Skip to main content
Report
Abstract Summary
Link
Report
The Legal Landscape for Opioid Treatment Agreements (coauthored by DEPC Affiliated Scholar, Patricia Zettler)
Abstract Summary

We sought to identify the jurisdictions that require Opioid treatment agreements (OTAs), how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in which the law permits flexibility for clinicians and health care institutions to adopt best practices. Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions’ requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts’ reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability.Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician–patient relationships and patient care within the bounds of relevant legal requirements and risks.

Report
The Impact of Statements from Federal Agencies on Public Perceptions of Efforts to Reduce Opiate Overdose Deaths
Abstract Summary

This study examined whether public opinions about efforts to reduce opiate overdoses varied after the introduction of competing statements from federal agencies. We utilized an experimental information provision survey sent to head of households in South Carolina with an associated email address. After deleting incomplete cases, the final sample was approximately 4,600. The randomized treatment contained three conditions. The first condition presented participants with a statement from the National Institutes of Health arguing for a treatment-based approach to reduce overdose deaths. The second condition presented participants with a statement from the Drug Enforcement Administration arguing for an enforcement-based approach to reduce overdose deaths. The third condition presented no statement and served as a control. Overall results indicated that more respondents favored a get-tough approach (rather than a treatment-based approach) to opiate overdose reduction. Regarding the impact of the experimental conditions for the treatment-based approach question, those who received the DEA condition were less likely to agree with the treatment-based approach than those who received the control condition. Regarding the impact of the experimental conditions for the get-tough approach question, those who received the DEA condition were more likely to agree with a get-tough approach than those who received the NIH or control statements. Taken together, these results provide some support that statements from federal agencies can impact public opinion about opiate overdose approaches.

Report
Perceived Culpability in Drug-Induced Homicide Scenarios
Abstract Summary

While some have argued that drug-induced homicide laws were largely meant to target higher-level drug dealers, others have pointed out that most drug-induced homicide prosecutions have involved low-level dealers as well as family and friends of victims. However, no research has formally explored public opinion about whether there should be differing levels of culpability in drug-induced homicide scenarios. This study examined whether perceived culpability levels in a drug-induced homicide situation differed by race and factual scenario. We utilized an experimental information provision survey sent to head of households in South Carolina. There were two randomized treatments. The first treatment was race (White and African American). Participants were randomly assigned scenarios with two White individuals, two African American individuals, or one White and one African American individual. The second treatment randomly assigned participants to one of two factual scenarios. In the first scenario, participants received a fact pattern where both individuals (trafficker and user/victim) had an existing friendship, and the trafficker was not a traditional drug dealer. In the second scenario, participants received a fact pattern where there was no existing friendship, and the trafficker was a traditional drug dealer. Our results showed large and statistically significant differences between scenarios that involved a friend relationship and a dealer relationship. Specifically, respondents who received the dealer scenarios were far more likely to assign culpability. Additionally, our results did not indicate levels of culpability assignment that were significantly (statistically) higher for African American traffickers when compared to White traffickers. Relevant decisionmakers may want to consider policies or formal laws that recognize public opinion favoring lower culpability levels for traffickers in drug-induced homicide scenarios that are not traditional dealers.

Report
Attitudes of Veterans/Active Military, Family Members of Veterans, and Non-Military Individuals on the Legalization of Marijuana and Other Substances for Recreational Use
Abstract Summary

Polling has shown that, over time, public opinion favoring the legalization of marijuana for recreational use by adults has grown. Other research has explored public opinion on the legalization of psychedelics, and has compared perceived risks of various illegal substances (e.g., LSD versus heroin). However, little research has focused on exploring differences in perceptions across one’s veteran status. Utilizing a survey of veterans/active military, family members of veterans, and non-military individuals, we built upon the existing literature by exploring whether perceptions regarding the recreational legalization of various substances varied across veteran status. Results showed that a majority of individuals, regardless of their veteran status category, supported the legalization of recreational marijuana. The results also showed that a majority of veteran families and non-military individuals supported the legalization of recreational psychedelics (the veteran/active military support level was approximately 40%). Finally, a large majority of respondents from all veteran status categories did not support the legalization of cocaine and heroin for recreational use. Overall, these results indicate differing levels of support depending on drug type and whether one is a veteran/active military, a family member of a veteran, or non-military.

