Does Congress care more about one kind of drug addict than another? Research by Associate Professor Rob DeLeo and Alex Duarte ’19 suggests that legislators have missed the mark when it comes to policymaking for prescription opioids compared with illegal drugs like heroin and fentanyl. 

What are the main questions your research sought to answer?
Alex Duarte:  Our goal was to look at the relationship between policymakers’ attention to the opioid crisis and the specific indicators attributed to it, including overdose rates and lobbying data from pharmaceutical companies. 

Rob DeLeo:  Using overdose rates for heroin, fentanyl and prescription opioids, we wanted to explore the extent to which policymakers paid more or less attention to certain opioid overdose deaths. For example, are they more likely to pay attention to an overdose from heroin versus oxycontin?

What are some of your findings?
RD:  The literature on agenda-setting suggests indicators should correlate with issue attention. We found that was true in regard to fentanyl and heroin overdose rates: As the number of overdoses went up, policymakers paid greater attention. With prescription opioid overdoses, however, what we found was quite striking. As the number of overdoses went up, policymakers paid less attention. There seemed to be a shrinking Congressional agenda, with limited conversations on the issue. 

AD:  Though I can now appreciate the significance of the findings as a more experienced researcher, at the time I was far less surprised. Growing up I spent a lot of time in my cousins’ neighborhood, a low socioeconomic community where illegal drugs were prominent. Seeing the effects drugs can have on a person-to-person, citywide and nationwide basis is what started my interest in substance abuse disorder, particularly with regard to why certain underprivileged communities were more heavily impacted.

Rob, why were you interested in collaborating with Alex on this topic?
My research focuses on the relationship between hazards and Congressional attention, so the theoretical framework we apply in our paper is one I've worked in for over a decade. However, I hadn’t actually applied that framework to substance abuse disorder, despite having worked at the Bureau of Substance Abuse Services during graduate school. When Alex took my public policy course, he continually tied discussions back to substance use disorder. That really peaked my interest in opioid cases.

What are implications of your findings?
RD:  On a broader level, our findings contribute to understanding the ways in which powerful companies, such as those in the pharmaceutical industry, are able to shape the Congressional agenda — not just in creating policy change, but also in preventing it. 

AD:  Some of that can be attributed to the very system of Congress and its interactions with private entities. It is easy to blame pharmaceutical companies, but they are just taking advantage of the system they are in. 

RD:  As we talk about lawsuits surrounding the opioid epidemic, there is something to be said for having statistics and data that seem to indicate that Congress, at the very least, was asleep at the wheel.

How do your perspectives complement each other as researchers?
RD:  I enjoy working with motivated and excited students; it’s what fuels my passion for teaching. Alex very quickly demonstrated a unique ability to tie theory to empirical application, and I made a decision early on that I was going to work with him as if he were a colleague. 

AD:  It was never, “I am the student and you are the teacher.” I had a lot of autonomy. Rob would give me material and tell me to provide a summary of what I thought was important. I still remember going to his office and sketching the ideas. That was empowering. 

On a personal level, why do you work so well together?
AD:  Rob was one of the first teachers  to get me. I never liked school and considered going into the military after high school, but my mother wanted me to go to college. When I took Rob's course sophomore year, he extended his hand first and took a chance on me by offering a directed study. The fact that he had so much confidence in me -- even when I may not have seen my own potential -- helped me get to where I am today.

RD:  To be honest, I saw a lot of myself in Alex. I struggled in high school and didn't think I would go to college. But it was in college that I discovered academic research. That resonated with me because it wasn't based on memorization or excelling on a standardized test. It was melding strict, systematic research with creativity. Those professors empowered me to express myself creatively, which helped me realize that I love this work. 

Alex, did you ever imagine you would pursue a doctoral degree?
Honestly, no. Having never enjoyed school much in the past, I never dreamed of studying for a PhD. Conducting research with Rob gave me the chance to help make the world a better place and inform people. I’m considering a dissertation on stigma and the role it plays in substance use disorder and health outcomes for people who use drugs. My long-term goal is to become a professor, so I can have the opportunity to see the potential in a student who may not see it themselves. I want to help bring out the best in them so they can better their communities and the world, just as Rob did with me.

The research agenda of Rob DeLeo, associate professor of global studies and associate director of the Honors Program, focuses on the relationship between hazards and risks and Congressional attention. He previously worked at the Massachusetts Department of Public Health’s Bureau of Substance Abuse Services.

Former Public Policy major Alex Duarte ’19 is pursuing research on substance use disorder at the Heller School for Social Policy and Management at Brandeis University, one of the top doctoral programs of its kind in the country.