From Health Policy to Stigma and Back Again: The Feedback Loop Perpetuating the Opioids Crisis

Abstract

An earlier article, Structural Determinism Amplifying the Opioid Crisis: It's the Healthcare, Stupid, 11 NUSL L. Rev., (forthcoming 2019), concentrated on flaws in the healthcare system, arguing that healthcare itself was a structural determinant of the continuing crisis. Specifically, that article was critical of access and benefit stratification, the failure of some states to adopt Medicaid expansion (or having done so to make enrollment dependent on burdensome administrative or work requirements), and persistent problems associated with fragmentation of care, sub-optimal care coordination, and the lack of wraparound services. This article seeks to provide additional context for those structural determinants. Further, this analysis extends to identifying causes that are upstream (for example, social determinants) or downstream (for example, exceptionalism) from those identified healthcare structural determinants. These causes and effects include the limitations of our federal structure, social and structural determinants and the implications of stigma-reinforcing policymaking. Together they conspire to create a feedback loop fueled by inadequate goals, strategies, and tactics. The article concludes with a brief analysis of the SUPPORT Act of 2018 and explains why this, the latest well-intentioned federal “solution” to the opioid crisis, hones true to the systemic issues outlined herein.

Keywords: Public Health, Opioids, Substance Use, Social Determinants of Health, Structural Determinants of Health, Health Policy

JEL Classification: K32