Authors: Petter Törnberg, Abhimanyu Sud, Fiona Webster
Title: The Opioid Epidemic as a Sociotechnical Crisis
The factual building blocks of the origin stories of the opioid crisis currently ravaging countries around the world are at this point well-established and widely accepted, but what lessons to draw from this is largely a function of how these blocks are put together; that is, how the story is told. A tendency for these stories has been to emphasize one or another actor in the crisis – be it pharmaceutical companies, regulatory agencies, physicians, or substance users. At the same time, factors point to there being more systemic underlying dynamics at play, which tend to be lost due to the lack of systemic perspectives.
This paper finds such a systemic telling of the story through the lens of the innovation and sociotechnical transition literature, arguing that the opioid crisis is not fundamentally different from other types of sociotechnical transitions. The paper integrates two literatures on technological change that both emphasize the systemic and complex nature of technological change. First, the Multi-Level Perspective (e.g. Geels 2002) is a middle-range theory that conceptualizes overall dynamic patterns in sociotechnical transitions, focusing on the interaction between institutional, conceptual, and cognitive transformations. The second literature is the complexity-informed “exaptive bootstrapping” perspective on innovation (e.g. Lane 2016), which focuses specifically on the dynamics of cascades of innovation crises, and the way unsustainable innovation systems can produce cascades of endogenous societal crises.
Together, these approaches provide a framework for how the innovation dynamics of the nexus of contemporary health care and pharma industry – what Moran (1995) calls “health care as an industrial capitalist state” – brought about a crisis that is simultaneously contingent and predictable. This telling implies that the opioid crisis unfolded along similar trajectories as a range of other societal crises, pointing to that the lessons that are to be learned are not only broader than about a few bad actors, but also broader than questions of the health-care industry: the systemic failings in the processes of pharmaceutical innovation can be traced to questions of the sustainability of how we as a society organize our innovation processes.