Eliminating Opioid Addiction in the VA
Area of Study: Co-Design
Duration: April 2017 - May 2017
Team Size: 3 people
Role: Researcher, Experience Designer
Keywords: co-design, social design, research
There is currently an opioid epidemic in the VA. In the last 20 years, the rate of prescription of opioid painkillers has skyrocketed, leaving many veterans with addictions to manage. Even worse, many veterans are using opioids to treat their PTSD. There is really no support in place currently to help veterans beat their addictions. What we need to do is find a way to prevent addiction from happening in the first place. We cannot prevent chronic pain from happening, but we can change how pain and PTSD are managed.
We were significantly restricted by time. We had less than a month to complete this project. Fortunately, I had an excellent team of two other individuals with user experience backgrounds.
We create a stakeholder map to get a sense of distribution of players in this issue. Some of the most concerning parts of this stakeholder map are the breakdowns and their severity.
Doctors are encouraged by pharmaceutical companies to prescribe their painkillers. This is big reason why the rate of prescribing has fluctuated so much in the last 20 years. Pharmaceutical companies claimed early on that their painkillers were not addictive and that there was no risk in prescribing. We know this to not be the case now that so many veterans are saddled with addictions to these pills.
Veterans in the throws of addiction can behave in destructive ways. Some veterans even end up committing crimes in order to pay for the painkillers they need to feed their addiction. Some even end up going to prison because of an addiction they did nothing to deserve. This causes extensive suffering for the families and friends of the veteran in question.
It would be hard to come up with a solution to the opioid epidemic that managed the problem after the veteran becomes addiction. In this way, we want to prevent rather than intervene in the addiction. In order to find what could be the most impactful players in prevention, we did a power vs. interest chart to identify those individuals who are either really powerful or have the drive to want to solve the problem. Ultimately, pharmaceutical companies and the government have the most power to solve this problem, but they probably have the least interest. This is not to say that they don't have any interest, but they have significantly less interest than many other parties in this issue. Those that have the most interest are veterans themselves, psychiatric professionals, and the families and friends of veterans. Those that have significant interest do have power, but it's a different kind of power than the pharmaceutical companies and the government. It's this power that we need to harness to find a way to prevent addiction.
There are two kinds of veterans that develop addictions to opioids. One kind is those that are managing chronic pain. There are many alternatives to painkillers in order to manage pain, but painkillers are often the go-to for many doctors. It's not hard to see why - pharmaceutical companies are pushing these drugs and it's much cheaper to prescribe than to spend time and resources putting a veteran through PT or teaching them about mindfulness as a way of pain management (for example). The other kind of veteran is those that are managing PTSD. They see painkillers as a way to shut out the thoughts that have been plaguing them, and thus may fake injury in order to get a prescription
We used a timeline of a veteran's journey to see where where we could prevent addiction from developing. The team decided that the best chance any veteran would have would be in basic training. More specifically, we thought that there may be ways to increase coping methods in the context of basic training. We wanted to develop the outline of a co-design session in order to co-create an experience for soldiers that include the development of coping skills such that veterans, whether managing pain or PTSD, have a foundation in coping already.
Design - Organizing the Co-Design Session
We decided we needed representation from the VA, the Army, and coping specialists in health and wellness in order to develop a solution that would be most effective. The co-design session would be held at Fort Bragg, North Carolina, and deliverables from this session would include such artifacts as a veteran journey map and a 2x2 matrix of self care practices that already exist in a soldiers life such that we can find opportunities to build off of these.
One of these schedules is participant facing while the other is design group facing for us to plan on outcomes and make sure we come prepared with the right materials.
Outcomes - Co-Design Artifacts
While this co-design session never actually happened, here are some artifacts that would have come out of the co-design session. You can see that there are many acts of self-care that already take place in a soldiers life. The ideas now is to build off of these such that self-care and methods for coping become second nature, just like the honing of other skills in basic training.
The yoga and meditation specialists ultimately would need to work with the other parties present at this co-design session to produce actionable ways for the Army to incorporate self-care into basic training such that it becomes second nature. Basic training is meant to break a soldier down and build them back up as soldiers. If a part of that build up could be effective self-care practices, then throughout a soldiers journey, they would have these skills to draw from.
Civilians cannot begin to completely understand the journey of a soldier, but our hope was to create a solution with veterans so that their voices would be heard, and thus this would be a veteran-driven solution. I would like to someday have this co-design session so that perhaps we could really put a stop to what could be a soldiers journey into addiction. It seems so unfair that the people who have served our country are made so vulnerable. They deserve better, and I think having a veteran-driven solution is the best way to do this.