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[ Opinion ]

A Farewell to (H)Arms 

ENLISTING Silicon Valley to help defeat America’s Opioid Crisis.

by Jason Smith

Recently  Facebook founder and CEO Mark Zuckerberg sat down for an interview at the University of Kansas to discuss his observations on the American political and social landscape following his visits to all 50 states. When asked what stood out to him most, if there was some kind of unifying theme, he responded that one thing did indeed stand out, glaring back at him regardless of where he found himself: the opioid epidemic.

The biggest surprise by far has been the extent of the opioid issues. And it is really saddening to see… Now, I do think that the opioid crisis is starting to get more attention. From my perspective and what I saw this year, it’s still getting nowhere near the attention that it needs. But the good news, if you can call it that, is that you can look at other countries that have had serious heroin and opioid issues, like France, for example, in the early 2000s, and there is a roadmap for how you deal with this. It’s not going to happen overnight, and I think the issue will likely get worse before it gets better, but if we do the right things as a country — and more often actually at the state level — there is a roadmap for how we can improve this situation.

Over the past year I’ve watched the community here at Addiction Unscripted utilize the tools offered by Facebook to strengthen the bonds of meaningful dialogue to produce happiness from misery. AU’s use of Facebook to foster online communities that then strengthen real-world communities, has been incredible to watch.

These new communities are comprised of the formerly-shamed, jaded, embarrassed-into-silence individuals. The word “addiction” spent most of the last century on the ‘things we don’t talk about in public’ list. The word was used to verbally paint ominous societal portraits of the worst parts of ourselves, huddled in dark corners wrapped in our vices with dirty faces and filthy fingernails.

And I watched as AU used Facebook to take the word “addiction” and turn it upside down.

That’s why I couldn’t be more proud to have been a co-founder of this site. You guys came together and told your story, even though doing so scared the hell out of you.  By sharing your experiences, you provided support for one another, and look at the result – you turned “addiction” into something from which strength can be drawn by others, that assists those who are drowning in life, by using your own as a flotation device until they’re strong enough to swim on their own. 

The world used the word “addiction” in such ugly ways, for such ugly reasons, and you reclaimed it. You took it back and reformed it into something beautiful. A word that once embodied isolation and loneliness became the foundation for a community built upon connectivity and friendship.

Dying of thirst in the middle of an ocean

Last summer, I was at a book signing in Northern California. I was scheduled for the entire evening, and I was excited. I’ve always enjoyed hearing others share their stories, or describe how they took something I wrote and used it in a way I’d never even considered when I wrote it. But on this day, things were different. There was a line across the room of parents of dead children, and children of dead parents. Some had family members still in the grips of addiction, some were noticeably in the grips as they stood before me. After waiting patiently, a woman approached the table, towing an eight year old little girls behind her. The woman told me she wanted to buy my book for the little girl, who she introduced as her niece. The woman explained to me how her  sister – the little girl’s mother – had died of a heroin overdose two months earlier, so she was buying the book for the girl, hoping it would help.

I was lost for words. My book isn’t that book. I’m certainly no recovery expert, and I’m fairly certain there’s some content in those pages that most people would might find unsuitable for an eight year old.  But what was I supposed to say? “No, don’t buy it?” “Ok, buy it, but don’t expect too much?” Shit, I don’t know. Yet, one person after another wanted me to tell them where to get help.  What could they do to get their child to stop.  Where could they send their father when he gets out of jail so he could get the help he needed.

There I was, neck-deep in this thing, connected, networked, familiar with the various treatment options, the array of models and philosophies, the costs. I’d read the studies, compared the data, I knew which treatments were showing promise, which were outdated, and yet when asked point-blank by a mother whose eyes were welled with tears because she knew her kid was going to die, “Where can I go for help?,”  I just looked at her, frozen and speechelss, because the truth was, I did’t have a goddamn clue what to say to her.

That night I sat in my car in the parking lot and stared into the night sky. Angry. Frustrated. Hurt. Confused. I’ve spent the past year staring into the same sky, every night, and I still don’t have an answer to her question.

