The Law of Unintended Consequences

I like to imagine that summer is a time for “inceptions.” In my first months as a graduate, I’ve started a new job in a new city. And as an intern with Pilleve, I’ve set my eyes on a new issue area which I assumed would remain really foreign to me. However, familiarizing myself with the nuances of the opioid crisis has been anything but foreign:

With the opportunity to live and work in the DMV area, the epicenter of America’s healthcare institutions, I’ve already started to recognize broad patterns in our understanding and approach to the opioid crisis. Just within my first week, the Pilleve team has had the privilege of presenting in the final round of a pitch competition, attending the 2019 Healthcare Policy Forum and engaging in numerous discussions about the nature of policy solutions from all angles of healthcare. Both events were hosted in part by CareFirst BlueCross BlueShield. At both events, panelists and presenters spoke on the realities facing emerging tech companies working in the healthcare space. The following phrase was iterated as many times as solutions were being flagged:

“Make sure that your company does not offer a solution in search of a problem”

Unintended consequences are..well…just that. They are elusive, unsubstantiated, and indiscriminate to the original intention of any decision-maker. Unintended consequences just happen. However -- after enough time and enough conversation -- it is incumbent upon us to acknowledge the danger of our own best intentions.

A study published in the New England Journal of Medicine offers one perspective on the dangers of finding solutions in search of a problem. It walked me (the reader) through the story of a patient dubbed Mr. P. Stricter regulation of opiate prescriptions revealed an unintended consequence; it’s seen in the increased reliance on illicit synthetic substances by patients facing the same hardship as Mr. P. According to the article, Mr. P was turned away from a total of 7 pain clinics due to their “updated” policies on opiate prescription.

There is a caveat here. Most of the healthcare professionals at both events I attended last week would agree that regulations work. Less opiates are being prescribed, with almost a 22% drop over the last 5 years. That means less pills in fewer bottles and less pills prescribed by physicians.

“We worry about the potential unintended consequences of these medications even if they’re used appropriately. More immediately, it’s difficult to walk into an exam room knowing that we have to significantly reduce or stop a patient’s opioid treatment — and then deal with the lengthy, emotional, possibly confrontational encounter that typically ensues.”

In the last 5 years which documented that 22% drop in opiate prescription, the fatality rate has only increased. In 2017 the death rate increased by 45% from illicit substances like Fentanyl. This was during regulation of overprescription. Before regulation, pills were diverted into the hands and mouths that were not informed about appropriate use. After regulation, entire patients are being diverted into synthetic -- illegal -- means of pain management.

Unintended consequences reveal unconsidered approaches. Regulations and synthetics alternatives are solutions in search of a problem. Fostering trust, monitoring intake, and assessing risk in patients with access to opiates should be our next best approach.

#opioidepidemic #opioidprescriptions #opioidoverdosedeaths

Varad Dabke is a recent graduate from the University of Georgia, with a background in English & international affairs. He enjoys being concurrently exposed to a diverse array of style, content, form and pedagogy employed by both of his majors. Varad likes to consider multidisciplinary approaches to new challenges. His research interests include education policy and design efficiency in community planning. Following the summer in D.C., he plans on pursuing a career in the legal field.


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