Opioid misuse and legislative responses in U.S. states: politics and lawmaking to address a public health crisis

U.S. state legislators have increasingly adopted new laws in response to rising rates of fatal and non-fatal opioid overdoses. Legislative interventions vary in number and scope across states, prompting questions about the effects of problem severity, partisan politics, and population characteristics in formulating these opioid misuse policies. This study first identifies the geographic distribution and frequency of three types of opioid misuse laws enacted at a time when multiple waves of the opioid crisis converged (2015-2019): rescue drugs, provider training, and prescribing limits. Next, the study evaluates the roles of overdose problems, partisanship, and socio-demographic factors in contributing to a state legislature's likelihood of enacting such legislation. The study finds that laws increasing access to drugs that reverse overdoses represent the most common type of legislative response. States with higher overdose death rates are more likely to proscribe an opioid misuse law, especially if these policies involve restricting opioid prescriptions or requiring more training for professionals who provide opioids. Economically advantaged states have increased odds of adopting prescribing limits. Results suggest a notable, but uneven responsiveness to this public health concern. The influence of problem severity relative to partisanship on legislative enactments, though, suggests a place for informed reform advocacy.