Reports on the Opioid Crisis are Full of Misidentified Problems and Poorly Calibrated Solutions

Photo by striatic/flickr

This post is part of a symposium from speakers and participants of Northeastern University School of Law’s annual health law conference, Diseases of Despair: The Role of Policy and Law, organized by the Center for Health Policy and Law.

All the posts in the series are available here.

By Nicolas Terry

The epidemic associated with Opioid Use Disorder (OUD) has birthed a proliferation of reports, many with notable provenance. They include the Surgeon General’s Report (2016), the President’s Commission on Combating Drug Addiction and the Opioid Crisis (2017),  and the National Governors Association Recommendations for Federal Action to End the Nation’s Opioid Crisis (2018). We can add innumerable regional and state reports to that list.

Placed next to each other, their recommendations are broadly similar. While they may differ somewhat to the extent that they emphasize criminalization versus medicalization, overall, they tend to coalesce around harm reduction (such as broad naloxone availability and syringe exchanges), upstream opioid reduction strategies (such as prescription limits and prescription drug monitoring programs), and increased public health surveillance based on improved data collection and analysis.

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Amy McGuire and Natalie Ram on ‘The Week in Health Law’ Podcast

By Nicolas Terry

This week on the pod I welcome Amy McGuire, the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine and Natalie Ram, a Professor of Law at The University of Baltimore School of Law. Our conversation revolves around the arrest of the suspected Golden State Killer who was partially identified by a DNA match through a publicly accessible database. Legal topics range from the Fourth Amendment to HIPAA and the Common Rule as we discuss implications for personal privacy and major, DNA-led projects such as Precision Medicine. For background see this and this

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Scott Burris and Abraham Gutman on ‘The Week in Health Law’ Podcast

By Nicolas Terry

Special guest host Wendy Mariner from Boston University and I welcome Scott Burris and Abraham Gutman from Temple University’s Center for Public Health Law Research. We discuss the failures associated with the Fair Housing Act, including the delayed implementation of the Affirmatively Furthering Fair Housing rule, the eviction epidemic highlighted in Matthew Desmond’s book Evicted: Poverty and Profit in the American City, the tragedy of the silos in public health interventions, and the application of the concept of “health in all policies” to the housing crisis. Continue reading

Thad Pope on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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Our guest this week is Thaddeus Mason Pope, Director of the Health Law Institute and Professor of Law at Mitchell Hamline School of Law. Thad is also a Ph.D. with multiple global academic posts. This week we discuss grave and complex problems in end of life care, focusing on the tragic case of Jahi McMath. Thad recently published “Brain Death Forsaken,” and offers a wealth of insight on this and similar situations. The definition of death has complex implications for insurance, reimbursement, malpractice, and even criminal law.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Jessica Roberts on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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Jessica Roberts, the Director of the Health Law and Policy Institute and a George Butler Research Professor at the University of Houston Law Center, returns to the pod. In her research, Jessica has offered compelling and innovative perspectives on a range of issues in heatlh care research, finance, privacy, and ethics.

Jessica’s book on “Health-ism,” co-authored with friend of the pod Elizabeth Weeks Leonard, is forthcoming from Cambridge University Press. We begin by discussing health discrimination before, during, and after the ACA. Then, we discuss Jessica’s take (admirably articulated in a recent Michigan Law Review book review) on the nudging at the center of healthcare’s version of behavioral economics.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Diseases of Despair on ‘The Week in Health Law’ Podcast #2

By Nicolas Terry and Leo Beletsky 

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In April, 2018 the Northeastern University School of Law held a conference titled “Diseases of Despair: The Role of Policy and Law.” TWIHL was asked to be the event’s podcast partner and we roped in Leo Beletsky, our friend and one of the conference organizers, to act as co-host for two special TWIHL episodes. Professor Beletsky, holds a joint appointment with the Northeastern University School of Law and Bouvé College of Health Sciences. His research examines the use of law to improve health, with a focus on drug policy, reducing the spread of infectious disease, and the role of the criminal justice system in shaping public health outcomes. Continue reading

Diseases of Despair on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Leo Beletsky 

Subscribe to TWIHL here!

In April, 2018 the Northeastern University School of Law held a conference titled “Diseases of Despair: The Role of Policy and Law.” TWIHL was asked to be the event’s podcast partner and we roped in Leo Beletsky, our friend and one of the conference organizers, to act as co-host for two special TWIHL episodes. Professor Beletsky, holds a joint appointment with the Northeastern University School of Law and Bouvé College of Health Sciences. His research examines the use of law to improve health, with a focus on drug policy, reducing the spread of infectious disease, and the role of the criminal justice system in shaping public health outcomes. Continue reading

Andrew Torrance on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

Subscribe to TWIHL here!

