How consumer technology can make a dent in the opioid epidemic
Everyday tech can serve as the Rogue One during this opioid war.
Addiction and distraction is a heated topic in the land of consumer technology. A few weeks ago Anderson Cooper reported on CNN that Silicon Valley is engineering our everyday tech to hook us. No doubt technology makers want their designs to be as engaging as possible for the people who use them.
Just as we discuss why everyday technology can be “bad” (e.g. increases social isolation, decreases focus, increases loss of control, etc.) we need to speak to and build on why it is “good.” People with Type 1 diabetes and folks with all sorts of disabilities depend on these technologies to survive. Children who are anxious before a medical procedure when given a handheld video game to play with need less sedatives before and during the procedure. Facebook has a safety check in feature so people all over the world can connect or help during times of crisis, natural disasters, or terror attacks. Text4Baby delivers critical health and safety information and much needed social support to pregnant mothers anywhere in the world. I could go on and on, but you get the picture.
This week the NIH, the worlds largest funder of medical research, announced it is upping its commitment to fight the opioid epidemic:
“Every day, more than 90 Americans die from opioid overdoses,” NIH director Dr. Francis Collins and Dr. Nora Volkow, head of the NIH’s National Institute for Drug Abuse, wrote in a special report for the New England Journal of Medicine. Collins said the NIH will be meeting with “a dozen or more” drug companies over the coming weeks to develop better overdose drugs; better drugs to treat opioid addiction; and pain drugs that not only work better, but that are not addictive.
Okay. This is an important step, and one that will hopefully produce meaningful results. But it reminds me of the essay I just read by Dr. David Katz, in which he described how “America willfully propagates obesity for profit, then spends taxpayer money to explore the mysteries of the obesity epidemic.” The opioid epidemic in America evolved in much the same way: humans are wildly susceptible to opioids, players are financially incentivized to disseminate them, and overall healthcare system factors promote them. The opioid epidemic is not a linear problem, and therefore requires more than a linear solution.
The most common story we hear about people who are addicted to opioids is that they start with a basic prescription for pain. Over time, their mind/body learns to need the medicine in order to get through the day. Pathways to opioid addiction are well documented and beyond the scope of this article. However, the moral of the story is that people end up incapable of coping on a daily basis without their pain medication.
Injury rehabilitation requires a holistic approach, and what if everyday consumer technology became a normal aspect of pain management prescriptions/programs?
Hope for Better Coping
A few years ago I did some work with colleagues in the Calming Technology Lab at Stanford University to increase coping among recently injured people. We got as far as publishing a white paper about our experiments, but here’s what we outlined:
Physical injury is a source of stress. Injury-related stress comes in many forms including pain, depression, anxiety, anger, insomnia, and social isolation. These stressors prevent successful healing. Regular methods of treating physical injury focus almost exclusively on the physical condition, often ignoring the psychosocial component even though decades of research provides evidence that psychosocial stress is a primary determinant of injury rehabilitation and effective healing.
Mindbody science proves that how a person physically feels during an injury is made worse by psychological stress. As such, a person who can more successfully manage stress during injury rehabilitation will more successfully recover. What needs to be understood better is how a person emotionally copes while injured. Coping is defined as ‘dealing effectively with something difficult’ and includes internal factors such as general self-care, decision making, mental skills (i.e., management of thoughts, energy, attention), and other stress management strategies. Coping also includes external factors such as social support.
Big opportunities exist to use interactive consumer technologies to increase emotional coping among people dealing with injury-related pain.
This is what our research was about: how to use mobile technology to boost emotional coping skills among recently injured individuals. Specifically, we wanted to influence thoughts, attention, and emotional energy by increasing levels of calm during initial stages of injury recovery. We defined ‘calm’ as restful alertness, or a state where one is present and able to function in a sustainable manner. We referred to these types of technologies as calming technologies (CTs): systems that induce cognitive, physiological, or emotional states of calm.
Modalities for Inducing Calm
- Cognition. Stress can have a number of negative effects on cognition. Even mild acute stress can cause a rapid and dramatic loss of cognitive abilities; ongoing stress has been shown to cause architectural changes to the prefrontal cortex (PFC), impacting memory function, behavioral control, and attention regulation. CTs can promote calm by sustaining one’s attention or eliminating distractions, increasing self-regulation, augmenting working memory, reframing thoughts, and increasing focus on solutions (rather that roadblocks) when solving problems. Meaning: when you suffer an injury, it’s hard to think straight. Calming technologies help you think better.
