Fighting the Opioid Crisis: An Ecosystem Approach to This Wicked Problem

Most people know of the game called Six Degrees of Kevin Bacon. Based on the concept of “six degrees of separation,” it was invented by three college students who believed that every person in the entertainment industry stands no more than six acquaintance links away from the actor Kevin Bacon. Now, consider a similar exercise focused on the much-publicized opioid and heroin epidemic. Many people today, us included, find themselves just “one degree” away from this calamity, having seen friends, family members, and communities devastated by opioid abuse and heroin use.

The opioid epidemic cuts across every sector of society. Much like an environmental disaster—the ongoing release of toxic chemicals into air and water, for example—it endangers not just one population, but entire communities. The sources of this crisis are diverse and the problem is emergent and shifting --- at the same time, it is a criminal justice, physical health, behavioral, public health, and a human services crisis. It is a wicked problem.

There will never be one answer, one solution to this crisis. Such a broad crisis requires an equally broad response – an “ecosystem” approach. Having studied several other solution ecosystems that have made the most progress in addressing societal problems, we found they often have five elements in common. And these five elements could help address this crisis.

1. Engage a broad community of stakeholders and partners to innovate, convene and fund solutions

Across the country, stakeholders in the opioid crisis are coming together through commissions, roundtables, and conferences. As these convening groups shift into implementation, it seems critical that they engage new partners and collaborate on novel solutions beyond health and criminal justice stakeholders. New and unusual partners may be brought into the fold, including people who are in recovery. The current set of stakeholders can ask themselves, how might we involve innovators, technologists, and experts from beyond our current groups? 

2. Establish an ecosystem integrator to coordinate and align strategies and solutions

State governors and their administrations are increasingly serving as “integrators” in the anti-opioid ecosystem. State commissions, such as the Commonwealth of Virginia Governor’s Task Force on Prescription Drug and Heroin Abuse and New York’s Heroin and Opioid Task Force, are helping to drive real action. They achieve this through improved coordination and alignment of strategies focused on opioid abuse and heroin use prevention, intervention, treatment, recovery, and enforcement.

The integrator role, however, need not be limited to governments. Give the wide-scale impact of the opioid crisis, other organizations may be able to step into the role of integrator. Foundations or companies that focus on public health, economic development, or the welfare of children and families may be well-positioned to drive collaboration across the ecosystem.

3. Attack the problem with a portfolio of interventions.

Successful ecosystems recognize that working together doesn’t necessarily mean agreeing on one best solution. Instead, it means coordinating a full portfolio of strategic interventions which, when taken together, have the best chance of hitting the goal.

For example, the Physicians for Responsible Opioid Prescribing with support from the Drug Enforcement Administration and the National Association of Attorneys General petitioned the Food and Drug Administration to request labeling changes for all opioids prescribed for non-cancer pain and a “black box warning” label on opioids prescribed to pregnant women. Most recently in March 2016, the Centers for Disease Control and Prevention issued new guidelines for prescribing opioids for chronic pain.

In addition, state agencies, federal agencies, physicians, and medical colleges have been updating their educational materials to better warn physicians. This portfolio of interventions has prompted pain clinics and emergency rooms to stop, or drastically reduce, the use of opioids for chronic conditions, according to an article in Health Affairs. A similar coordinated approach could be applied to the many challenges impacting addiction treatment.

4. Create an innovation engine to drive ideas for solutions that upend the problem.

Groups fighting the opioid epidemic try to approach the problem from every possible angle. But members are the first to admit that without new solutions, the epidemic probably won’t let up anytime soon. Governments may consider going beyond roundtables and commissions: They may need to create opportunities for new partnerships to form, such as:

Prize-based challenges: Organizers define the challenge, offer a prize, and then open the competition for individuals or teams to offer solutions.

Pay for Success: This is an approach that ties payment for services to outcomes so instead of paying an organization for each service rendered or via a grant, the government pays a service organization—wholly or in part—based on performance against particular metrics.

Advanced analytics: With governments collecting more opioid-related information, data scientists are connecting data from different sources and using it in new and innovative ways to help identify patients’ pill-seeking behaviors, and prevent opioid addiction and dependency before the habits form, according to a Health Affairs article.

5. Use the power of the market to support the development of new products or services

Creative ideas are out there and smart, innovative entrepreneurs can play a critical role. For example, what if locking devices could be used on bottles? In Illinois, legislation was recently passed to support a pilot program in which pharmacies can dispense medications that contain hydrocodone in bottles that are secured with combination locks. Other promising products already on the market include pouches that can be used to safely dispose of medication and long-acting treatments for opioid addiction. Ecosystems can help create a climate for the development of innovative, market-driven solutions.

The opioid epidemic is a “wicked problem” of the worst kind. An ecosystem approach could become the best hope in the battle against opioid addiction. From engaging new partners in the fight and aligning action across the ecosystem, to using a portfolio of interventions, driving innovation, and using markets to support sustainable solutions, the ecosystem is likely to generate the most powerful response. We may need those innovations to ensure that people in future generations all stand far more than six degrees apart from the opioid and heroin epidemic.