Transition Design Assignment 5 Designing Interventions
Michelle Cedeno, Ekta Verma, David, Jo, Patrick, Sofia
Introduction:
The opioid crisis differentiates itself from the other wicked problems studied in this course because of its socio-economic nature. Our linear economy paired with our mechanistic culture creates social inequalities among the wealthy and poor. The impunity that we are seeing with the Sacklers is causing a direct response of political clientelism and lobbying in society because of a needed change.
Thus, we believe many of the intervention that could be developed in order to alleviate the opioid epidemic can be solved socially. There is a need for political change and new legal reforms to be implemented so that a crisis like the opioid crisis cannot repeat itself again. We drew inspiration and learned from the tobacco and cancer epidemic. From these campaigns, we believe that clear, transparent information can change mindsets and trends. However, many of the solutions that involve social interventions about drugs and pain management exist already. We believe that a transition pathway for change in the opioid epidemic needs to amplify these interventions and bring more transparent information to the people so that niche interventions can ultimately rise up and change the landscape level.
Our “original” ideas for interventions in the opioid epidemic included educational programs in middle and high schools –where we discovered the well-implemented anti-alcohol and drug abuse program D.A.R.E has created a similar initiative. For a city scale intervention, we thought our solution was similar to the City Health Dashboard. We also really wanted to campaign targeting stakeholders in the front lines like pharmacists and doctors; this inspiration drew from tobacco company logos. Our holarchy meetings for this project had rich conversations surrounding many possible intervention points. These points included intervention such as: grassroots movements, guerrilla information campaigns, recovery sanctuaries, mixed-use centers, information platforms fed by doctors, academics and the government in order to overpower pharma’s information monopoly, a mandatory background of drug sales representatives in pharmacy or chemistry, higher taxes for pharma and a political push towards universal health care.
The following are three intervention that we ultimately found could work in a synergistic form, leveraging each other’s assets and benefits, creating a stronger narrative than just 3 isolated projects.
We divided the task into groups of two so that our group was able to get a fair share of their vision for designing interventions that they felt passionate about. David and Jo teamed up to talk about the household label intervention, Pat and Sofia paired together for safe injection facilities, and Michelle and Ekta teamed up to think of new interpretations for pain.
Project 1
Labels
Overview:
This project seeks to label opioid medications in order to indicate public funds and potential risks. Our hope is that governmental regulation will enforce pharma to create labels for opioid medications that are distributed to the market. The labeling will help the consumers develop better knowledge about where the fundings for pharmaceutical R&D comes from, the potentially addictive nature of opioids, and empower them to take initiatives to educate the community they live in. Tying back to Max-Neef Needs, the labeling would create a synergic satisfier for the need of understanding, participation, and freedom.
1. How does the project connect to amplify others?
The awareness developed from the labeling on these opioid medications could help people seek alternative treatment, and choose safer facilities such as the safe injection facility.
2. Which of the present day fears/concerns or hopes/aspirations does the project address?
Currently, there are a lot of fears and concerns on the lack of transparency in the pharmaceutical industries, especially for pain-killers. Patients fear that they are not aware of the potentially addictive nature of opioids. Furthermore, pharmaceutical companies are currently holding an information monopoly, controlling all the information about opioids and withholding this information from opioid users.
3. What are the challenges and barriers to implementing the project? What new resources, tech, skills, policies or changes in infrastructure will it require?
Resistance from pharmaceutical companies would be a substantial barrier and would hinder the implementation of this project. Therefore, this project will require the government to step in and enforce the labeling through policies and agencies, such as the EDA and FDA. It will also require pharmaceutical companies’ R&D departments to disclose information on opioids. All of this together will allow the government to disclose opioid-related funding and tax flow information to the general public.
4. What under-utilized resources might be leveraged to aid in implementing the project?
Hospital regulations that doctors can only prescribe medication with such labels
Resistance from the patient community that demands doctors to only prescribe medication with such labels.
5. How it will shift the attitude and beliefs connected to the problem that might lead to the new social norm?
This solution could help individuals develop agency through the raising of their own awareness of the risks attached to opioid use and the funding channels and profit models related to opioids. With labeling, the likelihood for patients to use and physicians to prescribe opioid medications can be reduced. Ideally, this project will also help society gradually reduce its dependency on the use of opioids and start searching for better, alternative treatments.
6. In what ways can it positively impact/resolve the complex problem? In what ways will it help restore local and regional social and environmental systems?
