Large pile of amber prescription pill bottles

How Policy Surveillance Might Help to Counter the Opioid Epidemic

By Erin Napoleon

In 2017, more than 47,000 people had died of an opioid overdose, and 2 million people were dependent on opioids. This astonishing number is attributable in part to the lack of federal and state legislation to curb the over-prescription of opioids.

Opioids first entered the US market in the late 1990s. Pharmaceutical companies’ assured physicians that opioids were less addictive than morphine and posed less dangerous side effects, and doctors began prescribing the pills at unprecedented rates.

Understanding how the dearth of federal and state legislation, coupled with prescribing patterns based on race and socioeconomic status, influence the over-prescription of opioids can potentially lead to new and innovative ways of solving the opioid epidemic that continuously threatens the United States.

The federal government has failed to promulgate legislation specifically tailored to prescribing opioids. Rather, the government, via the Centers for Disease Control and Prevention (CDC) and Department of Veterans Affairs, merely published guidelines for physicians to refer to when prescribing opioids to treat pain.

While 33 states have adopted opioid prescribing legislation as of 2018, a lack of uniformity between states’ policies also contributes to the over-prescription problem. For example, in the Northeast, Massachusetts set its statutory limit on opioid prescriptions in terms of duration—seven days—while its neighbor Rhode Island sets its statutory limit in terms of dosage, known as morphine milligram equivalents. Similarly, Maryland sets its statutory limit to the lowest effective dose, while its neighbor Delaware does not have any statutory limits in place, and Pennsylvania’s statutory limit is fourteen days.

Physicians are two times more likely to prescribe opioids to white patients than black patients with the same pain. Dr. Andrew Kolodny, director of opioid policy research at Brandeis University, explains this can be attributed to physicians’ stereotypical ideas of an addict—nonwhite members of low income communities. Such stereotypical ideas cause physicians to believe white members of middle class communities are incapable of becoming addicted to opioids. As a result, physicians continue to prescribe opioids to white Americans at growing rates while simultaneously ignoring the concerns of black Americans as they continue to suffer with their pain.

Lastly, as race and socioeconomic class are often associated with one another, it follows that there is a discrepancy in the prescription of opioids for patients in different socioeconomic classes. More specifically, healthcare providers are more likely to prescribe opioids to patients in a higher socioeconomic class than those who are categorized as being in a lower class. This prescribing difference can be attributed to health care providers’ general inclination to associate wealth with whiteness, despite the fact that 9.7% of white Americans live in poverty.

Surveillance of existing policies governing opioid prescribing can provide legislators and physicians with tools to track associated prescribing patterns along state, racial, and socioeconomic lines. For example, the Policy Surveillance Program at Temple University’s Center for Public Health Law Research provides essential groundwork to further understand how factors such as state-level policies impact the rates at which healthcare providers prescribe opioids to treat pain. This information can then be exploited in attempts to reverse the detrimental damage that opioids have caused in the U.S.

Erin Napoleon is a 2L at the University of Pittsburgh School of Law and is a summer intern with the Center for Public Health Law Research.

Temple University Center for Public Health Law Research

Based at the Temple University Beasley School of Law, the Center for Public Health Law Research supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. It works by developing and teaching public health law research and legal epidemiology methods (including legal mapping and policy surveillance); researching laws and policies that improve health, increase access to care, and create or remove barriers to health (e.g., laws or policies that create or remove inequity); and communicating and disseminating evidence to facilitate innovation.

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