Association for Public Policy Analysis & Management

Panel: Perspectives on the Opioid Crisis

(Crime, Justice, and Drugs)

The combination of over-prescribing of powerful opioids and the arrival of new synthetic opioids on illegal markets has led to an extraordinary increase in the number of opioid related deaths.  The 2016 fatal overdose figure exceeded the highest level for AIDS deaths and the 2017 number is almost certain to be larger.  A presidential commission has recommended major policy changes and Congress has appropriated large sums of new money for a public health response to this crisis, even as the Administration muses about the death penalty for fentanyl traffickers.

 

The policy research response has been modest.  There are frequent calls for more treatment capacity and for more provision of Naloxone as a life-saving intervention for those who have over-dosed.  While both are important responses they leave a great deal of policy territory to be explored.  The papers in this session provide insights on three important dimensions:

1. How prescription monitoring programs PMPs), aimed at reducing overprescribing of powerful painkillers such as Oxycontin, affect opioid-related deaths. The concern is that those dependent on prescription opioids will purchase in illicit markets instead, exposing themselves to still higher risks.  This study corrects for systematic undercounts of overdoses, reflecting the limits of medical examiner data.  It offers new results on the effectiveness of PMPs.
2. How effectively states have been able to implement mandates for additional treatment capacity. This study of eight states, involving 83 qualitative interviews, assesses the role of health care reforms and other state level political factors to understand the variety of responses in terms of providing more Substance Use Disorder treatment capacity in the state.  It finds substantial differences across states reflecting for example the implementation of the ACA.
3. Whether the single source of estimates for the number of individuals using heroin, the National Survey on Drug Use and Health (NSDUH), is of acceptable quality. NSDUH can provide credible estimates of the numbers of users of frequently used substances such as marijuana and cigarettes.  The study shows that it lacks credibility in estimating the number of users of expensive addictive drugs such as heroin and offers an alternative indicative estimate.

 

The Discussants are both prominent figures in policy debates on drug policy, one of whom is a practitioner.