CURBING OPIOID ADDICTION

By Melinda Rogers, media relations manager, S.J. Quinney College of Law

When University of Utah S.J. Quinney College of Law professor Teneille Brown presented research related to opioid addiction and legal issues to a group of county commissioners last fall, the atmosphere in the room could be summed up in one word: Desperate.

PHOTO CREDIT: University of Utah

U professor Tenielle Brown

“You could see the desperation from these county officials. It was, ‘We don’t know what to do. Our overdose rates are through the roof. Our medical examiners are quitting, because they are saying, we didn’t sign up for this, we are seeing so many 19-year-olds dead,’” said Brown describing an epidemic that is killing hundreds of Utahns each year.

As Brown listened to county officials from across Utah speak about the problems associated with opioid abuse and how it has crept into every corner of their communities, she saw potential for an educational opportunity in the midst of the conversation.

She brainstormed ideas for how to transfer the topic into her classroom and created a new seminar course at the U, The Opioid Crisis, which debuted at the law school this month at the start of the summer term.

The class approaches the subject of opioid addiction from a regulatory perspective. Students learn how gaps in laws, regulations and their enforcement, contributed to the opioid crisis while exploring how specific policy proposals could help curb the current crisis. They dig into issues such as physician conflicts of interest in over-prescribing opioids; how FDA approved OxyContin as “potentially less addictive” without adequate evidence, and the civil suits filed against manufacturers and physicians for the costs of dealing with the aftermath of these reckless practices; the difficulty going after “pill mill” distributors as DEA enforcement has been crippled; as well as public health responses and legislative efforts in Utah to reduce opioid overdose and addiction, including voluntary physician education and the mandatory tracking of prescriptions.

Outside of traditional legal coursework and readings, students have witnessed the face of the epidemic by visiting Odyssey House, an addiction, mental health and medical services program in Salt Lake City where they met individuals affected by opioid abuse and providers who are working to help them into recovery.  They have also learned from Christy Poruznik, a leading public health professor at the U, and Ray Ward, a state representative from Davis County, who has been on the frontlines battling the epidemic both clinically and legislatively.

Several students enrolled in the course say the innovative content will be useful to their future legal careers. The class is a mix of law students who envision working in the criminal justice system one day as either prosecutors of public defenders and others who hope to work in health law and public policy to facilitate change.

“Opioid addiction is a public health threat with thousands of individuals dying from opioid related causes. Personally, I have witnessed the impact addiction can have on families and communities. Generally, I am passionate about health care and my grad studies were in public health so it was a very easy choice to take this class,” said Carlos Quijada, a third-year law student.

U student Carlos Quijada.

“The opioid epidemic is only getting worse. Federal, state and local governments are in the middle of tackling this crisis through appropriate regulation. I would like to work in the health policy field. Through this class I will be better informed as to the causes and factors affecting opioid addiction in the U.S. and better prepared for a career in health policy,” added Quijada, who after the course will leave for a competitive and prestigious summer internship at the U.S. Department of Health and Human Services in Atlanta, an organization with a key role in working toward solutions for the current addiction problem.

Student Emily Mabey Swensen said the course will help to prepare her for a future as a prosecutor.

“I know people whose lives have been destroyed by these addictions. I also see that in criminal law, which is my area of interest, the opioid epidemic permeates every aspect of the system these days. From drug court to prosecution of robberies to justice court traffic offenses and domestic violence offenses, addiction plays a role in so many of the cases I’ve seen. The epidemic felt overwhelming to me and I wanted to understand how it came to be, and what any of us could possibly do to help once we get out there to practice law. I didn’t want to feel like it was hopeless,” said Swensen.

Brown’s opioid class is part of a broader initiative by the College of Law’s Center for Law and Biomedical Sciences to harness its health law expertise to address the epidemic.

The center, launched in 2015, is designed to offer resources and academic support on issues tied to improving the law as it relates to the rapidly evolving areas of health policy, the life sciences, biotechnology, bioethics and the medical and technological arts, in order to help overcome critical health care challenges.

Earlier this spring the center collaborated with the Honors College, and the Program in Medical Ethics and Humanities at the University of Utah School of Medicine to host a conversational summit on the opioid crisis in Utah. The summit aimed to develop coalitions between health care providers, public health agencies and the criminal justice community; to identify barriers to effective treatment of pain, addiction, and their aftermaths; and to begin to explore strategies that address such barriers.

During the 2018-2019 academic year, the conversation will continue with several events at the law school devoted to the topic of opioid abuse, including the Utah Law Review annual symposium on Nov. 30. The event, “The Opioid Crisis: Paths Forward to Mitigate Regulatory Failure,”  will further the discussion of the epidemic from a legal point of view. It is free and open to the public.

“We are uniquely positioned to bring together lawyers, public health professionals and a wide variety of health care professionals to address these issues. One of the major achievements of the conversational summit was the initiation of connections that we will be continuing in smaller groups — for example, between pharmacists, physicians and public health; or between prosecutors, defense attorneys, and health care providers,” said Leslie Francis, director of the center and a professor of law who is working with Brown on many of the educational components at the law school related to the opioid crisis.

The opioid epidemic in the U.S. and in Utah has received considerable attention in recent months and for good cause.  In 2016, there were 466 opioid-related overdose deaths­­­ in Utah — a rate of 16.4 deaths per 100,000 people and more than the national rate of 13.3 deaths per 100,000 people, according to the NIH’s National Institute on Drug Abuse.

Nationally, more than 63,600 people died as a result of drug overdoses in 2016, with most of those deaths attributed to painkillers such as heroin, fentanyl, oxycodone and hydrocodone, according to a recent report from the National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention.

Opioid addiction hits home for many people because those affected are often not “stereotypical” drug abusers, with many addictions spurring from a prescription given by a doctor for a back injury, dental work or other fairly routine medical problem, noted Brown.

Besides teaching, Brown will continue researching issues related to addiction and the law. Earlier this month, she traveled to St.George, Utah, where she presented at a judicial education conference to Utah appellate judges about character evidence, and the problems in the current rule of law given advances to the understanding of addiction.

Brown is well-suited to take on the task of addiction-related scholarship.  She holds a joint appointment at the U with the College of Law and the School of Medicine, where she focuses her research on legal and ethical implications of the biomedical sciences and health care.

Her expertise was tapped by Utah county commissioners last fall as a resource for counties considering filing a lawsuit against pharmaceutical companies accused of using misleading marketing tactics that have resulted in the country’s escalating opioid epidemic.

States including Texas, Florida, Nevada, North Carolina and North Dakota have filed cases in state court against Purdue Pharma, the manufacturer of OxyContin. Similar legal cases by other states have been lodged against Endo Pharmaceuticals, the maker of the opioid painkiller Opana ER.

The legal battles are likely only to grow as overdose deaths continue, said Brown. And solutions to address the broader opioid crisis are as ubiquitous as the diverse population affected by addiction, with no one-size-fits-all approach available to help reverse the troubling trend.

Still, uniting the community in a research and scholarship capacity and focusing on the law’s role in the dilemma is a start, she said.

“I don’t think any of us have any delusions about solving this problem,” said Brown of opioid addiction as a societal issue. “But we can chip away at it and prevent future cases of addiction,” she said.

“The law is pretty powerful. It can enable problems, but it can also work to mitigate them. Having students think about a big problem but also how you can chip away at it — that’s valuable. The law can make a difference.”