This project is a grassroots approach from the niche level to better educate the patient and the medical community about the potential risks that opioid use might entail. Labeling will better provide transparency to the medical community on where the fundings for pharmaceutical research and R&D come from and where the profits go. Currently, a majority of the funding comes from taxpayer money, while all of the profit goes to the pharmaceutical companies. Hopefully, people will begin to notice the discrepancy and realize the profit-driven nature of big pharmaceutical companies; and hopefully, this new mindset will scale up and impact change on the system level.
Project 2
Safe Injection Facilities > new options to treat pain/addiction
1 — How does this project connect and amplify the others?
With more safe injection facilities set in place and made more readily available for use, patients are more likely to visit one when dealing with opioid use or any other pain relief medication. At these facilities, patients will be given the opportunity to learn more about the drugs they are taking. Labels on these drugs and pharmaceuticals will help aid both patients, nurses, and pharmacists in raising the awareness on who is supporting the research and development of the drug and what the drug consists of.
At these facilities, patients will also be given the opportunity to assess their own amounts of pain with the new pain interpretation project set in place. Along with this new interpretation of pain, patients will also be given more alternatives and options for pain relief, thereby not forcing themselves into resolving to take painkillers for short term pain relief.
2 — Which of the present-day fears/concerns or hopes/aspirations does the project address?
Currently, there are a lot of stereotypes surrounding painkiller users and the whole process of dealing with pain and seeking pain relief. Stereotypes such as isolation, self-deprecation, introversion, and depression. With facilities set in place to better facilitate community inclusion, patients can more safely and confidently inject pain medication while having the support group right there to provide any sort of emotional or physical assistance.
More importantly, safe injection facilities address the issue of improper medication injections, which can lead to infections and other diseases. SIF’s will make sure the equipment that is being used is clean and being used the right way to ensure safe and proper injections.
3- What are the barriers and challenges in implementing the project? What new resources, skills, technologies, policies, or changes in infrastructure will it require?
Creating and implementing new safe injection facilities is not going to be easy and is going to require a lot of resources. Cities are going to need new infrastructures to host these facilities, which is going to require money from the city and manpower from construction workers to build. Once built, these facilities will need to employ nurses and other staff members to run the clinic and provide hospitality to patients. With that being said, the facilities are going to require a lot of funding to operate and, at the same time, should be made available and accessible for everyone in need, meaning it should be easily affordable.
Furthermore, there are currently a lot of social barriers set in place that might make it hard for safe injection facilities to become viable. There is no certainty on the successfulness of these clinics and whether attending these clinics for injections are actually better than injecting pain killers independently. Because of this, there is a hurdle for current opioid users to overcome in order to start taking advantage of these facilities.
4 — What underutilized social resources might be leveraged to aid in implementing the project?
Already existing clinics and community sites might serve as these safe facilities for users. Also, thinking specifically in Pittsburgh a political push towards the legalization of marijuana in the State of Pennsylvania would be a progressive jump towards a new, more natural form of treating pain. Research has found there is a direct correlation between the states that have legalized marijuana and a decrease in the consumption of opioids. These safe centers or sanctuaries could also serve as smoking or marijuana consumption facilities for people in pain or depression. It has also been demonstrated it is a form of alleviating withdrawal symptoms as well as decrease relapse.
For this to happen there is a heavy reliance on grassroots movements which can create enough lobbying and political leverage for state legislation to be changed.
5 — How will it shift attitudes & beliefs connected to the problem that might lead to new social norms?
These centers will open up the conversation of different ways of treating pain, allowing also for the community as a whole to understand the pervasiveness and vastness of the problem. Information and visibility, as well as a physical space which would become a sanctuary for people in pain, would allow for interactions to change. This can be learned directly in the form of tobacco addiction started to be tackled as early as the 1960s.
Changing people’s perception of what a “good” life is, healthy life and wellbeing in imperative. Therefore a completely new way of relating between members of the community is necessary. Shared spaces as these could be susceptible for this new social links to be developed and relations to drugs based on modern medicine.
6 — In what ways can it positively impact/resolve other complex problems? In what ways will it help restore local and regional social and environmental systems?
These centers not only would function as safe facilities for users but could become points were the restoration of the social fabric would take place. People in the community could volunteer in these centers, generating new ties between users and local neighbors.
These spaces would try to generate a new understanding of the problem. As they because open and accessible, the stigmas surrounding the problem could be little by little tackled, changing stereotypical ideas of opioid addicts.
Promoting new lifestyles, where users can try to regain their lives through the trust and safety net of the community, other spaces open to the public that would encourage a new lifestyle and pace would be available. If we consider local gardens as catalyzers for new ways of dealing with stress, depression, and pain, they could also be spaces where pollinators could thrive with neighbors planting local plants and crops. It would also be a space for exercise and conviviality. Elders could be in charge of the proper organization and functioning of these local gardens. Finally, more green spaces would help combat air pollution in the city and promote a greener, more humane city.
