Ecosystem (Review of System) is incorporated into the Pain Opioid Epidemic Case Presentation and serves for testing the use of the case presentation in addressing policy challenges. It is the objective of the Pain Opioid Epidemic Case Presentation to be used by local entities and to be easily configured to local needs and resources.


Creating the County (Local) Based Opioid Epidemic Platform

We provide an easy to use platform that can be used by local entities to assist in their efforts to provide solutions to the opioid related problems. The platform includes best practice information, and process and related resources to provide services and link to providers at the local level. The Pain Opioid Epidemic Project and Case Presentation websites are focused on cities, neighborhoods, counties and other local entities. Entities interested in “duplicating” and customizing the websites for their local environment can contact Citizens4health.

The Website for our first local site, Montgomery County, PA, will be made “Public” April 2019.


Optimal Care: Pain Opioid Best Practice, Evidence-based Inventory and Database

Developing and updating an evidence based inventory of clinical, social, legal and public policy materials and process related to the our vision. We start with focusing on pain to be followed by opioid use conditions, overdose prevention and addressing “the drug war.” This section will focus on stakeholder best practice addressing the Pain-opioid Epidemic Challenge. Building on the recently passed legislation associated with the ‘‘Comprehensive Addiction and Recovery Act of 2016” as well as the recommendations of the Presidential Commission’s report and The Support Patient and Communities Act of 2018 we provide a framework and resources . to the evolving evidence based guidelines available for individuals and healthcare stakeholders. Additionally, we monitor and report on the performance of institutions and other stakeholders within the Pain Opioid Ecosystem.

Competency based approach and the last mile Crowdsourcing

Optimal Care: Pain Opioid Best Practice, Evidence-based Inventory and Database

Monitoring and contributing to the evolving evidence based guidelines available for individuals and healthcare stakeholders.

Competence based approach to stakeholders will be used to provide a framework for monitoring the performance of the various stakeholders in providing the services that address the Pain Opioid Epidemic.

Implementation of best practice can be thought of as the problem of the last mile…a concept derived from the challenge associated with the cost of the last segment of providing cable service to the consumers home.

Competence based approach to stakeholders will be used to provide a framework for monitoring the performance of the various stakeholders in providing the services that address the Pain Opioid Epidemic.

  1. Patients
  2. Health systems and hospitals
  3. Counties
  4. Clinicians
  5. Criminal justice
  6. Federal and state government

Citizen Toolbox for the 21st Century: Taking personal, social and political action

Pain Opioid Epidemic Take Action Take Action: Pain Opioid Epidemic Project(Google Doc)

Providing individual facing action plan options, Personal Health Manager for personal engagement for individuals suffering with pain and opioid addiction. Social and political tools to engage with stakeholders locally and nationally. The Citizen Toolbox for the 21st Century to empower citizens. The take action section provides ways you can take part in addressing the Pain Opioid Epidemic. Whether you would like to better understand your personal experience with pain or opioid use, or you are interested in making an impact on a social challenge, you will find actions that can help you, your family as well as your community. The specific actions are divided into personal, social and political actions.

Get Personal: Action that will allow you the best personal outcome in addressing the challenge of Pain, Opioid Use, and Opioid Dependence.

Get Social: Actions that will impact the availability of evidence based, best practice interventions that you can undertake to address the challenges of Pain and Opioid use in your community (Social Ecosystem)

Get Political: Actions you can undertake within your political ecosystem to have a meaningful impact on the Pain-Opioid Epidemic.


Health of the Nation: Real-time Monitoring the Opioid Epidemic and its Consequences

The Health of the Nation Initiative provides data and information that will help you be part of the political conversation and take part in solutions. Current political decision making and government performance suffers from information asymmetry. It is crucial for decision making to have relevant, accessible, reliable and timely information. We will seek to provide information where available and to seek to create a political process to develop the needed data sources for public use. We will continue ongoing collection and analysis of population and individual data associated with the Opioid Epidemic. The data will feature The Pain Opioid Epidemic Case Presentation progress notes and an occasional Clinical Case Conference focusing on individual situations.

Health of the Nation: Real-time Monitoring the Opioid Epidemic and its Consequences

Outcomes are crucial to “proper administration” of government role and function. Ray Dalio has described the importance of setting goals and measuring outcomes in the business sphere. In the public sphere there is a shortage of similar processes and ways for citizens to learn of the performance of their representatives.

Information and facts are often replaced by opinions and self-serving statistics by both the government and the media today the media is fragmented and driven by incentives of faction and interest groups more than the role envisioned by our founding fathers. The developments in the areas of artificial intelligence and machine learning weaponizing the impact of digital technology makes seeking a different approach essential.

“A popular Government, without popular information, or the means of acquiring it, is but a Prologue to a Farce or a Tragedy; or, perhaps both. Knowledge will forever govern ignorance: And a people who mean to be their own Governors, must arm themselves with the power which knowledge gives,” said Madison to W.T. Barry in August of 1822.


The Pain Opioid Epidemic: Solutions through Technology

Data and technology solutions for a major medical challenge for individuals and a public health problem that the CDC has declared a national epidemic: abuse, overdose, and death from prescription painkillers and other opioids. Specifically, our digital and communication tools and use of data analytics support providers at the point of care when treating patients with pain disorders, at risk of opioid and other controlled substance addiction.

Creating a framework for the case presentation

Current technology allows us to rewire the body politic through digital technology. These tools allow unprecedented opportunity to get access to information, mobilize, challenge misinformation provide for a more deliberative dialogue. Digital technology can enhance the effectiveness of government services and provide a way for citizens to be more actively engaged, connected to their political ecosystem. Citizenism (United States 4.0) will includes a Citizen’s Toolbox that will contains tools for individuals of the 21st Century to fully actualize their citizen role.

Providing individual facing action plan options, Personal Health Manager for personal engagement for individuals suffering with pain and opioid addiction. Social and political tools to engage with stakeholders locally and nationally. The Citizen Toolbox for the 21st Century to empower citizens. The take action section provides ways you can take part in addressing the Pain Opioid Epidemic. Whether you would like to better understand your personal experience with pain or opioid use, or you are interested in making an impact on a social challenge, you will find actions that can help you, your family as well as your community. The specific actions are divided into personal, social and political actions.


Crowd-sourcing & collaboration: The Liberty Bell Challenge (Contact Us)

The Liberty Bell is an iconic symbol of American independence, located in Philadelphia, Pennsylvania. In its early years, the Liberty Bell was used to summon lawmakers to legislative sessions and to alert citizens to public meetings and proclamations. We believe that given the right 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 believe that together, informed by the case presentation and following a treatment plan, we can solve the health care problems and build a system that is uniquely American and that we can be proud of, and change the political culture that has been so destructive. How can we all, including the private sector, nonprofits, government and citizens, best achieves effective solutions to our problems, solutions that will work in a complex world of escalating need and diminishing resources?

Written by

Shrink the Government: Psychological insight about our politics. www.shrinkthegovernment.org

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