Could a Hackathon Help Solve the Heroin Crisis?

What’s the value of crowdsourcing technological solutions to societal problems? Could a hackathon help solve the heroin crisis in Cincinnati, Ohio? Professor Mitch Weiss discusses the underlying skepticism and emerging realities that unfold during protagonist Annie Rittgers’ journey to organizing a successful hackathon in his case "Hacking Heroin."

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Recorded September 25, 2017.

Transcript edited for length and clarity.

Brian Kenny: In 1810 a new painkiller, named after the Greek god of dreams, Morpheus, was introduced in the United States. A derivative of opium, morphine was considered miraculous by the medical community, in its ability to treat severe pain. But, there was a problem: it was highly addictive. During the Civil War, morphine addiction reached epidemic levels among soldiers in the US, and doctors were completely in the dark as to how to treat it. That is, until 1874 when a new drug arrived from Bayer, the German pharma company that first brought Aspirin to market. The new drug, named heroin, after the German word for heroic, promised all the benefits of morphine with none of the side effects. It was advertised as the safe, non-addictive painkiller. There was even a version available for children. Bellevue Hospital in New York admitted its first patient for heroin addiction in 1910. Just five years later, they admitted 425. In 2017 the White House declared opioid addiction a national health emergency. And heroin is contributing exponentially to opioid-related deaths, which have increased 439 percent from 1999 to 2014 according to the Center for Disease Control. Today, we'll hear from Professor Mitchell Weiss about his case entitled Hacking Heroin. I'm your host, Brian Kenny, and you're listening to cold call.

Mitch Weiss is in the Entrepreneurial Management Unit at Harvard Business School, and he created and teaches the school's course on public entrepreneurship. Prior to joining HBS in 2014, Mitch was chief of staff to the late Boston mayor, Thomas Menino. I assume that heroin was a problem in Boston at that time, as it is everywhere else. Mitch, thanks for joining us today.

Mitch Weiss: Thank you for having me.

Kenny: This is a really timely case study in a sad way. This is a huge problem, and I think people who read the case will immediately be able to relate to it. Can you set up the case for us? Who is the protagonist and what's on her mind?

Weiss: The protagonist of the case, Brian, is Annie Rittgers. She's the founder of 17a Consultancy in Cincinnati. She's a budding entrepreneur in her own right, and she finds herself at Union Hall. Union Hall was in Cincinnati in their Over-The-Rhine neighborhood, which has become one of these neighborhoods where a small hotbed of technology and entrepreneurship are bubbling up. Union Hall is their incubator, accelerator gathering space. She's pulled together a team to organize a hackathon to address the opioid crisis in her home state of Ohio.

"If I'm being honest about it, I was actually more than curious; I was pretty skeptical"

The hackathon is a ways away at this point. It's going to be held in Union Hall, and something close to 50 people have signed up. She's not sure whether they will show up. They've come [up with] eight challenges to give to hackathon participants. She's not sure if maybe these are too broad, if they're too narrow. The sponsorships for the prizes had been slow to come in. They're dribbling in, and Annie is not quite sure what to make of all these uncertainties. She's wondering, one, maybe these are signs that there's something I could be doing here in the dwindling days before this hackathon is going to take place, but what should I do? She's also wondering a little bit whether the hackathon skeptics have been right all along. What kind of way is this to address a problem of epic proportion anyway?

Kenny: How did you find out about this? What prompted you to write the case?

Weiss: Well, Annie was a student of mine. What prompted me to write it was that I had been curious about hackathons as a way of doing idea generation. In my course in public entrepreneurship I was adding a new module on ideas, where do they come from, and especially of whether they should come from inside government and inside experts, or whether they should come from the outside. I was curious about these as a way of sourcing ideas. And, if I'm being honest about it, Brian, I was actually more than curious; I was pretty skeptical.

I had been to too many meetings where I was either in government or in business, where there was a big intractable problem and people said, "How are we going to address this problem?" And somebody would say, "Hackathon." I was wondering, are they just throwing up their hands?

Kenny: What is a hackathon?

