By Sonal Parekh

The United States regulatory framework for addressing substance use disorder (“SUD”) increasingly relies upon loved ones of those who suffer from the disease. In an important sense, it deputizes family members, using them as a regulatory tool to influence the decisions or behaviors of their loved ones. However, such deputization raises questions of not only whether family involvement helps or hurts patients’ health outcomes, but also how it affects families’ health and relationships, and whether such impacts are distributed equally. Professor Lawrence explores these questions in his recent article, Deputizing Family: Loved Ones as a Regulatory Tool in the “Drug War” and Beyond. 

While many traditional tools are used to address the addictions crisis, efforts to prevent, treat and reduce the harms of drug addiction increasingly enlist family members. Though not always recognized, families often play a vital role in prevention, harm reduction, access and quality of treatment for SUD. Families may discourage misuse, help identify risk factors and encourage early treatment, provide safe housing and supervision, and facilitate access to treatment through various methods such as arranging insurance coverage, giving personally-costly financial support, and providing transportation.  

The law operates through family members in various ways. Examples abound, some prohibition laws explicitly deputize family, enlisting them in prevention-by-prohibition by making the family liable for failing to intervene or stop prohibited use or sales in their home or presence. The American Medical Association’s guidance encourages providers to prescribe naloxone to a family member or close friend of SUD patients. Consistent with this guidance, may states have standing orders that explicitly identify family members as eligible for third-party prescriptions of Naloxone, thus deputizing family to meet public health goals of harm reduction. As for treatment, involuntary treatment laws explicitly deputize family by allowing loved ones to petition to send a SUD sufferer into treatment without their consent. Treatment protocols that call for incorporating family into the recovery process recognize research which indicates social relationships are a significant positive influence on recovery.

Focusing on the role of family underscores the fact that family support groups could be better supported by providing funding and educational resources to make families more effective in supporting those with addiction, while reducing the personal, financial and emotional burdens of providing such support. However, it is important to consider the costs and benefits of deputizing family in fighting disease to ensure law does not alter family involvement in ways that have an adverse impact. In the article, Professor Lawrence noted “such considerations include the potential for interference with the underlying family relationship; the invisibility of and lack of compensation [for the burden of care work]; and the inequality of relying on care work when its performance or availability varies across genders, race or class.” Caring for a loved one with SUD can be personally, psychologically, emotionally and financially devastating. The invisibility of care work can contribute to an under-supply of educational resources and support that could increase the burdens on care givers and inhibit the quality of their help. It is essential that the legal framework recognizes families as frequent participants in their loved ones’ battle with addiction.

Because social consequences like interference, invisibility and inequality are difficult to quantify, it is imperative to invest in evaluation and research that can facilitate the recognition and consideration of social consequences when implementing or revising laws that deputize family. Involuntary treatment laws serve as a prime controversial example. Such laws raise enough reason for concern about social consequences to justify continuing research. It is important that legislators and policymakers interested in crafting such laws assess possible detrimental impacts on a family’s ability to improve health, reduce mortality, improve access and aid in recovery when doing so.

 “Break-even analysis” is a normative framework for decision-making in the face of hard-to-quantify costs or benefits. This framework would help regulators decide how to proceed when there is limited information as to social consequences and impact by establishing reasonable upper and lower thresholds that benefits would have to reach in order to be justified.

While difficult, consideration and understanding of the social consequences of deputization in the prevention and treatment of SUD is imperative in the implementation of a legal framework that serves to address the addiction problem and benefit sufferers of SUD.