Competing Issue Publics in the Opioid Epidemic: Implications for Public Policy

Public perception matters for policy outcomes. Most research finds that, in contrast to past drug waves, the public views the contemporary opioid epidemic as a medical rather than criminal justice issue, although a smaller body of research suggests that criminal justice frameworks persist. We know less, however, about how issue publics with direct experience—who are more likely to take action and have the ear of policy makers—understand it. How do people involved in the ecosystem of drug use and policy understand the opioid epidemic, and what are the implications for policy and policy change? We identify the competing issue publics that people with experience represent by the frameworks they draw from and the perceptions they hold. Through in-depth interviews and participant observation, we, too, find that people with direct experience more often use language of the medical framework than the criminal justice framework. Yet underlying the seemingly strong surface-level support for the medical framework, the criminal justice approach remains in place. Within the issue publics critical for policy debates, individuals apply the medical framework selectively to people proximate to them, or they are ambivalent, holding multiple frames (including criminal justice) at once, even among those outside the criminal justice field. Further, our research reinforces how even the medical framework is compatible with many punitive elements. The hidden persistence of a punitive framework allows differential treatment for specific populations today and paves the way for dramatic policy change, potentially in the future. Our research has implications for public perception and policy change more broadly.