Changing a complex system is hard
I’ve been reading Drift into Failure by Sidney Dekker, and it’s a fantastic book about applying systems thinking to understand how complex systems fail. One of the things that a systems thinking perspective teaches you is that we don’t know how a complex system will respond to a change in inputs. In particular, when you try an intervention that is intended to improve the system, it might make things worse.
There’s a great example of this phenomenon in a recent paper by Alpert et al. entitled Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids, that was mentioned on a recent episode of Vox’s The Weeds podcast.
The paper examined the impact of introducing an abuse-deterrent version of OxyContin on drug abuse. The FDA approved OxyContin pills that were more difficult to crush or dissolve. These pills were expected to act as a deterrent to abuse since addicts tend to consume the drug by chewing, snorting, or injecting it to increase its impact. The authors examined the rates of OxyContin abuse before and after these new abuse-deterrent drugs were introduced in different states.
What the authors found was that this intervention did have the effect of decreasing OxyContin abuse. Unfortunately, it also increased heroin-related deaths. The unexpected effect was that addicts substituted one form of opiate for a more dangerous one.
The only way for us to know that our interventions have the desired effect on a complex system is to try and measure that effect.