Weiss: A hackathon is basically a two-, two-and-a-half-, three-day gathering of people from diverse backgrounds, often to work on a hardware or software solution to a problem. And typically, they end up working in teams of four or five people over the course of say, a weekend. They start the weekend with a sense of what the problem is and maybe some ideas, and ideally they finish the weekend with a prototype, or even a product to try to address the problem.

Kenny: Why did Annie decide to get involved?

Weiss: Annie grew up in Ohio. She ends up on the East Coast, going to college, going to business school and law school at Harvard, working in investment banking, working at consulting for McKinsey. She felt like she was becoming too distant from her native Ohio; she wanted to return back there. She was looking for a way to return that would really reengage her with community in a very active way. In addition, she was struck, I would say brokenhearted, by how prevalent the heroin and broader opioid epidemic had become in her home state, and was wondering whether she and others together might be able to do something about that.

Kenny: Just how bad is this problem in Ohio and elsewhere?

Weiss: In the case we cite this 2015 statistic that drug overdoses killed about 52,000 Americans that year. The New York Times recently looked at emerging data from 2016. Drug overdoses killed roughly 64,000 people. So, first of all it gives you a sense of the size of this, and also the size of the growth. That's a 23 percent increase in just one year. To give you some context, The New York Times also reported this is higher than, say, peak car crashes were in 1972, higher than peak HIV was in 1995, higher than peak gun deaths. This is a very large problem, and it's not just the deaths; although, of course, it is the problem of death. But it's also the impact that this disease and this epidemic has on the families that it touches, on the communities, both in terms of just the social fabric of these communities, and also the resources that are being dedicated to addressing this crisis.

Kenny: Yes, emergency services, health care services, everybody is impacted by it.

Weiss: Everything.

Kenny: How did we get here? How did it get so bad?

Weiss: There are many accounts of this. The one I found most impactful was actually the book Dreamland, that Sam Quinones wrote. And among other factors, there was a very large shift in the approach to pain management in this country over this period of time. Alongside that, you get the bubbling up, both of these “pill mills,” these outfits in the middle America that were churning out pain medication to anybody who could get on it, and then also big pharma.

There was a lot of money to be made in pushing addictive, it turns out, pharmaceuticals onto the public, ostensibly to manage pain. Those two things happened together, this belief that we should help people manage more pain, which is a seemingly well-intended belief, and the willingness by businesses and doctors, small and large, to address that issue. At the same time, Quinones traces the influence of the drug cartels and their ability to basically infiltrate middle America, and I hate to use the word, in fairly innovative ways. He describes ways they would supply these drugs in towns like Cincinnati and nearby as “just-in-time” delivery, a phrase you and I would hear in operations classes here at Harvard Business School.

"Why can't well-meaning entrepreneurs, software engineers, political leaders of other types, use their own ingenuity to try to break the back of this crisis?"

Kenny: For people who find it, perhaps, peculiar that this topic is being discussed in an MBA classroom, they may start to see some of the connective tissues that you've seen.

Weiss: I think they should. I think that we all should say look, business and "entrepreneurs," although not in the good sense, in terms of people starting these pill mills or drug dealers, have used their own personal ingenuity, again, in a perverse way to bring this to our country. Why can't well-meaning entrepreneurs, software engineers, political leaders of other types, use their own ingenuity to try to break the back of this crisis?

Kenny: We say it's a problem everywhere, but Cincinnati seems to have it particularly bad.

Weiss: What they had seen was that in Ohio, in 2015, more than 3,000 people died of drug overdoses. They had seen 414 people die in 2015 of drug overdoses. In Hamilton County, which is where Cincinnati is located, in 2016 they were approaching 2,400 911 calls just on drug overdoses, and on pace to exceed that this year, Brian. They saw these things, and they were trying to address the crisis, of course. In Ohio and Cincinnati they did some of things you would expect--they were working to try to create more more treatment beds so people could get into treatment. The governor had expanded Medicaid, which expanded people's access to treatment. It was controversial, given the politics of all this.

At a local level in Cincinnati ... a quick response team was organized so that police and social workers could visit people who had been in the hospital, say, for an overdose. They also were working to try to get Narcan, which is the overdose reversal drug, into the hands of family members and community members so they could possibly save lives.

