Gavel and stethoscope.

Eight Opportunities to Use the Law to Address Social Determinants of Health

By Jon Larsen and Sterling Johnson

Addressing the opioid crisis cannot stop at providing better access to treatment for opioid use disorder (OUD), expanding and enhancing harm reduction efforts, and reimagining the role of law enforcement, as explored previously in this blog series. The response must go further to make treatment and harm reduction more effective, by acknowledging the opioid epidemic as a reflection of the conditions of the whole society, identifying those conditions, and addressing them head-on. A whole-person response to OUD and other substance use disorders needs a well-coordinated whole-of-government response to address myriad societal issues that are critical to effective drug treatment, including, but not limited to, housing, education, economic development, and tax policy.   

Read More

Disposable syringe isolated on black background.

Six Opportunities to Use the Law to Support Harm Reduction

By Jon Larsen and Sterling Johnson

Harm reduction in the context of the opioid crisis is focused on preventing overdose and infectious disease transmission by working with people who use drugs without moral judgment. Far too often, the public health imperative of harm reduction is blocked by federal policy, state laws, and other structural barriers anchored in the “war on drugs” that reduce the effectiveness of harm reduction efforts. To maximize the potential of harm reduction requires a whole-of-government approach, involving coordination across levels of government. 

As noted in this recent report, “Bringing the W-G approach to bear on a complex problem depends on several components, including agreement as to the problem, understanding the problem, and the causes of the problem. For many involved in government at all levels, the harm reduction challenge unfortunately falls at the first of those hurdles.”

Read More

Judge's gavel, handcuffs and scales on grey background, flat lay with space for text. Criminal law concept.

Seven Opportunities to Use the Law to Address Drug Policing

By Jon Larsen and Sterling Johnson

There is a well-established whole of government response to drug policing centered around the “war on drugs.” However, the existing response is largely built on flawed policies that have resulted in mass incarceration, structural racism, and lagging improvements in treatment and harm reduction related to the opioid crisis. Policy changes must be considered to replace acknowledged failures and reimagine the whole of government response to drug policing. 

With support from the Foundation for Opioid Response Efforts (FORE), public health law experts from Indiana University McKinney School of Law and the Temple University Center for Public Health Law Research at the Beasley School of Law recently embarked on a systematic review of US drug policy using a whole-of-government (W-G) approach to assess where these misalignments are occurring among different agencies at the same level of government (referred to as horizontal W-G), and across different levels of government (referred to as vertical W-G). It ultimately provides a tool to address these misalignments directly. 

Read More

Suboxone.

Five Opportunities to Use the Law to Address Persistent OUD Treatment Gaps 

By Jon Larsen and Sterling Johnson

People who need opioid use (OUD) treatment in the United States are often not receiving it — at least two million people with OUD are experiencing a treatment gap that prevents or hampers their ability to receive life-saving care and support. This reality reflects structural, policy, and legal misalignments common to the entire U.S. health care system, but that are especially present for behavioral health needs like substance use, and are exacerbated by other challenges related to stigma, lack of employment, and fragmented or nonexistent care coordination.  

With support from the Foundation for Opioid Response Efforts (FORE), public health law experts from Indiana University McKinney School of Law and the Temple University Center for Public Health Law Research at the Beasley School of Law recently embarked on a systematic review of U.S. drug policy using a whole-of-government (W-G) approach to assess where these misalignments are occurring among different agencies at the same level of government (referred to as horizontal W-G), and across different levels of government (referred to as vertical W-G). It ultimately provides a tool to address these misalignments directly. 

Read More

City with trash in foreground and smokestacks producing smog in background.

The Privatization of Cancer

By Daniel G. Aaron

Cancer is fearsome, unstoppable even. So the story goes. Yes, you can secure some extra time with loved ones, and — if you are lucky —  maybe your cancer is susceptible to drugs or surgery. But for most people, cancer sounds like a death sentence. The proper response is to throw drugs and radiation at it.

Cancer seems so unstoppable that many have started rifling through their cosmetic products and foods to eliminate all possible carcinogens. Despite the fact we have regulatory regimes to ensure our food, makeup, the air, and drinking water are free of carcinogens, people don’t trust them. There is an intuitive sense that products are not well regulated, leaving individuals to moderate their own cancer risk. In fact, the majority of Americans do not hold strong trust in our health agencies like FDA and CDC.