This week we welcome Kansas University law professor Andrew W. Torrance, who teaches and conducts research in patent law, intellectual property, innovation, and so much more! Andrew is Earl B. Shurtz Research Professor at the University of Kansas School of Law, and a winner of a 2015 University Scholarly Achievement Award at the University of Kansas.

Andrew leads us through a couple of fascinating topics on the bleeding edge of law & technology. First, he discusses the use of a page ranking-like model to value patents. Second, he introduces us to some governance and related models applied in the synthetic biology community to avoid the tragedy of the commons and supplement or replace traditional IP protection. Our conversation covers both how cutting edge technology of network analysis can help us better understand law, and how law can better govern cutting edge technology like synthetic biology.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Jamila Michener on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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A warm welcome to political scientist Jamila Michener, Assistant Professor in the Department of Government at Cornell University. Her research focuses on poverty and racial inequality in American politics. She is the author of a compelling new book, Fragmented Democracy: Medicaid, Federalism and Unequal Politics (Cambridge University Press, 2018). We discuss Medicaid’s policy and politics from her original perspective—how and why federalism (not to mention Section 1115 waivers) allows for unequal treatment of Medicaid recipients across out nation, and some of the damage to democratic institutions that result. An illuminating perspecive on both Medicaid policy and federalism, Fragmented Democracy is a great source of insights for lawyers, policymakers, and activists.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Philip Rocco on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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A welcome to first-time Pod guest Philip Rocco. Philip is Assistant Professor of Political Science at Marquette University. His research examines the consequences of institutional fragmentation for the development of public policy, with a focus on the politics of health reform in the United States.

We cover a lot of territory inspired by Phil’s recent publications on Medicaid managed care data, all-payer claims databases, and public comments received during the Medicaid waiver process. Those interested in the politics and sociology of knowledge are in for a special treat as Rocco deftly applies findings in the social studies of science to cutting edge health law & policy debates.

A brief lightning round touches on ACA stabilization, more data about Indiana’s 1115 waiver, and the stinkbug-in-chief. The White House Council of Economic Advisors has also trumpeted gains in the key health care performance indicator of the Trump era: health insurer profitability, soon to be boosted by AHPs, MEWAs, and VA privatization.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Rachel Sachs on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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​This week’s episode features a welcome return from Rachel Sachs, Associate Professor of Law at the Washington University in St. Louis School of Law. Rachel’s primary research interests lie at the intersection of patent law and health law, with a particular focus on problems of innovation and access and the ways in which law exacerbates or ameliorates these problems. She is a prolific scholar who has a knack for identifying cutting-edge research. We focus on her most recent publication, Delinking Reimbursement. We discuss various aspects of the drug price phenomenon, attempting to find some explanations for our current predicament, while exploring some possible solutions.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Jeanne Lenzer on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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​We are joined by award-winning medical investigative reporter Jeanne Lenzer. We discuss her book, The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and One Man’s Battle to Survive It. Lenzer puts forward strong arguments that the medical device industry is under-regulated, and that whistleblowers are insufficiently protected. Woven through her analysis is the story of one patient’s dangers and difficult journey involving an implanted device together. Related stories about physicians and researchers help leaven the medico-legal loaf with the human impact of this massive industry.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Heather Howard on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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We welcome back one of the pod’s most popular guests. Heather Howard is a member of the faculty at Princeton University’s Woodrow Wilson School of Public and International Affairs. Previously, she served as New Jersey’s Commissioner of Health and Senior Services from 2008-2010. With her help we unpack the latest flurry of Section 1115 waiver approvals and Medicaid refractive surveillance apparatus. Some seem ripe for considerable skepticism, threatening the healthcare of many. Others, current or proposed, give some cause for cautious optimism.

In our lightning round, we discuss the latest judicial challenge to the ACA, a non-severability argument reprising themes of the key NFIB v. Sebelius dissent. We also discuss states’ asserting increasing ability to ignore aspects of the ACA, and the grim prospect of lifetime limits on Medicaid beneficiaries.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Diane Hoffman on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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This week our guest is the Director of the Law and Health Care Program and Jacob A. France Professor of Health Care Law at the University of Maryland, Diane Hoffman. Diane has directed a groundbreaking, interdisciplinary team of researchers exploring the regulation of the human microbiome market, probiotics, and microbiota transplants. She was lead author on the 2017 Science article “Improving Regulation of Microbiota Transplants,” and recently published work in Gut Microbes, JLME, and the AJLM.