Kenny: What led Annie to think that a hackathon could come up with solutions that are better than the kinds of things the city was already doing?

Weiss: I think Annie's instincts, and the instincts of the folks that she recruited to join her, were that even though a lot was happening in Ohio, not everybody who needed to be talking to each other was talking to each other. Annie had spent some time both in government, looking at this from an economic development standpoint, and also looking at it from a private-sector standpoint. You'd think that the hospitals are talking to the payment folks, are talking to the insurers, are talking to the government folks, are talking to the treatment folks. She found that not everybody who needed to be around the table was around the table. One of her first instincts was that this [hackathon] would be a way to get those people in the room together.

Kenny: What was the approach they took?

Weiss: They ended up doing four things, which turn out to be important in organizing hackathons. The first thing is problem identification. What would we like people to work on while they're with us? A second thing is you have to get people to show up. You have to secure sponsorships, so you need prizes to reward those people. A third thing you have to do is figure out how you're going to do evaluation. At the end of the day, who's going to win this hackathon? They do turn out to be somewhat competitive... Who should be our evaluators? Should it be the experts? And what kinds of experts? Well, if they're the experts, then are they going to be too closed-minded about these new ideas? That's a riddle. The fourth thing they do is start to lay some of the groundwork for follow-up, because one of things that Annie and Emily and Colleen had learned from researching other hackathons was that there's all this burst of energy over the weekend, but what comes afterwards?

Kenny: You mentioned competitiveness, and that some people are there because they like to compete and they like to win these things. But did you also get the sense that, with this rising millennial generation, there's more interest in participating in something like this, because you're really addressing a real problem?

Weiss: I think that almost everybody there had that as part of their motivation. One of the software entrepreneurs that we'd interviewed said, "Just the sheer creativity and knowing that I can try to help is reason for being there," and I don't think he qualifies for being a millennial anymore. But they also were there for other reasons. What was really surprising to me when we went to Cincinnati to interview everybody was how different everybody's particular interest in being there was. We had met a junior, a major in computer science at the University of Cincinnati who yes, wanted to be there because he wanted to help, but also thought this would be a good way to test out some of his developing skills, and even possibly meet a venture capitalist.

We meet in the case Terry Now, who works at one of the big treatment recovery organizations. She was hoping maybe there'd be an actual piece of software that they could use. Everybody is there, I think, for multiple sets of reasons, not entirely identical. It's incumbent upon, in this situation, Annie and the team to figure out why they're there and how you make the most of them while they're there.

Kenny: You've discussed this case in class?

Weiss: We discussed this case in class this fall. It was, as you said, very, very timely.

Kenny: And the case was written before the hackathon actually took place, so could you give us any insight into what has happened since then?

Weiss: I don't want to give too much away. The hackathon does take place, and the people do show up. There are a number of actually fairly interesting products and technology pieces that are conceived of, and even prototyped over the weekend. The winning one was a crowdfunding mechanism to help channel people's generosity around this issue towards people who might need it. What I'll leave [unanswered] is to what extent the hackathon was a success or not a success. What was the hackathon actually for? Did it produce enough? Will this idea come to fruition? And we honestly don't know that yet.

Kenny: Do you think that this kind of hackathon approach could be applied in other areas where we have real societal issues that need to be solved?

"Everybody is there, I think, for multiple sets of reasons, not entirely identical"

Weiss: The hackathon has been deployed around the world on intractable private problems and social problems, and I think it will continue to be and should continue to be. I think that some of my own skepticism has been revised in the wake of seeing all this take place.

One of my takeaways is that even if a hackathon doesn't reach all the way towards an instrumental end, it doesn't actually solve the heroin crisis, maybe in bringing together people around the topic, people who haven't felt comfortable coming to the topic, maybe it's accomplished something in bringing them out. Maybe people aren't throwing their hands up when they organize hackathons, they're actually throwing their hands out.

Kenny: Mitch, thanks for joining us today.

Weiss: Thank you.

