A policy mapping analysis of goals, target populations, and punitive notions in the U.S. congressional response to the opioid epidemic

Abstract

Background: The U.S. Congress has proposed numerous bills and resolutions in response to the opioid epidemic unfolding over the past decade. Although this legislative response has been the subject of considerable media attention and commentary, very little research has systematically analyzed congressional opioid-related legislation in terms of primary goals, focal populations, and the extent to which it includes punitive mechanisms.

Methods: To address this gap in research, we conducted a policy mapping content analysis of all opioid-related bills and resolutions (N = 188) proposed in Congress between 2009-2017 (111th - 115th Congresses). Two researchers independently coded basic characteristics (e.g. type, status, sponsorship, funding); goals, using a taxonomy developed by the researchers; focal populations; and punitive intent. Researchers compared codes and addressed discrepancies through consensus.

Results: Legislation addressed a wide range of goals, but frequently did not advance beyond the introduction stage (80.3%). Goals most often centered on treatment (43.1% of legislation), research (36.7%), and supply reduction of licit (34.0%) and illicit opioids (21.3%). Relatively little legislation addressed long-term recovery, avenues of safer drug consumption, or stigma reduction. Youth (21.3%) and veterans (17.0%) were the most common population categories toward which legislation was directed. Explicit attention toward racial/ethnic minorities, low-income populations, and sexual minorities was rare to nonexistent. Legislation was largely coded as not directly punitive (91.0%).

Conclusion: This study represents the first systematic analysis of key features of the U.S. congressional response to the opioid epidemic. Results indicate that the legislative response has largely focused on acute intervention, with limited attention to upstream social determinants and goal areas such as long-term recovery support. While the legislative response is primarily non-punitive, most opioid-specific policy does not explicitly address the intersection of opioid misuse and addiction with salient social factors such as economic disinvestment and social isolation.

Keywords: Congress; Drug policy; Legislation; Opioid epidemic; Policy mapping; Punishment.