Using the Problem-SolvingApplication Case (screenshot attached) entitled "OPIODS, PAIN RELIEF, GRIEF, AND PURDUE", what concepts and/or tools are most relevant for solving the key problems in this case study? Using your own experience and knowledge, what recommendations would you make in order to solve this problem? Remember to use the 3-Step Problem-Solving Approach at the bottom of the page (last page, screenshot attached) to examine the case study in detail. Book : Organizational Behavior: A Practical, Problem- Solving Approach, 3rd edition. Author: Kinicki A.

Page 192 PROBLEM-SOLVING APPLICATION CASE Opioids: Pain Relief, Grief, and Purdue HISTORY OF OPIOIDS AND MEDICAL USE The human experience contains both joy and pain, and physical forms of the latter have many causes. from disease to trauma. Since the 1800s humans have been treating pain with opioids. a class of very powerful painkillers extracted and created from the opium poppy. such as heroin. morphine. and codeine. To provide a sense ofthe long history and use of opioids, it is interesting to note the Bayer Company manufactured heroin for commercial sale in 1898. lOne of the major uses at the time was as a cough suppressant, and notjust for pain relief. The addictive properties became well Known by the 1920s and the sale of heroin was banned."5'GI World War II was a turning point in opioid use. The scale of the war resulted in enormous numbers of injuries and soldiers who suffered from both acute and chronic pain, but physicians then had a limited arsenal with which to treat such conditions. nycodone, manufactured from a chemical in opium, was one of the drugs used in what was then the early days ofwhat we now refer to as pain management. New drugs entered the market in the 19?Ds, like Percoclan [oxycoclone and aspirin] and Percocet [oxycodone and acetaminophen). but most physicians were taught to avoid prescribing such highly addictive medications to patients.151 CHANGING VIEWS The scenario began to change in the 1980s when an article printed in the New Engfancl Jour'nafofMeo'icine pushed back against the perceived dangers of prescribing opioids. The physician author claimed addictions were rare in patients with no history of addiction, and adverse effects were no greater than those of other drugs.152 People with chronic pain. such as those with terminal illnesses. became the new patients for opioids. In a few short years, physicians' perceptions had changed, and the risks of abuse and addiction were seen as relatively low compared to the benefits for patients in otherwise clire circumstances.153 Although addiction and abuse were very real. by the 1990s medical opinions were shifting and prioritizing pain management as a primary motive and responsibility for physicians everywhere.154 This resulted in a much greater use of opioids, which to this point had all been very fast-acting. This was problematic for millions of patients whose pain was more or less constant, such as those with cancer, since fast-acting pain relievers had to be taken about every four hours. Longer-acting and safer alternatives were desperately needed .155 L ENTER PURDUE PHARMA AND OXYCONTIN Purdue Pharma is a private company founded by three Sackler brothers in 1952, and it has been run or at least controlled by Sacklers ever since. The family has amassed an enormous fortune, estimated at approximately 513 billion by Forbes in 2016, and have donated generously to universities, medical schools, and museums around the world:155 Tuft's University, University of Nebraska, National Academy of Sciences. New York Presbyterian Hospital. Dia Art Foundation. Global Poverty Project, Victoria and Albert Museum in London, the Guggenheim. and the Brooklyn Museumf Purdue Pharma began testing OxyContin, an extended release version of oxycodone [in use since the early 19005}. in 1994 with the hopes of filling the need in the market: effective and extended pain reliefwith reduced addictive qualities. The drug was approved and brought to market in 1996 as a safe alternative to existing opioids. During the same space of time painkiller prescriptions increased from 2 million to over 10 million per year."51 One current estimate puts total sales of OxyContin at 535 billion for Pu rdue.'IEEII CONDUCT AND CONSEQUENCES Pu rdue's marketing efforts were aggressive and effective. For instance, a doctor in a promotional video stated: \"These drugs. which I repeat, are our best, strongest pain medications, should be used much more than they are for patients in pain." Only a year later painkiller prescriptions had jumped by 11 million, not to 11 million but an additional 11 million. Sales grew from $48 million in 1996 to nearly $1.1 billion in 2000. and this was spurred by dozens of pain managementand speaker training conferences across the US, attended by more than 5.000 physicians, pharmacists, and nurses (all- expenses-paid}. In 2001 alone. Purdue was said to have spent $200 million on promoting the Lise of opioids and OxyContin.150 The goal of course was to educate. and boost prescriptions. After nyContin's launch in 1996. Purdue more than doubled its number of sales reps and provided extremely generous sales incentives. Average annual salaries for reps were 355,000 and annual bonuses averaged over $0000 [ranging from 515,000 to more than $200000}. To spur sales further still. representatives provided coupons for physicians to offer to patients a free month's supply.151 Purdue didn'tjust incentivize sales, it pressured them too. Court documents show that a sales VP sent a message chastising the representatives in the Boston sales district. He threatened that if sales of opioids didn't increase then those representatives should be fired; he wanted to send a message. The sales manager allegedly agreed."52 By 2003 nearly half of all OxyContin prescriptions came from primary care physicians. rather than anesthesiologists page 293 and other specialists who previously dominated pain management and treatment. APPLY THE 3-STEP PROBLEM-SOLVING APPROACH TO OB STEP 1: Define the problem. Use the Organizing Framework in [ Figure 7.5 and the 3-Step Problem-Solving Approach to help identify inputs, processes, and outcomes relative to this case A. Look first at the Outcomes box of the Organizing