Kenny: You can find the Hacking Heroin case, along with thousands of others in the HBS case collection at HBR.org. I'm your host, Brian Kenny, and you've been listening to Cold Call, the official podcast of Harvard Business School.

 Read more

Recorded September 25, 2017.

Transcript edited for length and clarity.

Brian Kenny: In 1810 a new painkiller, named after the Greek god of dreams, Morpheus, was introduced in the United States. A derivative of opium, morphine was considered miraculous by the medical community, in its ability to treat severe pain. But, there was a problem: it was highly addictive. During the Civil War, morphine addiction reached epidemic levels among soldiers in the US, and doctors were completely in the dark as to how to treat it. That is, until 1874 when a new drug arrived from Bayer, the German pharma company that first brought Aspirin to market. The new drug, named heroin, after the German word for heroic, promised all the benefits of morphine with none of the side effects. It was advertised as the safe, non-addictive painkiller. There was even a version available for children. Bellevue Hospital in New York admitted its first patient for heroin addiction in 1910. Just five years later, they admitted 425. In 2017 the White House declared opioid addiction a national health emergency. And heroin is contributing exponentially to opioid-related deaths, which have increased 439 percent from 1999 to 2014 according to the Center for Disease Control. Today, we'll hear from Professor Mitchell Weiss about his case entitled Hacking Heroin. I'm your host, Brian Kenny, and you're listening to cold call.

Mitch Weiss is in the Entrepreneurial Management Unit at Harvard Business School, and he created and teaches the school's course on public entrepreneurship. Prior to joining HBS in 2014, Mitch was chief of staff to the late Boston mayor, Thomas Menino. I assume that heroin was a problem in Boston at that time, as it is everywhere else. Mitch, thanks for joining us today.

Mitch Weiss: Thank you for having me.

Kenny: This is a really timely case study in a sad way. This is a huge problem, and I think people who read the case will immediately be able to relate to it. Can you set up the case for us? Who is the protagonist and what's on her mind?

Weiss: The protagonist of the case, Brian, is Annie Rittgers. She's the founder of 17a Consultancy in Cincinnati. She's a budding entrepreneur in her own right, and she finds herself at Union Hall. Union Hall was in Cincinnati in their Over-The-Rhine neighborhood, which has become one of these neighborhoods where a small hotbed of technology and entrepreneurship are bubbling up. Union Hall is their incubator, accelerator gathering space. She's pulled together a team to organize a hackathon to address the opioid crisis in her home state of Ohio.

"If I'm being honest about it, I was actually more than curious; I was pretty skeptical"

The hackathon is a ways away at this point. It's going to be held in Union Hall, and something close to 50 people have signed up. She's not sure whether they will show up. They've come [up with] eight challenges to give to hackathon participants. She's not sure if maybe these are too broad, if they're too narrow. The sponsorships for the prizes had been slow to come in. They're dribbling in, and Annie is not quite sure what to make of all these uncertainties. She's wondering, one, maybe these are signs that there's something I could be doing here in the dwindling days before this hackathon is going to take place, but what should I do? She's also wondering a little bit whether the hackathon skeptics have been right all along. What kind of way is this to address a problem of epic proportion anyway?

Kenny: How did you find out about this? What prompted you to write the case?

Weiss: Well, Annie was a student of mine. What prompted me to write it was that I had been curious about hackathons as a way of doing idea generation. In my course in public entrepreneurship I was adding a new module on ideas, where do they come from, and especially of whether they should come from inside government and inside experts, or whether they should come from the outside. I was curious about these as a way of sourcing ideas. And, if I'm being honest about it, Brian, I was actually more than curious; I was pretty skeptical.

I had been to too many meetings where I was either in government or in business, where there was a big intractable problem and people said, "How are we going to address this problem?" And somebody would say, "Hackathon." I was wondering, are they just throwing up their hands?

Kenny: What is a hackathon?

Weiss: A hackathon is basically a two-, two-and-a-half-, three-day gathering of people from diverse backgrounds, often to work on a hardware or software solution to a problem. And typically, they end up working in teams of four or five people over the course of say, a weekend. They start the weekend with a sense of what the problem is and maybe some ideas, and ideally they finish the weekend with a prototype, or even a product to try to address the problem.

