What is the Exit Strategy?

I can’t recall a TV series or movie having such an impact on me. Maybe not since watching Band of Brothers in 2001 had something impacted me so profoundly. But after finishing the Netflix series Painkiller, a docudrama about Purdue Pharma, the Sackler family, and the crippling Oxycontin/opioid epidemic, I felt so many, for lack of a stronger term, things:

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Anger

Disgust

Sadness

The need to take a long shower

The desire to burn my pharmacy license and just walk away from healthcare

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As I put in a text to a friend who had recommended the series and felt the same post watch feelings, I just felt “icky.”?

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I am not here to talk about the specifics of the show, or the tragic story that ruined countless millions of lives. But instead? a broader view of what happened, and how anyone can try to avoid a similar mistake.

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Because as a pharmacist, I can say this: starting a medication is easy. All it takes is a willing provider, patient, and friendly neighborhood pharmacist to fill that legal document called a prescription and boom: intervention started.?

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Oftentimes, this comes without true shared decision making from the patient and provider. Oftentimes after that provider has been fed cooked up statistics (as well as some sort of cooked up fancy meal paid for by the drug company) about how “this time” the drug has few side effects and a “game changing” outcome. With influence like that, and a promise of no downside and only upside, getting started is easy.

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But what about the hard part? What is the exit strategy? For a medication like Oxycontin, it was ever increasing doses to overcome the tolerance patients inevitably experienced. But what about addressing the root causes of the pain? The potential for addiction? Getting a person off the medication? Oh, well, it would not have been in Purdue’s interest to have a person come off the medication. Where would their blood money have come from?

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Oxycontin is an easy, if sad target. And I work in the world of diabetes, and there is a whole world of new medicines that promise to help patients lose weight and improve their blood sugar. But what does the data say when we stop the meds? Oh, that’s right. The weight comes back, the blood sugars rise, and the patients become lifelong revenue streams for Big Pharma.

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Because these drugs, and many medical interventions, aren’t designed to have an exit strategy. The exit strategy is “lifelong dependence.”

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But it’s not just medicine. How many countries have started a war, but haven’t thought ahead of what the end looks like? What should the exit strategy be? The United States has a few tragic examples in the last half century that proves the downside of starting something without a plan to exit.?

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Now, these are big examples with players on a national stage and lives that have hung in the balance. But the idea of having an exit strategy can be taken down to a personal level.?

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How many people started college with one major in mind, realized they didn’t like it, but were too scared to change course? They didn’t have an exit strategy or plan to get out from the path they started. Or how about a job you didn’t like but had no way out? Or a car or house purchase that left you in debt with no exit available?

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I know it is popular opinion to “have a positive attitude” and I am not saying walking around in a negative headspace is a productive way to go through life. But it is foolish to assume everything we start, every intervention that happens, will go swimmingly according to plan. I think it is always wise to think of a way out of whatever you started.

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Because it’s easy to put on your Pollyanna Glasses at the start of any idea, project, or business and assume things will go great. It’s when shit starts going south that a good exit strategy is key. Otherwise, you may fall victim to the Sunk Cost Fallacy, throw good money (and time), after bad, and refuse to change course, or worse, have no course you can change to.

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And that is what happened to so many who were caught up in the tragic and deceitful Oxycontin epidemic. What for many honest, hard working people started as a minor injury was fed until it was a full blown addiction because there was no plan to stop the pain medications. So whenever you are asked to start a new drug, intervention, or venture in life, think about what the end may look like, if you have a path out, and perhaps more importantly, if the one doing the intervention to you would stand to profit if you were never able to stop.

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Hey, you read the whole thing! You go, you! If you enjoyed it, please comment or share to help others find it. If you find that a short newsletter just a few times a week isn't enough, why don't you go check out my book, "Permission to Care: Building a Healthcare Culture that Thrives in Chaos"? I also speak to groups! Send me a message if you think I'd be a good fit for your next event. Thanks so much again for reading.