There are resources. There are services. There are assessments. It’s not a lack of information that’s the problem. The problem is there is no systemic infrastructure in place to plug it in, to connect it all. There’s nowhere to send someone who needs help. And what good is help, if people can’t access it?

In War Logistics Beats Strategy

When you picture Operation Overlord, aka D-Day, when allied forces stormed the the beaches of Normandy, I’m guessing you picture something like the scene here. What you see in the photo is overwhelming force, as wave after wave of young men from all over the world were sent in by their governments to take back mainland Europe from the Germans. 

However, that’s just what you see in the small sliver of time captured in the photograph. What you don’t see are the two years of preparation and planning it took to design, construct, implement, and supply such a massive undertaking. You don’t see the construction of naval bases, warehouses, industrial and housing facilities, and hospital space.  You don’t see the 11,590 allied planes supporting the ground troops. 

What you see was what was only made possible by systemic logistical support and infrastructure, well in place years before the first boats landed, making the 326,547 troops, 54,186 vehicles and 104,428 tons of supplies that it took to to pull the whole thing off. 

In 1943 Eisenhower completely restructured allied command because he knew that the logistical operation leading up to the invasion would be the deciding factor of whether or not the operation was successful. None of it mattered – not the number of troops, or planes, or supplies – if there wasn’t a system in place into which it could all be plugged in once they landed.

Imagine an operation of this size, minus the infrastructure. Eisenhower was meticulous, ensuring that flow of information and resources between battalions was seamless, and operational procedures were fully understood. Otherwise, he realized, it’d just be chaos.

This is the chaos we’re currently seeing in the form of the opioid crisis.

Systems Don’t Fail

When a system produces a failed result – meaning it produces anything other than the desired product – then it’s because that system was in some way designed to fail.

They do what we design them to do.

Systems don’t fail. People fail at building systems. And the current system is producing precisely the result it was designed to produce. Let’s have a look at its greatest hits. 

In 2015, 52,000 people died from drug overdoses. In 2016, that number rose to 64,000, three-quarters of which were opiate overdoses.

But here’s the kicker – those aren’t the real numbers. 

There isn’t a system in place to accurately track overdose deaths in the United States, data which, one might assume, is important. Year-to-year, that information could be used to extrapolate which programs are working, and which are not. So if we don’t even know how many actual overdoses are occurring each year across the country, then upon what information are they currently basing the decisions they’re making? Are they even using actual, quantifiable data at all? 

Billions of dollars are being spent to fund a system for prevention and treatment, despite nobody having a clear understanding of how big the actual problem is that they claim to be preventing and treating.

There’s no system in place nationwide to force states or counties to report overdose deaths with a level of accuracy to such a degree that information collected in California could ever be used to compare with that which was collected in South Carolina. Such an ability would allow for new and progressive approaches in the treatment of addiction across all 50 states because each state could then rely upon the findings of previous studies, regardless of where they were conducted, and pick up where those studies left off. If a particular program showed a high rate of success in certain populations but not others, that could potentially provide an insight into the influence of environmental and genetic factors on compulsive behavior that doesn’t exist currently. If data is deemed unreliable, that means it must be re-collected so that its unreliability doesn’t contaminate the rest of the study. This prevents innovative approaches from ever being attempted, because it’s simply too expensive to begin studies that can’t build off of the work its predecessors. Therefore, it becomes cheaper to stick with what you know, than to try and break new ground. 

Some county hospitals here in California record overdose deaths. Others do not. Some face political pressure by county boards of supervisors to not record overdose deaths because they fear it’ll have a negative impact on the community’s reputation. Others over-report their numbers because they know that an increase in overdoses will trigger emergency funding, which is true. It’s also a concept –  hey, so uhh… what we’re doing isn’t working, so we need you to give us twice as much money so we can double the number of people it’s not working for – that’s so illogical, so counter-intuitive, and so mind-fuckingly stupid, that only a system like the current one could produce it. 

In an interview I conducted recently with the head of a Northern California narcotics task force, the agent told me that he suspected the actual number of overdose deaths was double the reported number.

