The Opioid Crisis in Indiana: Strategy as a Wicked Problem

We are working with Purdue Health Advisors and the Purdue Regenstrief Center for Healthcare Engineering on a tough topic.

How should the State of Indiana respond to the growing opioid crisis?

Here are some basic facts:

  • At least 11 state agencies are involved in addressing this crisis;
  • In 2016, the state created the Commission to Combat Drug Abuse to coordinate these activities;
  • The state has a difficult time keeping up with how individual communities and counties are responding;
  • Opioid deaths have nearly doubled since 2010;
  • In 2015, Indiana saw over 500 overdose deaths from opioids;
  • The sale of prescription opioids increased four-fold in the US from 1999-2014;
  • In Indiana, an average of 109 prescriptions of painkillers are given per 100 persons, significantly greater than the national average;
  • The Center for Disease Control estimated the cost of abuse to the US was over $78B in 2013, and 25% of these costs were funded by public sources such as Medicaid;
  • There is limited evidence on effective programs that help to provide clear guidance to state programs.

In other words, the opioid epidemic in Indiana shared all the characteristics of a “wicked problem”. In a 2008 Harvard Business Review article, John Camillus points out that wicked problems cannot be solved, but they can be tamed. (See the Camillus article, Strategy as a Wicked Problem.) He points out that:

  • A wicked problem involves many stakeholders with different values and priorities;
  • The problem emerges from causes that ate confusing and tangled;
  • A wicked problem is dynamic (it changes); and
  • A wicked problem has no clear solutions.

To address this wicked problem, we are recommending the development of a series of pilot projects, anchored by our agile strategy discipline, Strategic Doing. Within each pilot, Purdue would help the community convene

Over the past four years, we have seen neighborhood residents in Flint, MI using this discipline to deal with complex, wicked problems like teenage homicides. They make progress by coming up — not with one solution — but with a swarm of promising solutions.

Equally important, the residents of Flint became the “solution designers”. We simply provided the discipline of simple rules they could follow to address really complex challenges. As they launched experiments, they learned what could work. They then expanded on the successful initiatives. The result: They began reducing the teenage homicide rate.

We think the same lessons and insights can be applied to the opioid crisis.