There will be no silver bullet to end the opioid abuse epidemic in the United States. The magnitude of the problem has reached catastrophic levels nationally, warranting the recent declaration of a public health emergency on its behalf. In 2015, over 63% of all drug overdose deaths in the U.S. involved an opioid, accounting for 33,091 deaths. The sharp rise in opioid overdose deaths in recent years has been at the hand of non-prescription opioids, specifically heroin and synthetic opioids like fentanyl.
Despite the rise in deaths as a result of illicit opioid use, experts agree that this epidemic will not stop without addressing the flow of prescription opioids that get people hooked in the first place. In a 2014 survey of those seeking treatment for heroin abuse, over half of respondents claimed that their first regular opioid was a prescription drug. This suggests that one major cause—among multiple causes of this complex issue—is the preponderance of prescription opioids.
New guidelines and regulations have been implemented to limit opioid prescribing. For example, in Massachusetts, patients can opt-in to a non-opiate prescribing directive or request partial fills of their prescription to limit the number of pills in a prescription. These regulations are effective but limited in scope. They do little to address the issue of patients all too regularly being prescribed opioid painkillers in the first place, when a less risky solution may manage pain just as effectively. Fortunately, Disruptive Innovation can.
In healthcare, Disruptive Innovations arise from patients being overserved by a solution. In the case of pain management, overservice manifests itself as the consumption of a product or service (opioids, surgery) that exceeds one’s needs. A recent story published by Michelle Andrews in Kaiser Health News gives a personal account of such overservice, and her orthopedist’s order of 90 percocets (opioid pain pills) after a minor knee surgery. Andrews likened the prescription to “using a shotgun to kill a mosquito.” The over-prescription of narcotics in this manner are coming under new scrutiny as the example above is far from an outlier.
So how does Disruptive Innovation address this type of overservice? When existing solutions exceed consumers’ needs, Disruptive Innovations take root in less demanding applications, typically offering less costly and more accessible alternatives that eventually move up market to displace established competitors. In this case the cost of an opioid painkiller on a population level is high when we consider the costs associated with misuse and abuse. What we need, then, are disruptive solutions that may not have the analgesic strength of that of an opioid, but come at a lower cost in terms of side-effects and risk of dependence.
It’s important to note, however, that patients are not always overserved by their pain meds. In some cases, patients may be underserved when they’re not prescribed enough analgesic to combat pain, resulting in very real costs to patients and society. Thus, the key for innovators is identifying specific circumstances in which prescription opioid painkillers overserve patients, developing simpler, less expensive alternatives that work in less demanding circumstances, and creating processes to determine when their innovative solutions are appropriate alternatives.
Current innovative pain management solutions that are alternative to (or even complementary to lower dose) opioids utilize a more holistic approach to pain management. For example, a program at the Pain Rehabilitation Center at Mayo Clinic integrates multidisciplinary solutions not just for the biological aspect of pain, but also the psychological and social variables that contribute to how people experience pain. Such solutions are tailored to the patients’ everyday life and integrate methods such as relaxation and meditation training, cognitive techniques for managing mood, anxiety and anger, physical therapy, and occupational therapy.
This type of integrated, multidisciplinary approach brings expertise from multiple relevant specialties together to create more non-opioid pain management regimens than would otherwise be possible. This sort of collaboration can also accelerate the widespread adoption of more precise definitions for appropriate use, along with the rate at which new solutions improve and move upmarket for more demanding applications of pain management.
The long-term fix for the excess amount of opioid painkillers in the U.S. will be Disruptive Innovations in pain management that upend the use of prescription opioids. These new solutions will likely develop a foothold in cases where opioids are currently overserving patients, and as we’re already seeing, integrate experiences from multiple disciplines to address the psychological and social aspects of pain along with the biological. Is it a silver bullet for the whole of the opioid epidemic? No. But it is an example of how Disruptive Innovation can address one cause of the complex and catastrophic epidemic.