Regulation and the Opioid Epidemic

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This Saturday Seminar explores how regulation addresses and affects opioid use and addiction.

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This is the first of a new weekly feature for The Regulatory Review, the “Saturday Seminar.” Each week, members of The Regulatory Review staff will highlight important or recent papers, reports, or commentary surrounding a focused regulatory topic. Each week’s Saturday Seminar will focus on a different topic.

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Nearly one in five people in the United States aged 12 and older used an illicit drug last year. Substance use imposes major costs on the public, including addiction treatment and prevention costs, losses in productivity, incidents of drug-affected driving, and increased mortality. In terms of mortality, opioid use is of particular concern: In 2017, more than two thirds of overdose deaths in the United States—some 130 deaths per day according to the Centers for Disease Control and Preventioninvolved a prescription or illicit opioid. Despite these risks, providers continue to rely heavily on prescription opioids for pain management.

In light of these issues, how does regulation already address opioid use and addiction? How might it do a better job? The authors of the pieces featured in this week’s Saturday Seminar offer a variety of information and perspectives on these questions.

How Regulation Affects the Opioid Crisis

Regulating Pain Treatment

Safe Injection Sites and the Controlled Substances Act

  • Safe injection sites have emerged as a harm-reduction tool to reduce overdose deaths and disease transmission among people who inject drugs. After a systematic review of the literature, some scholars conclude that supervised injection services appear to reduce fatal and non-fatal overdoses while increasing access to health services. Moreover, the authors assert that safe injection sites did not appear to increase drug use or trafficking.
  • In a recent article for the Harm Reduction Journal, scholars argue that there is a “pressing need to create a more enabling environment” for safe injection sites by amending federal legislation. They further assert that permitting providers to assist in the injection process itself in a regulated setting may mitigate risks of infection, overdose, and drug-related violence.
  • Writing for the Boston College Law Review, Alex Kreit of the Thomas Jefferson School of Law argues that a Controlled Substances Act (CSA) provision may allow states and localities to establish government-run safe injection sites. The provision immunizes state and local officials who violate federal drug laws in the course of “the enforcement of any law or municipal ordinance relating to controlled substances.”
  • Last week, The Regulatory Review featured an essay about recent litigation over the legality of safe injection sites in Philadelphia. In United States v. Safehouse, a non-profit organization seeking to open a safe injection site argued that, by combining legal harm reduction measures endorsed by the U.S. Department of Health and Human Services and Centers for Disease Control and Prevention, safe injection sites may provide “lifesaving services” that comply with the CSA. The court agreed, giving credence to the notion that safe injection sites would not facilitate illicit drug use for the purposes of the CSA.