In my forthcoming article, I argue that our cancer regulatory regimes inadequately protect the public. I believe deregulation is one form of the “privatization of cancer.”

Read More

U.S. Supreme Court

Context Matters: Affirmative Action, Public Health, and the Use of Population-Level Data

By Wendy E. Parmet, Elaine Marshall & Alisa K. Lincoln

Last June, in Students for Fair Admissions (SFFA), the Supreme Court ruled that universities could not consider race in admitting students. In support of that decision, the Court dismissed the relevance of data about the varied experiences of racial groups, insisting that admissions decisions must be based solely on the experiences and merits of individual applicants. The Court’s rejection of group-level data evinces a critical misunderstanding about the uses and limits of such data that, if applied more broadly, portends troubling implications for health equity and health policy.

Read More

Participants listening to lecture in lecture hall.

A Categorical No to Categorical Accommodation Denials Related to COVID-19?

By Katherine Macfarlane and Irina Manta

Since fall 2021, when most colleges and universities reopened their campuses to in-person activities, it has become increasingly difficult for faculty and students with disabilities to obtain reasonable accommodations to teach or attend class remotely. Remote accommodations were granted freely during the first year of the COVID-19 pandemic, but in 2021, the in-person aspect of teaching and learning was suddenly deemed essential, and at many institutions, remote classes came to an end. Despite federal disability law’s requirement that each reasonable accommodation request be assessed individually, faculty and students alike were met with bright-line policies that remote teaching and learning were out of the question.

The language and logic used to deny these accommodations at universities across the country was suspiciously similar. We wondered to ourselves whether a memo had been circulated instructing universities about which magic words to employ to deny each accommodation request. But no matter what words are used, across-the-board policies that do not contemplate accommodation-based exceptions and fail to assess accommodation requests on an individual basis do not comply with federal disability law. A recent federal case brought by a high-risk professor against his university employer has recognized these well-settled principles and highlighted the problem with formulaic denials.

Read More

Hands with blue protective nitride gloves holding N95 respirator.

A Patient’s Right to Masked Health Care Providers

By Katherine A. Macfarlane

In May 2023, Mass General Brigham instructed its patients that they “cannot ask staff members to wear a mask because our policies no longer require it.”

Following patient protests, the hospital updated its policies with an imperfect fix, announcing that “patients can ask, but providers determine when and if masking in a particular situation is clinically necessary.”

This episode highlights the uneasy circumstances that people with disabilities face in the U.S. while accessing essential care: On the one hand, the law surrounding reasonable modifications in health care is well-settled. On the other, the practical reality of U.S. health care leaves little room for individualized accommodation and self-advocating patients vulnerable to retaliation.

Read More

Los Angeles, California / USA - May 28, 2020: People in Downtown Los Angeles protest the brutal Police killing of George Floyd.

Learning from the ‘COVID War’

By Sam Friedman

Amid an emergent international consensus that the COVID pandemic is “over,” writings about the pandemic and its meanings have burst forth like the flowers of June.

This article will focus on one such book, Lessons from the COVID War: An Investigative Report. Produced by an eminently established collection of people, The COVID Crisis Group. The book is intelligently critical of what was done during the pandemic, but at all points it remains within the confines of what is “politically respectable.” This respectability, I argue, means that their recommendations are too narrow to protect Americans, much less the populations of the Global South, from pandemics ahead (barring unexpectedly marvelous advances in vaccine breadth and rapidity of deployment).

Read More

an ambulance parked at the entrance of an emergency department

Psychiatric Care in Crisis

By Zainab Ahmed

Psychiatric care in the Emergency Department is all-or-nothing and never enough. Often, legal holds are the only intervention available, and they rarely are therapeutic. Upon discharge, our patients are, once again, on their own.

The ED acts as a safety-net for a failing health system, one that places little value on mental health services, either preventative or follow-up. The demand for acute psychiatric care is high; however, EDs have little physical capacity for psychiatric patients.

Read More