Framework to help identify the important problem(s) in this case. Remember that a problem is a gap between a desired and current state. State your problem as a gap and be sure to consider problems at all three levels. If more than one desired outcome is not being accomplished, decide which one is most important and focus on it for steps 2 and 3. B. Cases have key players, and problems are generally viewed from a particular player's perspective. You need to determine from whose perspective-employee, manager, team, or the organization-you're defining the problem. In this case, you're asked to assume the role of CEO and chair of the board of directors for Purdue (but not a member of the Sackler family). C. Use details in the case to determine the key problem. Don't assume, infer, or create problems not included in the case. D. To refine your choice, ask yourself, why is this a problem? Explaining why helps refine and focus your thinking. Focus on topics in the current chapter, because we generally select cases illustrating concepts specifically located within the current chapter. STEP 2: Identify causes. Using material from this chapter and summarized in the Organizing Framework, identify the causes of the problem you identified in Step 1. Remember, causes tend to appear in either the Inputs or Processes boxes. A. Start by looking at the Organizing Framework (LI Figure 7.5) and decide which person factors, if any, are most likely causes of the defined problem. For each cause, explain why this is a cause of the problem. Asking why multiple times is more likely to lead you to root causes of the problem. For example, do executive characteristics help explain the problem you defined in Step 1? B. Follow the same process for the situation factors. For each ask yourself, why is this a cause? By asking why Page 294 multiple times you are likely to arrive at a complete and more accurate list of causes. Again, look to the Organizing Framework for this chapter for guidance. Did particular policies or practices play a role? C. Now consider the Processes box in the Organizing Framework. Are any processes at the individual, group/team, or organizational level potential causes of your defined problem? For any process you consider, ask yourself, why is this a cause? Again, do this for several iterations to arrive at the root causes D. To check the accuracy or appropriateness of the causes, be sure to map them onto the defined problem and confirm the link or cause and effect connection. STEP 3: Recommend solutions. Make your recommendations for solving the problem. Consider whether you want to resolve it, solve it, or dissolve it (see [2 Section 1.5). Which recommendation is desirable and feasible? A. Given the causes you identified in Step 2, what are your best recommendations? Use material in the current chapter that best suits the cause. Consider the OB in Action and Applying OB boxes, because these contain insights into what others have done B. Be sure to consider the Organizing Framework-both person and situation factors-as well as processes at different levels. C. Create an action plan for implementing your recommendations and be sure your recommendations map onto the causes and resolve the problem.WHERE ARE THE LEADERS IN ALL OF THIS? Amid the growing evidence of abuse in the early 20005. Richard Sackler, then chairman and president of Purdue. fought back, advising the company and its representatives to push the blame onto the addicts themselves. He was quoted as saying. "We have to hammer on abusers in every way possible. . . . They are the culprits in the problem. They are reckless criminals.\"153 These aggressive tactics ultimately cost the company over 5600 million in fines, when in 2007r three executives pled guilty for misrepresenting the dangers of lDID-cyContin. The Sac klers, however. were not accused and faced no personal repercussions. The Sacklers and Purdue Pharma pressed on and explored selling the product in countries with no controls on such medications while at the same time expanding promotions in the US. OTHER CONTRIBUTORS At the turn ofthe millennium some regulatory changes accelerated the popularity of prescription painkillers. The Joint Commission, a major governing body that reviews and accredits hospitals and medical centers, began requiring all patients to be assessed for pain and failing to do so effectively would result in a sanction. The Joint Commission printed a book in 2000 to be used by physicians in continuing education seminars. citing the evidence for opioid addiction was limited and their use effective. (Note: The book was sponsored by Purdue Pharma, and the Joint Commission removed this standard in 20093154 In 2010 Purdue Pharma released a new formulation of nyContin. one which was reformulated to make it more difficult to crush and snort, as was commonly done by those that abused it. This was done in response to the growing evidence of abuse, but research and clinicians continued to question the efficacy of this reformulation. WHERE ARE WE NOW? By 2016 the director of the Centers for Disease Control. Dr. Tom Frieden, wrote in the New Engfand Jayme! of Medicine; "We know of no other medication routinely used for a nonfatal condition that kills patients so frequently." He noted that data on longterm opioid use was still lacking. but what he did know at the time was that perhaps as many as 26 percent of patients using opioids for chronic noncancer pain become dependent on it."55 In early 2019. Massachusetts Attorney General Maura Healy charged Purdue Pharma and eight members of the Sackler family with exacerbating the opioid epidemic. The indictment accuses them of personally micromanaging a longterm deceptive marketing campaign to encourage hundreds of employees and tens ofthousands of physicians to inappropriately prescribe Oxycontin. Citing the CDC, AG Healy claimed approximately 400,000 people died from opioid overdoses between 1999 and 201?, and the family's role was central and thus they should be held accountable. Thirty-five other states are also suing Purdue Pharma for downplaying the risks and promoting Oxy as a less additive alternative opioid.155 Assume you are the CEO and chair ofthe board of Purdue. but not a member of the Sackler family. What would you do