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Overdose - Service design in the time of crisis

Updated: Sep 17, 2020

Tai Huynh is the Creative Director of UHN OpenLab. He has spent most of his working life in the healthcare industry, first in consulting, then in policymaking. Nowadays he is mostly creating solutions that he hopes will make the health system work a bit better for people. Huynh had wanted to be a scientist when he was younger, but after getting his bachelor’s degree, he decided to step off that road. He went to business school to get his MBA and after a few years of feeling too “left-brained”, he decided to go back to school again to do a master’s in design. “And that’s how I tend to approach problems at OpenLab these days – a sort of anti-disciplinary mashup of scientific, business and design thinking”, he says in his profile on the design and innovation shop’s website.

At this year’s Service Design Global Conference which was held in Toronto in October, he delivered a talk on using service design when it comes to preventing an overdose crisis. “In most crises, you are forgiven for breaking some of the rules. In the overdose crisis, those rules happen to be the law”, he pointed out. He started his presentation by mentioning the SARS case from 2003 when 44 people lost their lives and most of the city of Toronto was shut down. The Rolling Stones had a benefit concert in one of the big open parks. 10 434 lives have been lost in that province since due to the Opioid crisis from 2003-2017 and 2018. “The real tragedy here is the failure of our institutions to do something about this”, he said.

If drugs are bad, why are people doing them?

Huynh believes that Big pharma is behind overprescribing opiates to patients who get hooked. But that’s only one part of the story. He is certain that the context helps designers to understand why the crisis is really happening. “The biggest driver is poverty. When people are growing in a bad situation, they need to find a way to escape”, he said. Turning to drugs and substances is quite common, especially if an individual is dealing with an intragenerational trauma. “The overall picture is quite complex. And to say to people that this stuff is bad and that they should stop using, can’t really resolve the problem”, Huynh says. If fact, many government policies are throwing people in prison. Law enforcement is used as a way to address the problem, but the issue is still present.

What’s the solution?

What a lot of the harm-reduction advocates have been saying for a long time is that there are many reasons why people engage in risky behavior and to preach abstinence isn’t going to solve the problem. The spotlight should be focused on finding a way to reduce harm. An example of this is the widespread distribution of condoms during the HIV epidemics back in the 80s. People were going to engage in a risky behavior anyway, so organizations, engaged with reducing the problem, had to think of a way to keep them safe.

Huynh also talked about two projects that are close to his heart. The first is developed around the idea of providing safe injection services allowing people can use drugs in a safe, supervised way. And the second is about giving people information about the kinds of drugs they are taking.

A bunch of activists in Toronto started the first safe injection site in 2008. Those individuals decided to just set up a tent to allow people to use drugs in a safe way. This was completely illegal, they had problems with the police. This puts harm reduction against the politics of running neighborhoods. The problem is that 50 000 Americans die within each year. And that number continues to escalate. 7 000 sites are needed to provide services that will keep people safe, but right now they are only 50 of them. “Partially because of the fact that we don’t have enough safe injection services, a lot of people use it alone. Also because of stigma. More than 50% of those deaths appeared because people were alone”, he said. Moreover, there are not nearly enough antidotes to overdose, so organizations advocated for making them available in every drug store.

One of the very first things that Huynh and his team did was to explore and come to some precision around the problem that they wanted to solve. They had to look beyond the community because people were not willing to talk to them. They were usually afraid of the police or the institutions that were supposedly there to protect them. That is when they realized that police officers were taking notes on what happened when it comes to an overdose or a death related to an overdose.

The design team conducted research on 2200 police notes that were taken within a year. Huynh and his colleagues spent a lot of time trying to get to know people and develop some trust with the community. They have worked with more than 1000 people who use drugs, but out of respect for them and not wanting to stigmatize them further, they did not take any photographs of the process. Now the antidote to an overdose can be found in any drug store. The problem is that if you buy it beforehand, chances are it won’t be used before it gets expired.

How to take advantage of the resources?

One of the solutions the team came up with is an application with a button on your phone. Pushing the button starts a 2-minute countdown. If you don’t physically turn down the alarm, the administrators will assume that you are overdosing and will send a signal to the people in your network who can come to the scene. It took 2 years to simplify the concept of this solution. The initial idea was to gather people who already work in the field and use them as an army to fight overdosing, to turn them into informal first responders. But the team gave this idea up in order to build a social network that is now at the core of their work.

One of the team’s other projects is related to people not knowing what substances they are taking. For instance, most of 900 samples that were examined were not consisting of heroin but another substance that has massively more powerful effects. This means that you can end up with a badge that can kill you. You can also get arrested for possession. That is why it is important to spread the message throughout the community. “In a time of crisis, you have to break some of the rules in order for something to work”, he said and concluded that power institutions need to play a bigger role in these situations.

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