ES 5. Create, champion, and implement policies, plans, and laws

Core Function: Policy Development

Why This Is Important

Local health departments play an important role in developing policies, codes, and local ordinances to protect the health of the public, including the consequences of opioid misuse and overdose. There are several key benefits to developing policies to prevent opioid and other substance misuse: they have far-reaching effects, they can reinforce programs directed at individuals, and they can be relatively inexpensive to enact and easy to sustain. 

What’s Involved

  • Develop and champion policies, plans, and laws that guide the practice of public health.
  • Examine and improve existing policies, plans, and laws to correct historical injustices.
  • Provide input into policies, plans, and laws to ensure that health impact is considered.
  • Continuously monitor and develop policies, plans, and laws that improve public health and preparedness and strengthen community resilience.
  • Collaborate with multi-sector partners to develop and support policies, plans, and laws.

Key Considerations

  • The decision to implement a policy should be based on a thorough assessment of community needs and a clear understanding of the factors that contribute to identified problems.
  • A policy can only be effective if it is a good fit with organizational or community context—that is, if there are ample resources to support it and it complements (rather than competes with or undermines) other policy initiatives. To determine fit, policymakers must understand factors such as awareness of and attitudes towards the problem the policy will address, norms related to substance use, and community readiness to act.
  • Once a policy is adopted, it is important to regularly assess public awareness of the policy, the effectiveness of enforcement efforts, and the extent to which the policy is still appropriate.

Get Started!

  • Consider which policies are already in place that address your identified problem or related factors. Are these policies working? Do they need to be strengthened? For example, Massachusetts has a statewide standing order that allows retail pharmacies to dispense naloxone without a prescription. Is there a need for a local policy that aligns with this order—that would, for example, help to ensure that naloxone rescue kits are readily accessible through other venues, such as naloxone vending machines?
  • Consider which policy solution is the best fit for your community, and who should be involved in moving the solution forward. For example, if yours is a college town, you will need to consider the unique challenges of addressing opioid use on campus and work with college officials to address those head-on. If yours is a beach town, you will need to consider the impact of any policy changes on tourism, and engage the business community in your planning efforts.
  • Consider community norms around substance use. This will help you gauge potential support for policy change. Public acceptance and support are necessary for several reasons. First, you will need both to get any policy passed. Second, you will need to ensure that the policy is enforced. And finally, widespread support will increase the extent to which individuals voluntarily comply. This is critical, since it’s nearly impossible to enforce a policy with which people are unwilling to comply. In fact, enforcement is only effective when most people comply willingly, since forcing everyone to do something they don’t want to do is unfeasible.

Policy in Action: Somerville’s Supervised Consumption Sites

  • Surveys with PWUD revealed high willingness to use an SCS. The most common reasons for using an SCS included: overdose prevention or treatment, safety from police, and safety from crime or violence. Reasons for not wanting to use an SCS included concerns about police around the site and not wanting to disclose their drug use.
  • Most community members surveyed reported that an SCS would be helpful to Somerville. The main benefits included connecting people to services and supports, reducing overdose deaths, and overall public benefits. The top three reasons an SCS would not be beneficial were negative community impact, concerns about the site enabling drug use, and increasing the number of people who come to Somerville to use drugs.
  • Two focus groups with PWUD explored facilitators and barriers to using an SCS. The four main facilitators included: anonymity and discreteness, availability of wraparound service, an interdisciplinary staffing model, and support for multiple consumption methods. Barriers included law enforcement interaction around the site and inaccessible location.

Based on these findings, the study recommended that Somerville establish at least one integrated SCS in either Davis Square and/or East Somerville that includes harm reduction and wrap around support services for PWUD. It also recommended that PWUD be meaningfully included in the planning, implementation, and operational phases of opening and running an SCS, and that the city engage in transparent, community-engaged planning and implementation efforts with a range of stakeholders.

Read the full report here: Somerville Supervise Consumption Site: Needs Assessment and Feasibility Report, Final Report—June 16, 2021