Diane has written influential articles in many subfields of health law, but today we focus on her work on the biome. The science is fascinating but the regulatory system is complex. Diane’s leadership in ELSI working groups researching these areas makes her the go-to source for ideas on the various options regulatory options (including by the FDA and FTC) and their potential impact on the growth of this new and rapidly evolving science.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Nicole Huberfeld on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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Pod favorite and BU public health and law professor Nicole Huberfeld makes a welcome return. We discuss Medicaid work requirements, lockouts, and health literacy testing, and reflect on the new CMS-imagined Medicaid space. As CMS blows past its traditional guardrails, we ask, what are the limits for post-ACA Medicaid, a tightly controlled welfare benefit rather than universality-enabling health insurance? Are Medicaid work requirements a kind of human subject experimentation, or something even worse?

We review administrative law as we discuss Nicole’s superb commentary on CMS’s authority to accelerate workhouse 2.0. We end our discussion by weighing the possible legal challenges to the recent Section 1115 waiver plans. Also, we try to stay cheerful!

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Jake Sherkow on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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We welcome Jacob Sherkow, a law professor at the Innovation Center for Law and Technology, at New York Law School, with affiliations at Columbia University and the University of Copenhagen’s Center for Advanced Studies in Biomedical Innovation Law. Jacob teaches a variety of courses related to intellectual property. His research focuses on how scientific developments, especially in the biosciences, affect patent law and litigation.

Jacob is a prolific scholar, the author of over two dozen articles on these and related topics in both traditional law reviews and scientific journals. (The latest include “Cancer’s IP,” a vital policy intervention.) A scholar capable of both “big picture” and very fine-grained analysis, he is a great guide for bridging the worlds of health care law & policy, and intellectual property. Our conversation begins with an excellent CRISPR primer before traversing some fascinating questions about gene-editing patent litigation around the world, licensing issues, and the broader array of regulatory issues generated by such emerging technologies.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Carl Ameringer on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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This week features a first time visit from Carl Ameringer, professor of health policy and politics at Virginia Commonwealth University in Richmond, Virginia. A lawyer with a PhD in political science, he is an expert on issues surrounding our national debate on health care reform. We discuss his latest book “US Health Policy and Health Care Delivery: Doctors, Reformers, and Entrepreneurs,” published by Cambridge University Press. Our conversation connects the past and future of American health care, from 19th century development to the ACOs of the ACA. We close with some reflections on path-dependence: is American exceptionalism a permanent impediment to health sector rationalization, or does it provide some models for improvement? Muddling through history, policy, and law has rarely been more edifying, and we hope you enjoy the conversation as much as we did.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Carl Coleman on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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Seton Hall Law Professor Carl Coleman leads our deep dive into human subjects research, the revised common rule, and the future of data and biospecimen use. We discuss the reasons for the continued delays of the revised common rule, and debate some of its merits. We also add some comparative perspective as we explore researchers’ objections to aspects of both the original and revised rules. Carl has previously written on “rationalizing risk assessment” in research, and brings a wealth of experience to the discussion.

Carl has served as Bioethics and Law Adviser at the World Health Organization (WHO) in Geneva, Switzerland, where he was one of the primary authors of the report, Ethical Considerations in Developing a Public Health Response to Pandemic Influenza. He has contributed to WHO reports on capacity building for research ethics committees, ethical issues in tuberculosis prevention, care, and control, research ethics in epidemic response efforts, standards and operational guidance for research ethics committees, and key issues in global health ethics. From 2010-2013, Carl was a member of the Secretary’s Advisory Committee on Human Research Protections (SACHRP), which is charged with providing expert advice to the Office for Human Research Protections of the U.S. Department of Health and Human Services.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw.

Dystopian Memes on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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It’s a stormy healthcare landscape out there, so this show is all lightning round. We cover several areas:

Litigation: Nic provides the Ariadne’s thread through a labyrinthine pharma-tort judgment out of California. The metal on metal hip litigation has resulted in a big judgment, but medical device regulation is still fundamentally broken. Disgruntled Centene enrollees are suing the ACA insurer of last resort for ultra-narrow networks (and Washington state is not happy, either). Washington may lead the way for future narrow network regulation or consent decrees. We followed up on the duodenoscope superbug litigation saga, focusing on duties to translate foreign language emails in discovery.

Regulation: We discussed a crisis in long-term care, following up on last week’s discussion with Paul Osterman. Medicare is not making it any easier for many who qualify for help. We reviewed the new priorities of HHS’s Conscience Rights, er, Civil Rights Division (and potential responses to conscience claims). The rise of Medicaid work requirements is a hot topic, as Kentucky Governor Bevin imposed them last week. Continue reading