Overview

Title

Opioids in the Workplace

Summary 

This study is from a service design jam. As a team of six, we sought to address the opioid crisis. Specifically, we wanted to design and introduce a preventative program in the workplace. After intensive research and detailed storyboarding, were able to conceptually build and present our “Pain-Free” Program.

Date

November 2018

Tools + SKILLS

Literature review, interview, persona development, journey mapping, service blueprinting, storyboard narrative

Exposition

Challenge

Design a solution that addresses opioid abuse in the workplace.

WHO/HOW/WHY

• Who are we designing for?

  • Employers, employees dealing with addiction, employees who are family members of those dealing with addiction

• How pervasive is it?

  • 70% of businesses say opioid use affects workers

  • Employees cannot be hired because they cannot pass a drug test

  • There are injuries on the job, people are overdosing on the job

  • Family members, who are also employees, are distracted

• Why the workplace?

  • It raises healthcare costs, limits employee availability and reduces worker productivity.

Process

Our team started by diverging in our research pursuits, so that we could gather as much information as possible. Because there is a lot to tackle when addressing opioids in the workplace we focused our efforts. We created a “How Might We” statement to narrow our problem space.

HMW statement: How might we incentivize employers with high risk industries to establish preventive programs for their employees?

findings from the literature

• More than 50 million Americans suffer from chronic pain, 25 million live with daily chronic pain.

• More than 2 million Americans have opioid use disorder (OUD).

• Even more abuse opioids and in 2017, more than 47,000 Americans died from an opioid overdose.

The opioid crisis reaches across all facets of family and community life. It causes stress, minimizes opportunity and depletes resources in all of the domains it pervades. Therefore, it requires collaboration and attention from not just the patents and physicians, but from advocates, families, academic experts, community leaders, private sector leaders, federal partners, policymakers, employers, everyone.

In addition to extensive network of people needed to find a solution, we found that it is important to consider the extensive continuum of care needed to treat OUD. This includes overdose prevention, medication-assisted technology, mental health services, job training, housing, and family support.

Detox→ Rehab→ Transition Services→ Halfway House→ Sober Homes→ Outpatient Services

Existing solutions

• HEAL Initiative by NIH: A series of intersectional studies and strategies focused on prevention and treatment for opioid misuse as well as enhancing pain management.

• Opioid Toolkit Program: A toolkit that includes two doses of Narcan, a mask, gloves and instructions for employees to respond to opioid overdoses on-site.

• Warn Me Labels: Label to put on prescription cards that lets medical professionals know that patients want to discuss risks of prescribed opioids because the label includes list of questions to ask of doctors.

• Hey, Charlie: Behavior modification app that responds to environmental triggers and logs data for doctors and families to see risky behaviors after patients leave hospitals or rehab centers.

Key findings and quotes from interviews

Shawn Nehiley, Iron worker, recovery addict

Shawn got injured severely while working at work. His doctor put him on oxycodone to relieve the pain. Shawn continued to go to work shortly after the fall. He worked through his pain, because if he didn’t, his family wouldn’t have health insurance. He did not get paid days off, so every hour counted toward his insurance, pension and paycheck. In order to alleviate the pain, he continued to take oxycodone.

“The switch got turned on in my head and it took 10 years to shut off.”

And then, he got addicted.

“The reality is that it’s not about will power...Next time you have diarrhea, try will power- tell me if that stops it”

Bobby, VP of Local 7, Ironworker

Bobby fell and broke both of his wrists. A physician prescribed him percocets. The physician did not check in regularly enough and when 9 months passed, he tried to wean Bobby off the medication. At that point, it was too late. It took 5 days to get addicted.

“The pain of coming off the opioids is worse than the broken bones.”

After “losing everything”, Bobby went to prisons and jails to detox. He opted for these solutions rather than a reputable detox center because he wanted to avoid a more explicit and public acknowledgement of the disease. The stigma forced him to hide the need.

Bobby knew he was addicted, but he admits that pride became his emotional barrier. Opioid use disorder often creates self-delusion that convinces sufferers, ‘I got myself in, I can get myself out’.

Bobby thinks this is why he was so scared to ask for help. In retrospect, he wishes more people knew how to approach and ask if he needed help, because he was unable to initiate the conversation.

It seems as though vulnerability and strength are often contrasted as opposites. Bobby’s story shows us just how untrue that is.

“Until I admitted my weakness, I couldn’t stop [choking up]...and that was my strength...admitting I was powerless.”

Takeaways: Opioid abuse is a disease. The disease is a manifestation of social factors and treatment is prolonged by a similar set of social factors (poverty, stress, trauma, education). Tragically, one of the greatest barriers to treatment is stigma. Solutions and strategies for prevention and treatment need to be equitable. There is not one way in which people get addicted and there is not one road to recovery.

Approaching Resolution

Our team regrouped so that we could summarize and assemble our findings. We each wrote down our key takeaways and facts on separate sticky notes. We then rearranged our notes into participant, opportunity and affinity clusters in order to identify patterns.

We identified six design principles that we wanted our solution to address and satisfy:

1. Establish trust

2. Increase access to help

3. Easy to understand

4. Actionable

5. Proactive/focused on prevention

6. Personalized

From here, we created a few user personas and highlighted one of these users so that we could create a journey map.

Robin, an 18-year-old is starting as a construction worker. He has not previously used opioids. His major motivations are to learn quickly, not get injured on the job, and to build camaraderie with his older, experienced co-workers.

We started journey mapping the stages of prevention in order to visualize what our potential solution needed to encompass: awareness, trigger point, procedure, treatment, and recovery. Then, we tried to pinpoint where the major shortcomings are in the existing system of OUD prevention. Finally, we introduced Robin to this map, meaning that we tried to anticipate his needs, emotions and behaviors at each stage. This materialized as a storyboard narrative.

A service blueprint helped identify all the process, channels and resources required to implement our prevention program solution. We were able to better understand how Robin, the program touch points and the “behind the scenes” actions would exist in one integrated solution.