Tag: harm reduction

Gavel and stethoscope.

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

Temple University Center for Public Health Law Research Leave a comment

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.   

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Disposable syringe isolated on black background.

Six Opportunities to Use the Law to Support Harm Reduction

Temple University Center for Public Health Law Research Leave a comment

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.”

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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

Temple University Center for Public Health Law Research Leave a comment

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. 

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Suboxone.

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

Temple University Center for Public Health Law Research Leave a comment

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. 

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Red corded telephone handset on blue background, top view. Hotline concept

To Promote Health Equity, States Must Restrict Police Intervention in Mobile Crisis Response

The Petrie-Flom Center Staff Leave a comment

By April Shaw and Taleed El-Sabawi

The COVID-19 pandemic and recent increases in the incidence of televised violence against Black persons by law enforcement actors and others have contributed to the worsening mental health of these subordinated and marginalized communities. While the policy solutions needed to address this disparate impact are structural and multi-faceted, the introduction of 988, a national mental health crisis hotline, offers an opportunity to positively contribute to the overall goals of decreasing police interactions with Black and Brown communities.

The Federal Communications Commission (FCC) issued a Final Rule designating 988 as a national suicide prevention and mental health crisis hotline in September 2020. Congress later passed the National Suicide Hotline Designation Act of 2020 codifying 988 as the dialing code. Per the FCC Final Rule, states are required to implement 988 into their networks by July 2022.

States have wide latitude in how they implement 988, and though many will likely stop at the bare minimum of creating a suicide prevention hotline, 988 could be coupled with the creation of police alternative (or non-police) mobile responses that assist with de-escalation, stabilization, and connection to treatment. Non-police responses promise to decrease police interaction, excessive use of force, and criminalization of mental illness. Such non-police responses have gained in national popularity due in large part to organization and protests led by Black Lives Matters activists.

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Police car.

New Data Highlights Complexity of Good Samaritan Overdose Law Landscape

Temple University Center for Public Health Law Research Leave a comment

By David Momjian

Since 1999, over 800,000 people have died from a drug overdose in the United States, with more than half of those deaths (500,000) resulting from opioid overdose.

Additionally, all 50 states have experienced a spike in overdose deaths in the wake of the COVID-19 pandemic. In the 12-month period ending in May 2020, 81,000 drug overdose deaths occurred in the United States; the highest number of overdose deaths ever recorded in a 12-month period.

To combat the rising death toll from drug overdoses, 47 state legislatures and the District of Columbia have passed Good Samaritan laws (GSLs) to protect bystanders from criminal prosecution if they call for medical assistance during a drug overdose. Bystanders to a drug overdose are often worried that by calling for help, they could be arrested for drug possession or evicted by the police, who often arrive first at the scene of a 911 call, even if it is a medical emergency.

A new dataset built by the Center for Public Health Law Research at Temple University’s Beasley School of Law and funded by Vital Strategies, covers the evolution of GSLs in the United States from January 1, 2007, to June 1, 2021.

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Healthcare concept of professional psychologist doctor consult in psychotherapy session or counsel diagnosis health.

The Case for Non-Police Response to Behavioral Health Crises

The Petrie-Flom Center Staff Leave a comment

By Jennifer J. Carroll and Taleed El-Sabawi

People who use drugs continue to die at staggering rates, due not only to overdose from contaminated drug supply, but also due to our persistent reliance on the carceral system to respond to behavioral health crises.

This approach stems from the state-sanctioned violence of the War on Drugs. It takes various forms, including the use of police officers as first responders to behavioral health crises (including welfare checks), the excessive police use of force, and the use of potentially lethal restraint methods to subdue agitated persons. It also manifests in police officers’ use of jail cells as tools for forced “detox” believing that coerced withdrawal while in custody will reduce overdose risk or help someone “go clean” (it very clearly does not).

Evidence-based alternatives to police response for behavioral health crises exist. However, despite being both feasible and effective, these alternatives to police intervention remain the exception, rather than the rule.

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medical needles in a pile

How Supervised Injection Sites Can Help Address the Overdose Crisis

The Petrie-Flom Center Staff Leave a comment

By Carly Roberts

Supervised injection sites, also known as safe injection sites, are among the most effective, evidence-based harm reduction tools available to counter the opioid overdose crisis.

Supervised injection sites are legally sanctioned locations that provide a hygienic space for people to inject pre-obtained drugs under the supervision of trained staff. Safe injection sites often provide additional services including needle exchanges, drug testing (especially important for detecting lethal fentanyl-laced drugs and preventing “mass overdose” events), and referral to treatment and social services.

The opioid overdose crisis in the U.S., which had a death toll of over 45,000 in 2018, and which is predicted to worsen amid the COVID-19 pandemic, warrants a bold, brave, and thorough response. Harm reduction programs, including supervised injection sites, should be integrated into opioid epidemic response strategies in order to save lives and improve individual and community outcomes.

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Pill bottles.

During the COVID-19 Pandemic, the Opioid Epidemic Continues

Laura Karas Leave a comment

By Laura Karas

“The boy’s first outcry was a rueful laugh,

As he swung toward them holding up the hand

Half in appeal, but half as if to keep

The life from spilling. Then the boy saw all—

Since he was old enough to know, big boy

Doing a man’s work, though a child at heart—

He saw all spoiled. . . .

He lay and puffed his lips out with his breath.

And then—the watcher at his pulse took fright.

No one believed. They listened at his heart.

Little—less—nothing!—and that ended it.

No more to build on there. And they, since they

Were not the one dead, turned to their affairs.”

This except from Robert Frost’s 1916 poem “Out, Out—,” which portrays the sudden death of a young boy after a woodcutting accident and the onlookers’ casual acceptance of his tragic death, is particularly apropos today, more than one hundred years later, in an America that looks very different than that of Frost’s time. Between the opioid crisis and the COVID-19 pandemic, America now suffers from a surplus of needless, untimely deaths.

Just as the protagonist of Frost’s poem became the casualty of a tragic accident, so too do the many victims of the opioid epidemic become casualties in a losing battle — lives “spoiled” by substance use disorder and cut short by tragic overdose. In this post I explore the status of the opioid epidemic in light of the COVID-19 pandemic and ongoing initiatives to address opioid use disorder (OUD).

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