Yale scholars tackle opioid crisis in groundbreaking journal issue

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More than two dozen Yale professors, doctors, and students have published a series of groundbreaking articles on the opioid crisis in the Journal of Law, Medicine and Ethics .

The special issue is notable for tackling the opioid epidemic from a variety of angles - including health law,  criminal law, addiction science, and social justice and race. It features prominent voices from across Yale University, including Yale Law School, the Yale School of Medicine, the Yale School of Public Health, and the Yale Jackson Institute for Global Affairs.

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"This issue is the product of a first-of-its-kind interdisciplinary seminar at Yale University that brought together faculty and students from a range of disciplines to explore the crisis and law’s role in it," said Yale Law Professor Abbe R. Gluck ’00 . "The seminar was built from the ground up, in response to overwhelming student and faculty demand from across the University to collaborate to study the crisis." 

The end product was approximately 20 academic articles from Yale faculty and students culminating with the Journal issue being published in July. Yale Law Professor Kate Stith noted that the articles cover a great range, including arguing for a constitutional right to opioid-use-disorder treatment in prison; questioning the use of involuntary civil commitment of those with the disorder; examining the particular toll of the crisis on Native Americans; probing the ethical difficulties doctors face in treating those suffering from addiction; and studying the unique litigation underway to resolve the crisis. The issue also includes an article co-authored by the former president of Mexico, Ernest Zedillo, now at Yale’s Jackson Institute, that investigates how the U.S. drug criminalization policy has contributed to the epidemic.

"This series reveals the overwhelming complexity of the crisis," Gluck said. "It also demonstrates how the crisis is a product of a wide variety of intersecting causes and incentives all of which contributes to its scale and all of which make it very difficult to resolve."

In the introduction, written by Professors Gluck, Stith, and Law Professor Ian Ayres ’86 , the authors acknowledge the challenges they faced in overcoming several barriers that arose from participants using different analytical frameworks.

"Those who embrace policy experimentation and see an urgency in trying all kinds of responses disagree with economists’ insistence on rigorous empirical testing," states the introduction. "Those interested in criminal justice divide on the extent to which criminalization of use and/or trafficking is a problem. Some blame physicians; others argue that physicians have been unduly targeted, and to the detriment of their patients. In the end, we believe this diversity of perspectives has contributed to a stronger product."

By taking a broad look at the crisis using these interdisciplinary lenses, the Journal series also reveals how the crisis is "one of even greater, ever-changing, complexity than we had initially imagined."

"So many in our nation have become opioid dependent, a dependence so great that even the risk of death does not deter," said Professor Stith. "Worse, the stock of people with this dependence continues to grow, spurred by many factors including the ubiquitous presence of fentanyl, manufactured often in Mexico or China. This is a public health crisis that has to be addressed on many dimensions."

David Fiellin , who leads Yale’s Program in Addition Medicine, said working across disciplines is the only way to find a true solution. 

"The historic and legal context in which the current epidemic takes place requires that we work in an interdisciplinary manner to coordinate medical and public health efforts," said Fiellin, Professor of Medicine, Emergency Medicine, and Public Health. "By rigorously examining state responses, we can determine if effective prevention and treatment efforts are being deployed and prioritized."

Gluck, who has led the charge at the Solomon Center to focus on this important issue, said the collaboration has been truly eye opening and will lead to important policy changes.

"This is a fantastic model for how we can harness interdisciplinary interests to do something really meaningful," said Gluck. "What we got out of this has been incredibly rewarding, both on the academic side and in the way we are already influencing policy."

As just one example, one of the authors, rising second-year law student Sam Marullo ’20, co-authored the article on the right to treatment in prison and is now working with Stith and other faculty and advocates on enacting that right into law in the Connecticut legislature.

The Solomon Center for Health Law and Policy at Yale Law School focuses on the intersection of law and the governance, practice, and the business of health care. The Center brings together leading experts and practitioners from the public and private sectors to address cutting-edge questions of health law and policy, and to train the next generation of top health lawyers, industry leaders, policymakers, and academics.

The Journal of Law, Medicine & Ethics (JLME) is a leading peer-reviewed journal for research at the intersection of law, health policy, ethics, and medicine. Read by more than 4,500 health care professionals, JLME is the authoritative source for health law teachers, practitioners, policy makers, risk managers, and anyone else concerned with the safe, equitable, and ethical delivery of health care services.

If you are a member of the media and would like to receive a PDF of the entire issue, please email debra.kroszner [at] yale (p) edu.


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