In the long term, spaces for conviviality, where everyday life is approached from a new mindset where a utilitarian approach to production and productivity would not be the dominant paradigm. People with chronic pain or depression would not rely on the options provided by pharma (as opioids), but through the agency of choosing the type of lifestyle, they want to undertake.
Project 3
New Interpretation of Pain
We wanted to expand on the Wong-Baker Faces Pain Rating Scale used by doctors and professionals by making a more transparent and agency rich scale for patients to understand and make an informed decision.
We propose a scale that includes various treatment alternatives along with time, money and side effects/addiction parameters for each treatment. This will help patients view the pros and cons of each treatment option and make the right choice for their situation.
How does this project connect to and amplify others?
This new and improved pain scale give autonomy to the patient. Instead of creating a governmental change we believe that more individual based choices and knowledge can help people to act against the opioid crisis. In tandem with the new label, we believe that we can help support change by giving people the information and resources for change. In the hospital context, patients can decide how they want their treatment to be catered to their needs.
Which of the present-day fears/concerns or hopes/aspiration does the project address?
The hope in this intervention is for people to choose a more holistic treatment option to combat their pain. By providing the full view of treatments available and the coinciding side effects, we believe patients can make a more informed decision and have more agency on how they want their pain to be managed.
What are the barriers and challenges in implementing the project? What new resources, skills, technologies, policies or changes in infrastructure will it require?
A barrier to these projects is how we can make our new intervention a system-wide accepted protocol and tool for hospitals, doctors, and professional to adopt in their daily practice. Another factor we need to consider is how we can customize our pain scale to different types of pain to meet each patient. We also anticipate pushbacks from various advocates for opioid use, by campaigning a more patient-derived decision-making process, we believe our intervention can help tackle the opioid crisis.
What underutilized social resources might be leveraged to aid in implementing the project?
We want to tap into the power of the people as we feel they are an underutilized force. We believe that awareness among people can empower communities and push for change and break the system. If we work together we can bring down pharma and stop the malicious spread of false advertising.
How will it shift attitudes and beliefs connected to the problem that might lead to new social norms?
We want to work with the grassroots campaign and educational bodies to help promote the idea of choosing holistic care and saying no to drugs. We aspire to tap into the youth and make this a trend. We considered a few hashtags to get our voice heard among the youth. #IChooseHolisticHealth #MyPainMyChoice
In what ways can it positively impact/resolve other complex problems? In what ways will it help restore local and regional social and environmental systems?
Our intervention will help endorse local and small businesses offering holistic and indigenous ways of dealing with pain. It will also help educate people on pharma monopoly and help break that system.
Conclusion | Steps along a Transition Pathway:
As a conclusion, we could say that our three projects or interventions, although minimal and quite localized in the larger scope of the wicked problem, can amount to a larger movement. The same way anti-smoking information and campaigns took more than a decade to take traction, tackling the opioid crisis will not be something linear, uniquely policy driven, or quick. The problem has been bubbling since the 1980s and has led to a shift in beliefs, in the way medicine is approached, in the doctor’s responsibilities and the abuse of vulnerable communities. In Western Pennsylvania, as we discovered through this research, the use and consumption of opioids is one of the highest in United States. This has a correlation with a series of factors: environmental, economic, political and a rooted predatory mindset from pharma companies in order to maximize profits.
Due to the complexity of it, we aimed to propose interventions at different scales which could shift mindsets and fulfill needs in a more mindful and humane way. We were also aiming to regenerate a sense of agency by considering participants direct creators of their future. In that sense, we concentrated in peripheral stakeholders which would not be considered decision makers directly (as politicians, public servants or elected officials).
Based on adaptive leadership, we believe some of the most potent changes can come from already existing projects and the empowerment of community leaders whom can take the reins of their futures while allowing others to also participate and engage.
Overall, the most pivotal influences in our research, map and idea generation where Rittel’s descriptions of wicked problems, Donella Meadows leverage points and Max Neef’s Matrix of Human Needs. Our intervention proposals try to tap into the higher levels of leverages points as well as projects that could be nested or connected between each other, generating a synergistic approach to problem-solving.
Our main learning outcomes from this project rely on the interdisciplinary nature of it. Working individually, or in pairs, we could have never have grasped such a far-reaching understanding of the problematics. Also, most members of the team are international students, which allowed for a larger international scope of how raw materials are provided and the consequences this has had in other territories. We were able to dig in depth into the historic aspects through the MultiLevel Perspective assignment, while these last projects allowed us to be more creative and reflective.