- Physiology. The physiological effects of chronic stress have been and continue to be extensively studied. For starters, there are significant negative cardiovascular and neurological effects of chronic stress. CTs counteract these negative physiological states in many ways such as promoting calm respiratory patterns, reducing muscle tension, eye movement desensitization and reprocessing (EMDR), and triggering progressive relaxation. Meaning: when you suffer an injury, several parts of your body, including your heart, struggle to function. Calming technologies help you physically relax to function better.
- Affect. Prolonged stress is a major risk factor for depression, and exposure to traumatic stress can cause post-traumatic stress disorder (PTSD). Stress can also exacerbate schizophrenia and bipolar disorder. CTs can mitigate these issues by inspiring and motivating users to maintain a positive short- and long-term outlook, savor current and past experiences, and reframe negative situations. Meaning: when you suffer an injury, it’s easy to get depressed, anxious, or mentally unstable. Calming technologies help you practice positive emotions.
Through research, instruction, and inspection of known systems, we identified three primary components of any calming technology.
- Cause/Effect of Stress. Design of CTs should be guided by an understanding of the nature of stress, how it emerges, and its effects on the body — cognitively, physiologically, and emotionally. By identifying the stressor’s characteristics (e.g., inadequate coping skills) in the domain where the person is feeling stressed (e.g., injury), one can begin to isolate the particular sub-components of the domain that actually are stressful. For example, many injured people feel stress when they experience pain. Rather than targeting pain in general, the designer can identify exactly what is stressful about being injured– e.g., besides physical pain, social isolation from not being physically able, anxiety due to missing out on daily life, being forced on medical leave, a diminished sex life, etc.
- Calming Mechanism. To be effective, CT design should consider the mechanisms through which a stimulus can have a calming effect. CTs can elicit different sensory experiences or aim to directly mitigate the specific characteristics of stressors. These main methods of designing calming mechanisms into a technology include: a) reducing or eliminating the presence of effects of a stressor or b) introducing or magnifying calmers, or c) both. CTs that introduce novel calmers, for example, can attempt to expose people to experiences that consciously or subconsciously increase calm in their daily lives. For instance, saying a new mantra, listening to a new sound to fall asleep, touching something warm, practicing different breathing patterns, etc.
- Human-Centered Design (HCD). An understanding of HCD and interaction design is fundamental for evaluating and designing methods of embedding calming mechanisms. To the extent that a designer empathizes how the user is experiencing his or her context, s/he will be more effective in targeting implied stressors. Furthermore, stress has been shown to effect people differently at different ages; thus a CT targeting a person in his or her teens may be ineffective for senior citizens.
Here is an example of a lightweight prototype I developed that provides meditation-based coping messages & social support to people dealing with injury pain.
In this prototype — called SMS Morphine Drip — the target users were injured adults who experienced high stress as a result of physical pain. Personalized and generic SMS-based calmers such as soothing messages, images, inspiring stories, and pain assessment prompts were delivered via text message. Messages were specified according to what the user was experiencing in that moment (e.g. angry thoughts, muscle tension, etc.). The system operated in either a user-initiated ‘pull’ manner, where the user texted an ‘SOS’ when in pain, or system-initiated ‘push’, where a ‘pain check’ was sent out during the user’s typical peak pain times of the day. In the pull scenario, the user’s physical pain triggered stress, to which these SMS-based messages triggered calm. In the push scenario, the SMS-based message triggered the user to practice calm during a pain cycle (e.g. high stress experience). This gave users a sense of control over their own pain management, and aimed to decrease the subjective cognitive and emotional suffering that accompanies physical pain, thereby increasing their coping.
While this prototype was a mobile 1–1 interaction, there are countless applications for group, environmental, and physical calming technologies.
Psychological stress has a proven impact on pain, injury recovery and rehabilitation. This theoretical model of calming technology guides the development and analysis of CTs that increase levels of coping in users through cognitive and affective means. By tapping into psychological thoughts, attention, and energy among recently injured individuals, CTs can provide emotional support during an injury rehabilitation experience. If people can learn non-medication ways to cope with pain earlier in their pain journey, then the liklihood that they end up addicted to opioids significantly decreases.
We did this research several years ago, and since then, consumer facing calming technologies have sprouted around the world. Spire came directly from work in our lab and is now available in the Apple store. Companies like Headspace, Yogaglo, and Muse want meditation to be as easy and regular as possible for consumers. Depending on the emotional regulation needed at any given moment in a person’s pain journey, even the Facebooks, Snapchats, and Slacks of the world could help. Much depends on the needs, motivations, and actions of the person and the context in which they are living. As multi-disciplinary pain management work to lessen dependency on opioids is underway at Stanford Medical Center and other leading centers around the world, let’s all hope the technology makers who are so very good at engaging us also play a role in this effort against our opioid crisis.