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Stanford Medicine X helps code-a-thon participants shape strategies for opioid crisis

Bill Williams is a teacher and theater director who lost his 24-year-old son to a heroin overdose in 2012.

Ashley Elliott is a former addict who journeyed to recovery through two stints in rehab, jail, a halfway house and a 12-step program.

Joe Riffe is an opioid-dependent emergency medical technician whose job puts him in touch with drug abuse almost daily.

And Frank Lee, MD, is a pain management specialist who, as a “conservative” prescriber, sends his patients home with more than a million pills every year.

All, in their own way, have been battling the opioid epidemic for years. But in Washington last week, they came together to try something new.

At a code-a-thon hosted by the U.S. Department of Health and Human Services, they worked alongside developers, as “end-users” of a sort, to validate potential solutions to the opioid crisis as they were conceptualized by competing teams over a 24-hour period.

Their participation was thanks to a Stanford Medicine X effort led by Professor Larry Chu, MD, MS, which assembled and mentored the stakeholders, hosted a design workshop ahead of the code-a-thon start and helped to establish the criteria by which contestants’ work at HHS would be judged.

Medicine X facilitators stressed empathy.

The unknowns presented by a public health challenge “typically revolve around humans,” Nick Dawson, executive director of the Johns Hopkins Sibley Innovation Hub, said -- meaning traction can often be gained simply by “giving people back their dignity.”

Implemented in the design workshop, that meant centering small pods of experts from academia and medicine around the stakeholders: Williams, Elliott, Riffe and Lee. Guided by a team leader, each group explored the issues in the current approach to battling drug addiction, with a focus not so much on solving a massive, complex problem, but on finding entry points to it – and on practicing listening.

As the pods worked, they identified three pain points in the opioid crisis:

  • lack of an actionable definition for the term “addiction”
  • lack of counseling and treatment for families of drug abusers
  • the need for the re-education of health care providers on issues of stigma and patient-doctor communication

When Department of Health and Human Services CTO Bruce Greenstein stopped by in the afternoon to thank participants for their efforts, he acknowledged the difficulty of the task at hand. “We are stuck," he said. "We can’t figure this out. We keep putting money [in], but we don’t have better results.”

Experiments like the one led by Stanford Medicine X, he said, are a crucial complement to efforts already underway: “I don’t think we could afford the amount of talent we’re getting for free here."

Ultimately, Greeinstein awarded $10,000 each to three concepts developed during the ensuing code-a-thon. They include: a visualization platform that juxtaposes major opioid use and anti-drug initiatives in a given area; a database that shows how prescribing behaviors vary physician to physician; and a prediction algorithm that would allow emergency personnel to allocate Naloxone, a drug to reverse overdose, more intelligently across regions in need of it.

Not a comprehensive solution to the crisis, for sure, but a “step in the right direction,” Joe Riffe, the opioid-dependent emergency responder, says – if only toward a more patient-centered approach to medicine and public health.

Previously: At code-a-thin, participants asked to develop solutions to combat the opioid epidemic and Misconceptions about opioid abuse: A Medicine X discussion
Photo of Joe Riffe, Ashley Elliott, and Sean Young by Ken Cedeno
Additional reporting by Julia James

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