Report
Characterizing prescription opioid, heroin, and fentanyl initiation trajectories: A qualitative study (coauthored by DEPC Affiliated Scholar, Tasha Perdue)
Abstract Summary

The purpose of this study is to describe opioid initiation within each of the three waves from the perspective of people who use illicit opioids, with a focus on emerging pathways into fentanyl use. We noted supply-side changes as influencing trajectories in all three waves. However, we also noted differences in the experiences of prescription opioid and heroin initiation, with these trajectories influenced by pharmacological effects, pain management, curiosity, intergenerational use, pricing, and peers. In comparison, most participants were unaware that they were initiating fentanyl, and many reported overdosing with their first use of fentanyl. We identified a trajectory into fentanyl with limited to no prior heroin use among a few participants.

Report
Attitudes on Marijuana and Psychedelics as a Treatment Option for Veterans
Abstract Summary

Many mental and physical health issues are prominent within the veteran community. Given the prevalence of health issues within the veteran community and the need for a wide range of treatment options, some researchers have started to explore whether and how veteran populations should have access to alternative treatment options such as marijuana and psychedelics. Additionally, some researchers have started to explore perceptions of alternative treatment options such as marijuana and psychedelics among military and veteran populations. Studies of veteran views on these issues, however, have not closely explored how veteran perspectives on certain drug issues compare directly to those in their immediate and broader community. Consequently, the current study sought to examine differences in attitudes towards marijuana and psychedelics as treatment options among veterans, family members of veterans, and non-military individuals. Our results indicated that a sizeable majority of respondents supported the use of marijuana as a treatment option, and that many respondents supported the use of psychedelics as a treatment option. That said, the results of this study also indicated that active and veteran military personnel remain somewhat less supportive in their viewpoints about use of historically illicit drugs as a medical treatment when compared to their family members and the general population.

Report
Clinician Perspectives on Opioid Treatment Agreements: A Qualitative Analysis of Focus Groups (coauthored by DEPC Affiliated Scholar, Patricia Zettler)
Abstract Summary

Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing we conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation.

Report
Cryptocurrencies and Drug Trafficking: A Primer for Ohio Prosecutors and Law Enforcement Agencies
Abstract Summary

The use of cryptocurrencies has grown over time, and this growth may be attributed to the asset’s ability to transfer funds anonymously (or pseudo anonymously), globally, and with little cost and skill. Additionally, cryptocurrency transactions are irreversible. While these features may be attractive for many individuals seeking to complete lawful transactions, they may also be attractive features for those seeking to complete unlawful transactions. Importantly, research shows that cryptocurrencies are being used for a wide range of illicit activity, including drug trafficking. In fact, some reports find that cryptocurrencies are the preferred method of payment for some drug traffickers. Further, there is evidence of cryptocurrencies being used for drug trafficking and related activities in Ohio. The purpose of this report is to provide a brief description about cryptocurrencies and cryptocurrency transactions, so that Ohio prosecutors and law enforcement agencies are better-prepared to identify situations where cryptocurrencies are being used for illicit actives. Being able to identify situations where cryptocurrencies are being used for illicit actives could meaningfully impact drug interdiction and asset forfeiture efforts.

Report
Sobriety Checkpoint Laws, Fatal Car Crashes and Arrests
Abstract Summary

This paper is authored by DEPC 2020-21 Drug Policy Grant recipients Lauren Jones, PhD, assistant professor, Department of Human Science and John Glenn College of Public Affairs, The Ohio State University and C. Blain Morin, graduate student, John Glenn School of Public Affairs, The Ohio State University.

Sobriety checkpoints have been used since the early 1980s to enforce laws prohibiting driving while intoxicated (DWI), and to deter DWI. However, their constitutionality has been questioned, as they allow police to stop drivers without cause. As a result, eleven states have banned their use. Using a two-way fixed effects event study analysis, we estimate the effect of rendering sobriety checkpoints illegal on state-level counts of fatal car crashes, and arrests for driving under the influence of drugs or alcohol (DUI), and drug possession. We find evidence that when states make sobriety checkpoints illegal, the number of annual fatal crashes increases by 17 percent. We also find evidence that rendering sobriety checkpoints illegal leads to a 25 percent increase in the number of annual DUI arrests in a state, suggesting that the deterrent effect of checkpoints is much stronger than their enforcement impacts. We also find suggestive evidence that eliminating sobriety checkpoints increases racial disparities in DUI and cannabis possession arrests, with larger impacts on arrests among Black residents.

