ES 6. Utilize legal and regulatory actions

Why This Is Important

While most legal efforts to address the opioid epidemic originate at the state level, local health departments can play a vital role in helping to promote and enforce these efforts. Legal approaches can reduce improper prescribing of opioids, protect individuals who report overdose, and improve access to overdose care. Health departments can also work with community partners, including public safety—who are often tasked with enforcement—to ensure that laws and regulations are applied fairly.

What’s Involved

• Ensure that relevant laws are equitably applied to protect the public’s health.
• Assess enforcement efforts already in place and determine their efficacy.
• Identify appropriate enforcement strategies for identified laws and regulations.
• Identify sectors that will be responsible for enforcing laws and regulations, and ensure that they are on board.
• Identify others who may need to be involved to support enforcement strategies.

Key Considerations

• Enforcement and policy are closely related, but they need to be considered separately. In the absence of enforcement, policies are merely abstract ideas, without action to back them up. However, the players who develop and articulate policies are usually not the same players tasked with enforcing them. Moreover, these players are not always accustomed to working together.
• Enforcement must be part of the policy planning process from the start. Enforcement increases the likelihood of compliance, which in turn produces the health-promoting changes that policies are intended to create. Without planning and dedicated resources for compliance and enforcement, even the most comprehensive and well-thought-out policy is unlikely to succeed.
• The decision to implement an enforcement strategy should be well-informed. It should be based on a thorough understanding of community needs and resources; strong community support; and a fairly strong assurance that the people who will be doing the enforcing are on-board.

• To what degree are existing policies enforced? This will help you anticipate potential roadblocks to new enforcement efforts.
• What enforcement strategies are already in place? This will help you determine what is working well and where there may be need for improvement. Will your new efforts complement existing strategies or duplicate them? If no enforcement strategies are in place, why or why not?
• Who is involved in current enforcement efforts? Are they the “right” enforcers? Are they well-supported? Do they have the bandwidth to take on something new? Are there new players who need to be engaged to improve the likelihood that new efforts will be successful?
• Is the community ready to act? Keep in mind that readiness isn’t static. You can build it through education, information dissemination, and the support of local champions.
• What’s feasible? Does your community have the resources to enforce local policies—and to do so consistently? Will you be competing with other enforcement efforts? Surveying available resources will allow you to choose a realistic enforcement strategy. If resources (or readiness) is lacking, you may want to take time to acquire the necessary resources (and build the necessary readiness) before moving forward.