This is one example of how the system is unable to meet the the demands we’re placing upon it, which creates a domino affect that compromises each subsequent step in the system’s process.

How someone died, especially in a hospital, should be like that first question on Who Wants to be a Millionaire. If you can’t get that right, your ass should be at home playing Go Fish.  And when the bureaucrats tell you that it’s just not possible to collect data across state lines, or between systems. When they tell you that it just doesn’t work that way, that it’s just not that easy, that change just takes time, and you just don’t understand, that’s when you tell them that they should just go find another fucking job, one that just doesn’t require problem solving, since that’s obviously just not their thing. Their intellectual laziness is killing people. “The system doesn’t work that way” is not a valid justification to continue doing something that isn’t working. It is however, a valid justification to remove the system and build a new one.

When they tell you that the system isn’t built to do whatever it is you’re asking, then tell them good. That’s the first sign it might just work.

Again – this is the collection of causes of death. It’s basic basic data with zero subjectivity. If the system can’t get this right, then what are its chances of accurately collecting the data necessary to assess programs and models, so we can determine whether or not something should continue to receive public funding? How can we find innovative approaches if we can’t assess outcomes? What in the hell data are they currently using to determine whether or not programs should continue being used?

This is the very best the current system can offer, so don’t let them tell you the system isn’t working, because they’ll try. 

The system is so termite-infested, in so many places, at so many levels, that one must question whether it’s salvageable at all. 

We’re asking the government to get us out of a mess they created, using the mess itself as the too to dig us out?

If we are all waiting for them to fix this for us, then very simply:

We. Are. Fucked.

But then again, maybe we don’t need to wait for them. In fact, perhaps we have before us a unique opportunity to build the type of wholesale systemic change that only a crisis like the current one could allow for.  

The bad news is, we have a very, very big problem.

The good news is, it might just be big enough to allow for real change.

Tapping into America’s greatest natural resource: Hustle. 

American ingenuity is unparalleled historically. Look at the start-ups, small businesses, entrepreneurs, angel investors.  We are a nation of inventors, with a portfolio ranging from the Lunar Module to the used car salesman. We hustle. We’ve never been a people to blindly accept the status quo, just because. If we think there’s a better way to do something, we’ll try it. We change the world because there happens to be nothing good on TV. Facebook was created in a dorm room. Other civilizations would have kept the advent of the internet for themselves, for personal gain. Not us. We gave it away, wrote some code to accept Visa and MasterCard, and unleashed upon the world the first Cam Model. 

We identify problems, and we solve them. We’re not always right, and we’re not always innocent, but at least we tried.

That audaciously brooding self-confidence in Thomas Jefferson’s voice as you read through Declaration of Independence is the music we were conceived to. It’s belief in individual right, but a faith in the wisdom of collective experience. And to win the war against the opioid epidemic, this is the collective experience into which we’re going to need to tap. 

What do you think Facebook would look and feel like if it were run by people who run your local Department of Motor Vehicles? How appealing would the landing page be? How clunky would the whole operation feel? What would the UX be like, how often would it update to keep up with the ever-changing needs of its users?

What would happen this holiday season if Amazon were taken over and operated by the good folks at the VA? How long would your order take to ship? Return? 

Think what Medium would look like, if instead of Ev Wiliams, it had Betsy Devos. 

 Twitter, eBay, Apple, just think where they’d be today if Silicon Valley was run like any one of these bureaucratic agencies? 

My guess is 2018 would be the year of the floppy disc. Not the small square one. Slow down  there, time traveller. I’m talking big, black, square, Oregon Trail floppy disc.

You think I’m lying?

In 2017, the system in Placer County, California to take residents who’d been approved for county funding for inpatient care, and get them into a bed in a treatment center, is to hand them a piece of paper – mind you, they’re more than likely entering the early stages of withdrawal, so patience won’t be a strength – and told to go home, an call the numbers on the sheet every morning until a bed opens up. 

Seriously. That’s the system that’s in place, not only in Placer County, but in many counties across the country. A 2013 study found that the average national wait time with this system is 30 days. A 2007 study found that nationally, 50% of those who go for help and are approved for funding, never make it to treatment. The primary reason, was this system. 

