Combating the Opioid Epidemic Requires a Plan

When President Donald Trump visited New Hampshire this week to discuss his plan to combat the opioid epidemic, people in attendance were disappointed by his glaring lack of specificity. The state holds the third-highest death rate from overdose and desperately needs a plan to prevent and treat opioid addiction. Instead, Trump gave vague promises of action.

Trump’s visit comes on the heels of Congress’ February allocation of $6 billion to fight the opioid epidemic. But with that funding comes the enormous responsibility of figuring out how to spend it—and both the administration and Congress are at a loss. Attempting to fix an epidemic that costs us around $500 billion each year is, unsurprisingly, no easy task.

Senator Roy Blunt (R—MO), who sits on the Senate appropriations healthcare subcommittee, has expressed an attitude shared by many of his Republican counterparts—that whatever we do, it should “give an amount of flexibility that we can figure out what’s working and what’s not.” That flexibility, which could fuel highly localized solutions based on the specific needs of each community, will require a change in the way we approach the fight against opioids. Trump’s Commission on Combating Drug Addiction and the Opioid Crisis has made some recommendations, but on top of being too gauzy to be helpful, strict limitations on treatment options and other barriers have caused federal policies to fail once they hit the state level.

Without any sort of model or framework in the healthcare policy space to guide efforts, it may be time to turn elsewhere for inspiration. Here, it could be appropriate to lift a tried-and-tested process from the tech world.

When Google, Amazon, and Apple face impossible challenges like this one, they use a delivery strategy focused on “minimum viable products,” or MVPs. AirBnB was actually founded using an MVP approach: When the company began, its founders tested the bare-minimum structure by renting out their own apartment to three people for a weekend. They then built on what worked, learned from what didn’t, and created a $2.8 billion business.

What the founders of AirBnB, and so many other tech companies, understand is that MVPs are crucial. They provide a trial phase of a longer-term solution. They’re created with only the most basic, in-demand features and deployed to users rapidly, setting up a feedback loop to iterate enhanced versions of the product. MVPs speed time to market and require significantly less investment than a fully fleshed-out product. Most importantly, this approach fails fast, and can quickly jettison things that aren’t working, shifting those resources to the things that are.

Applying an MVP framework to the opioid crisis could deliver patient-centered solutions quickly and efficiently at a time when implementation on a tight budget is challenging. All 50 states require a comprehensive solution, one that spans treatment, policy, education, criminal justice reform, and community partnerships, among so many other areas. Coordinating and prioritizing those solutions will be imperative to success.

Luckily, healthcare experts and researchers already know the root causes of the opioid crisis, and generally agree on what’s needed for a long-term solution. Now, national leadership must align the states so that they can work on different MVPs, learn from each other, and replicate success stories quickly across the country.

What might this local alignment look like? A comprehensive implementation plan from the federal government might first provide answers to the central questions that states have been asking for years: What should we do first? What’s worked and what hasn’t? After that, the plan ought to define which MVPs to invest the $6 billion in, who’s responsible for each MVP, when results are expected, and how success will be measured and reported.

Answering these questions doesn’t have to be as complicated as it seems. Manageable “work streams,” or groupings of tasks, can be used to organize disparate recommendations into a manageable scope of work for, say, 2018-2019, define the specific goals of the $6 billion, drive implementation, and ensure accountability. A web-based scorecard could provide transparency to citizens, letting them know which initiatives were successful and which failed and have since been abandoned.

Though MVPs and scorecards may be unfamiliar to policymakers, an MVP approach in government isn’t unprecedented. When former President Barack Obama created a new federal agency in 2010—the Consumer Financial Protection Bureau (CFPB)—he called on Silicon Valley to help him design it from the ground up. They used MVPs and a startup mentality to build a small-scale operating version of the Bureau before it was granted a $500 million budget .

But unlike the team that built the CFPB, the implementation team tasked with creating MVPs for the opioid crisis already would have a head start. They have a chance to monitor and build on the initiatives already employed by cities, states, and federal agencies. Buffalo, New York, for instance, launched the first opioid treatment court, which expedites treatment for defendants, getting them help within hours. Vermont has applied a “hub and spoke” model to create a comprehensive treatment plan for addiction recovery. Colorado is modernizing its health policy by passing bills that allow for safer disposal of opioids, prescription limits, and public education. West Virginia has set up a funding strategy that utilizes lawsuit settlements from drug companies to pay for treatment solutions, allowing them to give $20.8 million to nine drug programs. The Department of Veteran Affairs has established transparency guidelines for opioid prescriptions distributed at their hospitals, making it easier to map the epidemic across the country. The list goes on.

These are just a few of the things that we already know are working—and there are a host of other things that we’ve confirmed don’t work. We want to make sure that if one state experiences a failure, the other 49 states benefit from that information and don’t repeat it. The recommendations put forward by the various commissions fighting this epidemic are good, but they’re not a plan. And without a plan, smart and well-intentioned people will siphon away time that could be spent achieving meaningful outcomes. The time is ripe for national leadership to tap into all this potential and create an agile, lean, patient-centered MVP approach.