Public health and police: Building ethical and equitable opioid responses

Abstract

The opioid overdose epidemic remains a profound public health crisis in the United States, killing more than 500,000 people between 1999 and 2020 (1, 2). The dominant narrative explaining policy responses to the epidemic concludes that because opioids are disproportionately a problem of white populations, governments have opted for public health solutions rather than the criminal justice responses to previous drug epidemics, such as crack cocaine in the 1980s. We assert that this understanding is too simplistic. Opioid overdose mortality rates among American Indian and Alaska Native communities have long paralleled those of whites, and Black and Latinx people have seen precipitous increases in opioid overdose death in recent years (3, 4). Policy responses to the opioid epidemic thus far have entailed a counterproductive integration of public health and law enforcement. This approach has undermined the effectiveness of public health practice and threatens racial health equity. Image credit: Shutterstock/Kimberly Boyles. Additionally, we argue that, despite this apparent sea change, policy responses to the opioid overdose epidemic have not been primarily those of public health, defined as responses that prioritize nonpunitive and noncoercive treatment and prevention over interdiction and criminal enforcement. Rather, we believe policy responses entail a counterproductive integration of public health and law enforcement—namely, local health authorities and local police departments—thus creating new forms of surveillance and criminalization. We contend that this integration undermines the effectiveness of public health practice and threatens racial health equity. Public health and police collaborations integrate public health and law enforcement agencies and policy agendas. Implemented in jurisdictions nationwide, these collaborations take shape through cross-sector data sharing, policy, and programming (5). Despite the priority given to collaborations by policymakers, these initiatives remain understudied, with limited appraisal of their functions, benefits, and unintended consequences. We must assess these collaborations within the broad … [↵][1] 1To whom correspondence may be addressed. Email: bennett.allen{at}nyulangone.org. [1]: #xref-corresp-1-1