From Control to Care: Reframing Medication Access Policies Through Public Health Ethics

Area of Science:

• Public Health
• Health Policy
• Substance Use Disorder Treatment

Background:

• Ongoing prescription stimulant shortages are linked to Drug Enforcement Administration (DEA) quota restrictions and fragmented drug governance.
• Carceral health systems face similar challenges in managing medications for opioid use disorder (MOUD) due to control logics.
• Risk management, diversion control, and liability concerns shape medication access in both general and carceral settings.

Purpose of the Study:

• To analyze the prescription stimulant shortage by drawing parallels with carceral health systems managing medications for opioid use disorder.
• To explore how perceptions of risk, suspicion, and oversight contribute to medication scarcity and stigma.
• To identify actionable recommendations for promoting equitable access to evidence-based treatment.

Main Methods:

• Comparative analysis of drug governance systems.
• Examination of risk management and oversight logics in medication access.
• Literature review and policy analysis.

Main Results:

• Restrictive oversight and risk-focused management in both systems can inadvertently create medication scarcity.
• Perceptions of "deservingness" and stigma associated with stimulant use and MOUD can widen treatment gaps.
• Ineffective and fragmented governance exacerbates access issues.

Conclusions:

• Parallels between stimulant shortages and carceral MOUD management reveal systemic issues in drug governance.
• Addressing stigma and reforming oversight are crucial for equitable access to essential medications.
• Public health ethics should guide policy to ensure evidence-based treatment availability.