Kenny: Why did Annie decide to get involved?

Weiss: Annie grew up in Ohio. She ends up on the East Coast, going to college, going to business school and law school at Harvard, working in investment banking, working at consulting for McKinsey. She felt like she was becoming too distant from her native Ohio; she wanted to return back there. She was looking for a way to return that would really reengage her with community in a very active way. In addition, she was struck, I would say brokenhearted, by how prevalent the heroin and broader opioid epidemic had become in her home state, and was wondering whether she and others together might be able to do something about that.

Kenny: Just how bad is this problem in Ohio and elsewhere?

Weiss: In the case we cite this 2015 statistic that drug overdoses killed about 52,000 Americans that year. The New York Times recently looked at emerging data from 2016. Drug overdoses killed roughly 64,000 people. So, first of all it gives you a sense of the size of this, and also the size of the growth. That's a 23 percent increase in just one year. To give you some context, The New York Times also reported this is higher than, say, peak car crashes were in 1972, higher than peak HIV was in 1995, higher than peak gun deaths. This is a very large problem, and it's not just the deaths; although, of course, it is the problem of death. But it's also the impact that this disease and this epidemic has on the families that it touches, on the communities, both in terms of just the social fabric of these communities, and also the resources that are being dedicated to addressing this crisis.

Kenny: Yes, emergency services, health care services, everybody is impacted by it.

Weiss: Everything.

Kenny: How did we get here? How did it get so bad?

Weiss: There are many accounts of this. The one I found most impactful was actually the book Dreamland, that Sam Quinones wrote. And among other factors, there was a very large shift in the approach to pain management in this country over this period of time. Alongside that, you get the bubbling up, both of these “pill mills,” these outfits in the middle America that were churning out pain medication to anybody who could get on it, and then also big pharma.

There was a lot of money to be made in pushing addictive, it turns out, pharmaceuticals onto the public, ostensibly to manage pain. Those two things happened together, this belief that we should help people manage more pain, which is a seemingly well-intended belief, and the willingness by businesses and doctors, small and large, to address that issue. At the same time, Quinones traces the influence of the drug cartels and their ability to basically infiltrate middle America, and I hate to use the word, in fairly innovative ways. He describes ways they would supply these drugs in towns like Cincinnati and nearby as “just-in-time” delivery, a phrase you and I would hear in operations classes here at Harvard Business School.

"Why can't well-meaning entrepreneurs, software engineers, political leaders of other types, use their own ingenuity to try to break the back of this crisis?"

Kenny: For people who find it, perhaps, peculiar that this topic is being discussed in an MBA classroom, they may start to see some of the connective tissues that you've seen.

Weiss: I think they should. I think that we all should say look, business and "entrepreneurs," although not in the good sense, in terms of people starting these pill mills or drug dealers, have used their own personal ingenuity, again, in a perverse way to bring this to our country. Why can't well-meaning entrepreneurs, software engineers, political leaders of other types, use their own ingenuity to try to break the back of this crisis?

Kenny: We say it's a problem everywhere, but Cincinnati seems to have it particularly bad.

Weiss: What they had seen was that in Ohio, in 2015, more than 3,000 people died of drug overdoses. They had seen 414 people die in 2015 of drug overdoses. In Hamilton County, which is where Cincinnati is located, in 2016 they were approaching 2,400 911 calls just on drug overdoses, and on pace to exceed that this year, Brian. They saw these things, and they were trying to address the crisis, of course. In Ohio and Cincinnati they did some of things you would expect--they were working to try to create more more treatment beds so people could get into treatment. The governor had expanded Medicaid, which expanded people's access to treatment. It was controversial, given the politics of all this.

At a local level in Cincinnati ... a quick response team was organized so that police and social workers could visit people who had been in the hospital, say, for an overdose. They also were working to try to get Narcan, which is the overdose reversal drug, into the hands of family members and community members so they could possibly save lives.

Kenny: What led Annie to think that a hackathon could come up with solutions that are better than the kinds of things the city was already doing?

