Conclusions and Recommendations

The specific aims of this book have been to address four important questions regarding the opioid crisis: (1) What was the true scale of the opioid crisis, in terms of epidemiology and costs? (2) What were the main root-cause factors that contributed to the opioid crisis? (3) How might responsibility for the crisis be reasonably and fairly allocated across the myriad contributing factors? And (4) Given that the opioid crisis played out in one of the country’s most regulated industries, how did that happen, and what are the implications for the future interplay between regulators and litigators? The analyses presented in this book have numerous implications for public policy, particularly around the regulation of prescription drugs. Specifically, four policy recommendations emerge from the discussions. First, there is a comparative governance question that should be addressed in a proactive rather than reactive manner, with the intent of allocating responsibility based on core competencies. Second, the opioid crisis acted as a pressure test of current regulatory mechanisms and institutions, and the preponderance of evidence suggests that the regulatory system failed in several ways. Efforts should focus on regulatory reforms aimed at more rigorous and timely post-market monitoring, and the streamlining of pathways to implement post-market restrictions if deemed necessary. Third, in matters related to health and safety, the correct determination of causation is especially important because of its critical role in abatement. Fourth, the measurement of attributable costs and abatement costs is complex and warrants careful consideration, with the use of multiple sources for verification.