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Pain is Mandatory, it’s the Suffering that is Optional

What a decade of fighting the opioid epidemic taught me on how to think about Blockchain

If you come up with something new, don’t expect people to support you

When I arrived in 2008 to run the Division of Pain Medicine at the University of Washington in Seattle, the first multidisciplinary pain clinic in the world, little did I know that I would spend most of my time dealing with the consequences of the unintentional deaths from opioid (pain killer) overdoses.

At that time, Dr. Gary Franklin the Medical Director of the Department of Labor and Industries of the State of Washington was reviewing death certificates and showed me that prescribed high-dose opioids (like oxycontin) were killing injured workers who were claiming Workers Compensation. Alarmed from these findings, we immediately started to work with the Agency of Medial Directors Group (AMDG), a collaboration of state agencies, private practicing physicians and the University of Washington, to author the first in the country professional prescription guidelines (the WA State Opioid Guidelines) that were successful in reversing this devastating trend (below).

Decrease in opioid related deaths after the implementation of WA State AMDG guidelines (also see: Franklin GM et al, Am J Ind Med. 2012;55(4):325–31)

Encouraged from these initial results we proceeded to legislate these efforts statewide (HB 2876), however we received a very strong negative feedback from colleagues, professional pain organizations and patient advocacy groups including a lawsuit that was later overturned.

Once your idea is adopted, it’s not yours anymore

For the next five years and despite ongoing skepticism and resistance, we continued to tenaciously disseminate our guidelines and data, as more and more stakeholders adopted our approach including the Department of Defense (DoD), the Department of Veterans Affairs (VA) and the Center for Disease Control (CDC). In particular we insisted that measuring patient reported outcome at every clinical encounter and avoiding high dose prescriptions for non-cancer pain were essential for the guidelines to be successful.

The higher the dose prescribed, the higher was the risk of an overdose (from Franklin GM)

More so, not only are WA State guidelines used as a template for other state and national guidelines, but also WA State is finally suing those responsible for the predatory practices that led to the deaths we reported a decade ago.

What does all this have to do with Blockchain?

Just as it took us a decade to convince the world that unintentional deaths from opioids were due to overprescription and that the old ways need to change, I think it will take a decade to show that a decentralized world will inevitably replace the current non-sustainable centralized world we live in.

Blockchain adoption in Healthcare will take about ten years (Chilmark Research, 2018)

During this time we should expect to deal with five stages of grief (as described by Dr. Elisabeth Kübler-Ross):

  1. Denial (no one at first believed our data, just as many wonder what is the utility of blockchain, or ICOs)
  2. Anger (we were sued for ‘harming patients’, just as we already see law suits in the cryptospace)
  3. Bargaining (our guidelines recommended a prescription limit at 120mg/d, but some suggested to increase it. Similarly crypto regulation is currently in discussion)
  4. Depression (many are still discouraged from the ongoing increases in deaths from opioid overdose, just as many fear the ICO bubble and worry that blockchain will harm our future economy)
  5. Acceptance (soon everyone will use the WA State guidelines simply as guidelines, just as crypto-wallets and crypto-apps will simply be wallets and apps)

What we need is Strategic, not Theatrical Thinking

I learned from my ‘opioid decade’ that it is not easy to be creative without causing angst, it is not easy to be prescient without being misunderstood and it is not easy to be innovative without inviting jealousy.

But I also learned that it is important to embrace novelty not only with tenacity and conviction but also with humility and selflessness. Being criticized, sued and mocked can be traumatic, but if our goal is to change the world, let us do it kindly, generously and together. The pain of change is mandatory, but our suffering to change is optional or as David Brooks eloquently points out:

“Extremism is contagious. To fight it, you have to answer the angry shout with a respectful offer. It feels unnatural. But it’s the only way”…

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Dr. Alex Cahana

Veteran, Philosopher, Physician who lived 4 lives in 1. UN Healthcare and Blockchain expert. Venture Partner, ImpactRooms, alex.cahana@impactrooms.com