Report
Teaching Drugs: Incorporating Drug Policy into Law School Curriculum, 2021–2022 Cannabis Curriculum Survey Update
Abstract Summary

The landscape of cannabis prohibition has changed dramatically in the last decade with a larger and larger number of states legalizing cannabis for medical or adult-use. These new regimes present a complex legal environment for businesses and legal professionals given the individualized character of each state’s program and long-standing federal prohibition. Yet, few law schools appear to have addressed this challenging and ever-shifting legal area by offering courses on cannabis law and policy. This report is the result of the fourth annual survey of law school curriculum focusing on courses on cannabis law offered by accredited law schools in the United States. The survey confirms that law schools are adjusting very slowly to the new legal environment of cannabis, with very few offering courses on cannabis law, including law schools located in states that have legalized adult-use cannabis.

Report
Dying Inside: To End Deaths of Despair, Address the Crisis in Local Jails
Abstract Summary

This paper is authored by DEPC 2021-22 Marijuana and Drug Policy Grant recipients Regina LaBelle, J.D., Director, Addiction & Public Policy Initiative and Distinguished Scholar, O'Neill Institute for National & Global Health Law at Georgetown University Law Center & Director, Master of Science in Addiction Policy and Practice, Georgetown University Graduate School of Arts and Sciences and Shelly Weizman, Associate Director, Addiction & Public Policy Initiative and Adjunct Professor of Law, Addiction and Public Policy Initiative at the O’Neill Institute for National & Global Health Law, Georgetown Law Center.

Efforts at the local, state, and federal levels have begun a shift toward adopting more public health-oriented approaches in correctional settings, largely driven by an acknowledgement that addressing the health care and treatment needs of incarcerated people can positively impact both these individuals and the overall health of communities. However, government leaders and advocates at every level must undertake significant policy and practice changes to reduce deaths in jail custody and accelerate reform.

This brief outlines the legal framework on the right to adequate care and treatment for medical, mental health, and substance-related conditions in jails. The brief also highlights the findings of original research on litigation related to deaths in jail custody and provides recommendations for reform.

Report
Dealing in Lives: Imposition of Federal Life Sentences for Drugs from 1990–2020
Abstract Summary

The “tough on crime” era of the 1980s and 1990s ushered in a growing reliance on prisons, the ratcheting up of sentence lengths, and a broader expansion of the criminal justice system. Life sentences, historically rarely imposed, became increasingly commonplace in the 1980s through the 2000s, contributing to the ballooning imprisoned population. While there are growing concerns about the increased use of life sentences in the United States, there has been limited empirical study of these sentences. This report seeks to fill this gap with a particular focus on the federal sentencing system and the imposition of life sentences for drug offenses. Specifically, the current report documents federal life sentences imposed for drug trafficking over the last three decades, taking a closer look at the defendant and case-specific characteristics, and providing a descriptive account of the factors that are associated with those sentenced to life in prison in federal courts.

Report
Broader Implications of Eliminating FDA Jurisdiction Over Execution Drugs
Abstract Summary

This piece was authored by the Drug Enforcement and Policy Center's Patricia J. Zettler, associate professor at the Moritz College of Law and Comprehensive Cancer Center at The Ohio State University and Seema K. Shah of the Feinberg Medical School and Pritzker School of Law (by courtesy), Northwestern University, Chicago, IL, and Lurie Children’s Hospital, Chicago. The piece appears in the American Journal of Public Health.

Report
Perceptions of Psychoactive Drugs Among Psychiatrists in the United States: The Impact of National Drug Policy
Abstract Summary

This paper is authored by DEPC 2020-21 Drug Policy Grant recipients Alan K Davis, PhD, Assistant Professor, College of Social Work, Adam Levin, MD, PGY-1 Psychiatry Resident, Department of Psychiatry & Behavioral Health, College of Medicine, and Paul Nagib, BS, Medical Student, College of Medicine, at The Ohio State University.

The American Psychiatric Association has a long history of advocating for evidence-based policy changes related to psychoactive drugs. Given this precedent, addressing the contradictions in the current drug schedule represents an ideal area of advocacy for psychiatrists. However, no prior studies have directly explored psychiatrists’ attitudes about drug scheduling and the effects of a drug’s schedule on their beliefs about drug harms, benefits, or clinical care. This project aims to conduct a survey of psychiatrists to: 1) examine whether psychiatrists’ perceptions about the acceptability, potential harms and therapeutic benefits of different psychoactive drugs differ as a function of the drug's schedule in the US, and 2) explore perspectives about the impact of drug policies on psychiatry training and psychiatrists’ attitudes/beliefs about psychoactive drugs. Elucidating psychiatrists’ perceptions and attitudes in these two areas would represent a critical first step in building consensus among psychiatrists towards advocating for a more coherent and scientifically grounded drug policy.

