Mapping the Federal Legislative Response to the Opioid Epidemic

Background and Purpose: Although opioid abuse is not a new problem, a rapid increase in opioid-attributed overdose deaths beginning in 2009-2010 has prompted researchers and politicians to recognize opioid addiction as a national epidemic. While local, state, and federal policy solutions spanning the range from increased incarceration to increased treatment access have been proposed, very little research has systematically analyzed policy responses to the opioid epidemic. The objective of this study was to address this gap by using policy mapping to analyze federal legislative responses to the opioid epidemic between 2009 and 2017.

Methods: We used policy mapping methods to categorize federal legislative responses to the opioid epidemic by utilizing the publicly available database congress.gov, which catalogs all bills, resolutions, and amendments introduced in Congress. We constructed our policy dataset by extracting all proposed legislation between 2009 (111^th Congress) and 2017 (first year of 115^th Congress) that contained the terms “opioid” “opiate” or “heroin” anywhere in the title or text. This yielded a dataset of 358 policies. Based on a review of academic policy and public health literature, we created a taxonomic schedule of 11 distinct but not mutually exclusive goals of opioid–related policy (e.g. supply reduction of prescription or illicit opioids, demand reduction, treatment expansion). Two researchers then independently coded the dataset according to these as well as additional criteria such as policy type, status, party of sponsor, and if the policy was punitive to any group. The researchers met to discuss coding discrepancies and reach consensus. Descriptive statistics were calculated to summarize the policies in the dataset.

Results: The number of opioid-related policies rapidly increased during the study period, from 19 policies introduced in the 111^th Congress to 176 policies in the 114^th Congress and 114 policies in the first year of the 115^th.  Although all goals in the taxonomy were represented, supply reduction of prescription or illicit opioids occurred more frequently than demand reduction and other services. Policy sponsorship reflected near-equal efforts from Democrats (52%) and Republicans (48%). Only 7% of policies were coded as having punitive intent. These included proposals for capital punishment or mandatory minimum sentencing for particular drug offenses (e.g. combinations of heroin and fentanyl) and proposals to make TANF and unemployment benefits conditional on drug testing.

Conclusions/Implications: To our knowledge, this is the first policy mapping study of the federal legislative response to the opioid epidemic. Results validate the increasing policy prioritization of the epidemic since 2009. It is apparent that federal policy action has targeted supply reduction, largely to the exclusion of other goals such as demand reduction through alternative treatments for pain, increased access to health care, or challenging addiction stigma. Findings should inform social work advocacy efforts to shift policy attention and resources to these overlooked goals. The largely non-punitive nature of the proposed legislation, as quantified in our results, sharply contrasts with federal responses to previous drug use epidemics, most notably crack cocaine in the 1980s. This is an important topic for further policy research and analysis.