Evidence-based practice has long been the watchword in medical fields. Medical journals are filled with the latest research on what works and what doesn’t, what should be done and what to avoid doing. The United States Preventive Services Task Force (USPSTF) and the Cochrane Collaboration, among others, constantly review the best evidence and provide recommendations to clinicians and patients. In the public health world, we strive for not only evidence-based practice, but also its close cousin, evidence-based policy. The Guide to Community Preventive Services is a bit like the USPSTF for public health, providing systematic reviews of the effects of various program and policy interventions. The Robert Wood Johnson Foundation has created the Public Health Law Research program, which is dedicated in part to discovering how laws and legal interventions impact public health.
Unfortunately, policy makers are sometimes unaware of, or unmoved by this evidence. Policy is typically guided by three sometimes competing forces: political considerations, value preferences, and scientific knowledge — with the last often getting the short end of the stick. In perhaps no other area of public health is this more true than in the case of illicit drugs. The medical and public health communities understand that addiction is a primary, chronic disease of the brain. Unfortunately, U.S. drug policy has long focused on criminalization and other forms of punishment, rather than proved medical and public health approaches.
The story of syringe access programs (SAPs) has been oft-told but bears repeating. Despite decades of research showing conclusively that SAPs reduce health harms without encouraging drug use, and a statement to that effect by the Secretary of the Department of Health and Human Services (HSS) and the Surgeon General, our country continues to stymie the programs. For most of the past 25 years Congress has forbidden the use of federal funds for implementing SAPs, and in many states it is still illegal to possess a syringe with the intent of using it to inject illegal drugs.
While drug policies will continue to focus on criminalization, there are advancements in some areas. In September 2013, the HHS released an Overdose Prevention Toolkit that encourages the use of naloxone to reduce opioid overdose deaths. Prescription opioids such as OxyContin and Percocet continue to drive the increase in drug overdose deaths year after year. Naloxone, commonly known by its trade name Narcan, is a drug that reverses the effects of opioid overdose. In letter accompanying the Overdose Prevention Toolkit, the Office of National Drug Control Policy (ONDCP) — the “Drug Czar’s” office — declared that “The Obama Administration is implementing a science-based plan that works to reduce drug use and its consequences while pursuing drug policy reform.” ONDCP, which is led by a former police chief, also declared that it believes that naloxone “should be in the patrol cars of every law enforcement professional across the nation.”
Perhaps we are seeing the green shoots of evidence-based drug policy. Let us hope that they continue to grow and blossom.
This blog was developed by Corey Davis, J.D., M.S.P.H. , staff attorney, for the Network for Public Health Law – Southeastern Region at the National Health Law Program (NHeLP).
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this post do not represent those of the Robert Wood Johnson Foundation.