Report
Reprioritizing Responsibilities: Examining How Colliding Epidemics Impact First Responders
Abstract Summary

This paper is authored by DEPC 2019–20 Drug Policy Grant recipients Andrea M. Headley, PhD, Georgetown University, Christa Remington, PhD, University of South Florida, Kaila Witkowski, Florida International University, Santina Contreras, PhD, University of Southern California, and N. Emel Ganapati, PhD, Florida International University.

There is relatively little scholarly attention paid to the impact of public health emergencies on first responders and their work, let alone when diverse epidemics collide and present different (and potentially even conflicting) work-related demands. Understanding these impacts is essential in order to inform how first response agencies can mitigate potential adverse effects on their workers, build workforce resilience in the short- and long-term, and more effectively respond to both opioid abuse and other future health epidemics. The proposed research focuses on these impacts, specifically: (1) the impact of the COVID-19 epidemic on the response to the opioid epidemic; (2) changes in first responders’ perceived and actual work and responsibilities as a result of responding to two colliding epidemics; and, (2) the impact on first responders’ coping mechanisms including substance use and abuse as well as burnout and stress.

Report
The impact of national drug policies on the acceptability and availability of non-abstinent treatment interventions among clinical social workers in the United States
Abstract Summary

This paper is authored by DEPC 2019–20 Drug Policy Grant recipients Alan K. Davis, PhD, Assistant Professor and Yitong Xin, MBA, MSW, PhD candidate, College of Social Work, The Ohio State University.

Given that social workers comprise a large proportion of providers in the SUD treatment field, they are in prime positions to provide non-abstinence interventions and to advocate for changes in SUD treatment agencies’ practices and national/local drug policies. However, it is unclear to what extent social workers’ training, and their attitudes and beliefs about drug use, have been affected by national drug policies and whether their beliefs have influenced their willingness to provide non-abstinence interventions or advocate for changes to these policies. This project aims to use an internet-based survey to gain a better understanding of the attitudes and beliefs among social workers to help inform educational and training needs in the social work profession and help support short- and long-term changes in treatment settings. Data from this study will be used as pilot data for a larger grant submission that aims to develop a training/education intervention to help social workers understand the influence of national drug policies on clinical practices and to address this influence in learning the skills needed to use non-abstinence interventions in SUD treatment.

Report
Crime and the opioid epidemic: a mixed-methods examination of changing communities and criminal justice contact
Abstract Summary

This paper is authored by DEPC 2019–20 Drug Policy Grant recipient Eric LaPlant, Ph.D. candidate, Department of Sociology, The Ohio State University.

In 2016, opioid-related overdose deaths accounted for over two-thirds of all poisonings in the United States, representing the largest share of deaths attributed to the drugs in our country’s history. While the public health impact of the opioid epidemic is well-known, the economic ramifications are also substantial. It has been estimated that the annual value of the lives lost to opioid deaths is $504 billion, representing 2.8 percent of our GDP. Further, the increase in opioid-related policing and incarceration places substantial burden on criminal justice entities that are already under pressure to reduce spending. In response to this far-reaching issue, policymakers have sought to limit illicit opioid use in hopes of reducing the number of opioid overdose deaths. However, research has done little to investigate the underlying factors influencing continual increases in overdose deaths, limiting policymakers’ ability to develop targeted solutions capable of effecting change. Criminology theory has demonstrated the importance of economic factors, such as employment, inequality, and perceptions of success, as they relate to the likelihood of criminal activity; however, research has yet to utilize these theoretical frameworks to study the opioid epidemic. In this study, I draw on these concepts to formulate hypotheses that examine how changing economic conditions, especially signals of economic decline, have influenced counties’ opioid overdose death rates.

Event Recordings

Prioritizing Science Over Fear: An Interdisciplinary Response to Fentanyl Analogues

Drug Enforcement and Policy Center hosted this virtual symposium on March 16, 2021. The symposium aimed to educate advocates, congressional staff, administration officials, and scholars about the possibility that classwide scheduling of fentanyl analogues will yield unintended consequences, and to highlight evidence-based alternatives that can help reduce overdose deaths. More information at https://u.osu.edu/fentanylanalogues/.

Other Drugs Focus Area Experts