Weiss: I think Annie's instincts, and the instincts of the folks that she recruited to join her, were that even though a lot was happening in Ohio, not everybody who needed to be talking to each other was talking to each other. Annie had spent some time both in government, looking at this from an economic development standpoint, and also looking at it from a private-sector standpoint. You'd think that the hospitals are talking to the payment folks, are talking to the insurers, are talking to the government folks, are talking to the treatment folks. She found that not everybody who needed to be around the table was around the table. One of her first instincts was that this [hackathon] would be a way to get those people in the room together.

Kenny: What was the approach they took?

Weiss: They ended up doing four things, which turn out to be important in organizing hackathons. The first thing is problem identification. What would we like people to work on while they're with us? A second thing is you have to get people to show up. You have to secure sponsorships, so you need prizes to reward those people. A third thing you have to do is figure out how you're going to do evaluation. At the end of the day, who's going to win this hackathon? They do turn out to be somewhat competitive... Who should be our evaluators? Should it be the experts? And what kinds of experts? Well, if they're the experts, then are they going to be too closed-minded about these new ideas? That's a riddle. The fourth thing they do is start to lay some of the groundwork for follow-up, because one of things that Annie and Emily and Colleen had learned from researching other hackathons was that there's all this burst of energy over the weekend, but what comes afterwards?

Kenny: You mentioned competitiveness, and that some people are there because they like to compete and they like to win these things. But did you also get the sense that, with this rising millennial generation, there's more interest in participating in something like this, because you're really addressing a real problem?

Weiss: I think that almost everybody there had that as part of their motivation. One of the software entrepreneurs that we'd interviewed said, "Just the sheer creativity and knowing that I can try to help is reason for being there," and I don't think he qualifies for being a millennial anymore. But they also were there for other reasons. What was really surprising to me when we went to Cincinnati to interview everybody was how different everybody's particular interest in being there was. We had met a junior, a major in computer science at the University of Cincinnati who yes, wanted to be there because he wanted to help, but also thought this would be a good way to test out some of his developing skills, and even possibly meet a venture capitalist.

We meet in the case Terry Now, who works at one of the big treatment recovery organizations. She was hoping maybe there'd be an actual piece of software that they could use. Everybody is there, I think, for multiple sets of reasons, not entirely identical. It's incumbent upon, in this situation, Annie and the team to figure out why they're there and how you make the most of them while they're there.

Kenny: You've discussed this case in class?

Weiss: We discussed this case in class this fall. It was, as you said, very, very timely.

Kenny: And the case was written before the hackathon actually took place, so could you give us any insight into what has happened since then?

Weiss: I don't want to give too much away. The hackathon does take place, and the people do show up. There are a number of actually fairly interesting products and technology pieces that are conceived of, and even prototyped over the weekend. The winning one was a crowdfunding mechanism to help channel people's generosity around this issue towards people who might need it. What I'll leave [unanswered] is to what extent the hackathon was a success or not a success. What was the hackathon actually for? Did it produce enough? Will this idea come to fruition? And we honestly don't know that yet.

Kenny: Do you think that this kind of hackathon approach could be applied in other areas where we have real societal issues that need to be solved?

"Everybody is there, I think, for multiple sets of reasons, not entirely identical"

Weiss: The hackathon has been deployed around the world on intractable private problems and social problems, and I think it will continue to be and should continue to be. I think that some of my own skepticism has been revised in the wake of seeing all this take place.

One of my takeaways is that even if a hackathon doesn't reach all the way towards an instrumental end, it doesn't actually solve the heroin crisis, maybe in bringing together people around the topic, people who haven't felt comfortable coming to the topic, maybe it's accomplished something in bringing them out. Maybe people aren't throwing their hands up when they organize hackathons, they're actually throwing their hands out.

Kenny: Mitch, thanks for joining us today.

Weiss: Thank you.

Kenny: You can find the Hacking Heroin case, along with thousands of others in the HBS case collection at HBR.org. I'm your host, Brian Kenny, and you've been listening to Cold Call, the official podcast of Harvard Business School.

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