Team Holarchy Envisioning Alternative Futures in Regards to the Use of Opioids As Painkillers

As a group, we identified some of the beliefs and cultural norms that are currently dominating the landscape in relation to the opioid crisis, and what their counterpart in 2050 would be if the wicked problem was “solved” or at least under control. Some of the concerns, fears, hopes, and aspirations that relate to these beliefs in 2019 can be directly correlated to the landscape and regime level in the MLP map.
Most of them emerge from a mechanistic and profit-based emergence of the health system, which is why this wicked problem is quite localized to the United States. The magnitude of it has been alighted through a multiplicity of factors, but mainly from a lack of access to universal healthcare, and the trickle-down effects this provokes.
Lack of access to public health means patients are reliant to insurance companies which have dictated a rapid approach trying to always keep the costs to a minimum, which is why longer-term therapies and alternative methods to tackle chronic pain have been discarded from insurance coverage.

With this main thought as a basis, we created a list of beliefs and norms present in 2019 and speculated how they would change in 2050, in order for the problem to be resolved:

2019 BELIEFS & NORMS:

An approach to pain as administrative management

“One pill solves all” mindset

A mechanistic approach to medicine

> quick focalized cures

Disregard for addiction, mental health or family’s history

Commercialization of medicine

> Patient is treated as a customer

> Lobbying

> Acceptance of pharma sales representatives in doctor’s offices

> Treatment linked to purchasing power

Blind faith in modern medicine

> Idea that the doctor’s opinion is the ultimate

Media control by large companies

> Advertisement of painkillers

> concealment of important vital information

Success is measured in monetary value/gain or efficiency of procedures

2050 BELIEFS & NORMS:

Patients are given a multiplicity of treatment options which are not an isolated approach but a holistic one that would involve changes in lifestyle

> Natural treatments (indigenous wisdom)

> Human scale cities: walking, shares transportation, fewer pollutants, and stress

> A reconfigurations or work/life balances: more leisure time

> Redefinition of our relationship to nature

> Redefinition of the idea of what “being human” means in regards to our ecosystems

The wellbeing of the patient is above financial profits

More critical and informed medicine consumption

Trust in the community

Strictly monitored advertisement

Universal healthcare access

If we view this new set of beliefs from Max-Neef’s matrix of human needs and satisfiers, that would mean the need for Freedom, Protection, Affection, and Understanding would be covered by a locally informed approach. Nevertheless, a free, public and universal approach of healthcare would be provided by larger entities, as municipalities, state and federal governments. The cultural norms affecting citizens’ wellbeing and health needs would be covered in a cosmopolitan-localized way, shifting in a scalar form: creating personalized treatments, supported by a larger tax supported coverage.

Finally, some of the questions that remain uncertain after doing this visioning exercise are the following:
> Can there be “social foresight”, as defined by Richard Slaughter, in agony and pain?
> Are only the privileged able to foresee futures possibilities since they have a wider range of opportunities to think and tackle complex problematics?

These questions arise from the discussions had in the Futures modules. It becomes delicate and complex to envision the future when immediate problems as an addiction or restricted access to healthcare are in place. Exercises as the three horizons are valuable since they help create midway horizons (H2) as benchmarks for transitions.
If we try to merge and understand now the problem through the MLP analysis, 3 horizons and Max-Neef’s matrix we could say that there are quite specific points of intervention (Meadows’ leverage points) that are arising:

> one seems to be at the State and municipal level: people on the ground, in community centers, pharmacists and ER’s have direct contact with patients addicted to opioids. Their intervention could range from a change in practical procedures as information transparency and prescription.

> another seems to be at an organizational level of scale, through the imagining of co-operative and holistic health centers and clinics

> finally, the highest level, would be an ideological shift. For this, H2 is incredibly valuable: what are some of the things that are to be accomplished in 15 years in order to see change in 2050?
> shift in education (leverage points: schools and universities)

> shift in information (media and advertisement)

> shift in policy (access to health)

> actionable things for designers: pursuit of a public service job, work with institutions that support accountability from Pharma companies and government, pressure representatives, attend town hall meetings, demand transparent non-sponsored information in educational centers, be involved in community centers and with neighborhood organizations, learn from past examples (as the anti-tobacco mindset shift).