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Citizen Brief


The Pain Opioid Epidemic  

The Pain Opioid Epidemic 


The citizen brief is central to reclaiming the role of the citizen in the body politics. It is a stand alone document addressing a particular societal challenge, i.e the opioid epidemic. The citizen brief is utilized to establish a framework for a citizen oriented treatment plan that provides a comprehensive, multi stakeholder and multi phase road map for citizen involvement in their political ecosystem. It is best used as part of The Medical Case Presentation. The complete citizen brief provides a vision for the issue reframes a problem, provides data, discusses the various issues and proposes actions that can be undertaken by the citizen to address the problem.

The Pain Opioid Epidemic Project (Opioid Project)  is an ambitious multi year experiment in citizen engagement inspired by the belief that we as citizens must engage with our fellow citizens and relevant stakeholders to achieve solutions to the challenges that face our communities and our nation. The Opioid Project tests the hypothesis that citizens, provided with relevant, reliable, timely  information and tools, can be trusted and should be involved in solving complex problems in their community and nationally.


The pain opioid epidemic touches all of us to varying degrees. Some of us are struggling with a family member who is in the hell of opioid addiction, others suffer with severe pain and fear the lack of availability of opioids for relief, others are dependent on opioids prescribed for minor trauma, still others are in treatment for the disease of opioid dependence. It is up to all of us to prevent and reduce abuse, misuse, overdose and death from prescription drugs while at the same time making sure that those suffering with pain receive effective, safe evidence-based care.


The medical case presentation as an organizing framework to examine the “vices” of our political system. The challenges of the opioid crisis as a symptom and the role of the political and social ecosystem in its emergence, devastating impact and potential treatment will be introduced. To examine the challenges associated with the opioid epidemic we use the complexity lens to lay the foundations for a different way to understand the body politic and strategies to enhance, effective citizen engagement. In particular, building on Madison’s beliefs and the constitutional architecture they inspired, we examine the role of federal, state and local governments as well as non-governmental private and not-for- profit stakeholders and other “factions” in the emergence of this complex problem. Given the unique bipartisan support for action on all levels of government to address the opioid epidemic, it presents an opportunity for representative analysis of the pathology and potential for government action for its “cure”. Specific stakeholders such at the DEA (executive branch), Congressional committees, the judicial system, regulatory organizations (The Joint, overseeing hospitals), medical societies (AMA), Pharmaceutical companies, citizen groups, the media will be highlighted.



Pain and its treatment is part of the human condition and at the foundation of medical practice. Medicine as a profession,  including physicians, nurses, dentists, podiatrists, has been challenged to alleviate pain and its consequences. Drug discoveries to alleviate pain have led to restored function for many, however opioids, have become a major treatment option.  In the 1990s, responding to the challenge of inadequate pain management for patients suffering with severe pain, the medical profession, supported by specialized professional associations guidelines, national regulatory organizations and public policy initiatives treated pain complaints with pharmaceutical agents aggressively promoted by drug manufacturers who earned billions of dollars from the expanded use of their products. Unscrupulous medical professional driven by greed opened “pill mills”, essentially selling drugs to drug dealers and opioid dependent individuals.

The Ecosystem:

The opioid epidemic is a wicked problem confronting individuals, families, communities and our nation. Wicked problems are complex problems, requiring an understanding of symptoms on multiple levels. The challenge of pain opioid epidemic is best understood from the complexity/ ecosystem lens. The review of system (ROS) of the  pain opioid ecosystem is incorporated into the Case Presentation and serves for testing the use of the case presentation in addressing policy challenges. Citizens4health adopted systems thinking as a way to clearly illustrate the complex ecosystem of the pain opioid epidemic to highlight the various stakeholders and their roles, incentives and dynamics. The complexity ecosystem framework, which explores the multiple nested stakeholder nested in subsystems within the larger complex bio-psycho-social -political landscape that defines the current epidemic,  provides a good way to address the opportunities and barriers to improve the approach. We highlight the importance of transparency and accountability of the data, consider the role of the citizen and provide an action plan for personal, social, political engagement in the ecosystem.

Data and Facts:

Pain Disorders:  The numbers, cost and disability caused by pain disorders. Available treatments. 


Opioid Use: The number of prescriptions, expense, and related data. 


Opioid Dependence: The number of individuals who have become dependent on Opioids.


Opioid Overdoses: The number of people who overdosed, hospitalized, died, cost. 


"The War on Drugs": The number of people convicted, the cost of the criminal justice approach. 

Best Practice:

This systematic clinical evidence review addressed the effectiveness of long-term opioid therapy for outcomes related to pain, function, and quality of life; the comparative effectiveness of different methods for initiating and titrating opioids; the harms and adverse events associated with opioids; and the accuracy of risk prediction instruments and effectiveness of risk mitigation strategies on outcomes related to overdose, addiction, abuse, or misuse.


Developing and updating evidence based inventory of clinical, social, legal and public policy materials and process related to the our vision.  We start with focusing on pain to be followed by opioid use conditions, overdose prevention and addressing "the drug war".


Take Action:

The take action section provides ways you can take part in addressing the Pain Opioid Epidemic. Whether you would like to better understand your personal experience with  pain or opioid use, or you are interested in making an impact on a social challenge, you will find actions that can help you, your family as well as your community.  The specific actions are divided into personal, social and political actions.  


Get Personal: Action that will allow you the best personal outcome in addressing the challenge of Pain, Opioid Use, and Opioid Dependence.


Get Social: Actions that will impact the availability of evidence based, best practice interventions that you can undertake  to address the challenges of Pain and Opioid use in your community (Social Ecosystem)


Get Political: Actions you can undertake within your political ecosystem to have a meaningful impact on the Pain-Opioid Epidemic.

Join our Effort:

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