This is the bed management system found on the front lines of this epidemic.  

Phone numbers. 

The system used by the counties to place addicts into beds so they won’t die,  is the same one radio stations use to give away concert tickets.

Once again, call me crazy, but I think there might be a better system out there.

What if we enlisted the minds behind this century’s greatest innovations to help us find it? What if we asked the men and women behind the scenes who took Apple, Amazon, Facebook, and made them run more smoothly, more efficiently, more cost effectively, and asked them to help us win this fight.  To help us design a better way to do the things, because the current system is collapsing under its own weight. 

How long do you think it would take the minds that Jeff Bezos and Mark Zuckerberg  rely upon to keep things operating, to re-design that phone-in bed-management system? To scrap the whole thing, and build new one, complete with risk assessment, cost-benefit analysis, with built in data collection, wait time assessment, the whole thing?

The study I referenced that found 50% of those approved for treatment never get to treatment. That was published in 2007. Ten years later, we are still using it, despite overwhelming existence proving it’s harmful. 

Coincidentally, 2007 was the year of the very first iPhone. While Placer County has done nothing to fix their system, here is a shot of the iPhone over the same time period. This is how often they were willing to assess and evaluate their product, then fix what needed to be fixed to meet the shifting demand. 

Do you think the engineers at Amazon would find it acceptable if 50% of what they sold failed to be delivered?

Ask yourself why the current system does find it acceptable, and why Amazon would not. Because that right there is the cultural shift we need their help learning to embrace.

I’m not suggesting privatization. I’m suggesting we can’t even begin conversations about what might work best when we don’t have a system in place that’s capable of tracking any of the data we’ll need.

What I’m asking for is the open sharing of ideas to benefit the collective good. I’m not suggesting Google open up a detox on its Mountainview campus. I’m suggesting we invite the Mountainview Campus team down to shadow a detox facility, then share what they see. How can they offer what they’ve mastered in their industry to us, to help win this war.  How can we use their systems to meet our needs?  How did they create a functioning workplace culture, that embraced new ideas?

Picture Amazon making availible to HHS departments executives for two weeks, who shadow, observe, and watch. And after that week, they sit deliver their findings, and work toward fixing what’s broken. They help us see things they way they see them.

I’m calling on captains of 21st Century American industry to help  us win this war. I’m calling on policy makers to lean heavily on their staff to help make this happen, because you know as well as I do how reluctant they’ll be.  And I’m calling for a third party non-profit to handle the interaction, so that government doesn’t just add a layer of bureaucracy and  so there’s no appearance of conflict of interest for financial gain by anyone participating.

To leaders in these industries, I’m sure you’ve  learned lessons the hard way, I’m sure you have a wealth of resources at your disposal , some of which I’m hoping you’re willing to share to save lives. Nothing proprietary, I’m talking systems, ideas, culture. Help the leaders in our community be better. 

We saw American industry mobilize to fight wars before. Help us figure out a way to make this work. I don’t know what it should look like exactly, or who it should include, but I do know something needs to change, and the system isn’t going to change itself.   

Does this sound like a crazy idea?

Shit yes it does. But maybe that’s not such a bad thing. 

My call is to Silicon Valley, to the leaders of business and industry across the country who feel like they something they’ve created, improved, replaced, something in a way that’s unique and efficient and can be retrofitted into the fight against the drug epidemic on some level, somewhere. It could be leadership, structure, hiring, seminars, culture, growth, planting the next round of leaders, presenting seminars on new advances in medicated withdrawal, literally you have to offer that’s of value, that you need to teach because nobody does it better than you do.

Think of is at the same opportunity granted American industry during the second world war, because those industries benefitted from the partnership as well. Mobil used the resources it was given to increase their overall capacity which continued after the war. Here’s an opportunity to work alongside the public sector, to give back, and teach, to partner, and ultimately, to save lives.

We need you. We need help building an infrastructure that can handle what D-Day.

Any sucker can can change the world once.  Who’s willing to try for a second time?

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