Competing Emergencies: A Policy Analysis of the Opioid Epidemic during COVID-19

Abstract

The response to COVID-19 brought rapid policy change to substance-use services in the US and redefined its street-level bureaucrats (SLBs) as essential workers. What effect did policy changes have on SLB discretion and roles? This article examines policies prior to and after the onset of the pandemic and analyzes the implications for practice through interviews with managerial and executive staff in the substance-use field in New York State. In governments’ attempt to balance the risk of competing emergencies, the effects of the simultaneous extension and contraction of different types of discretion on organizations and their frontline workers are shown.

Note: In the interests of space, street-level theory and the pandemic context underpinning the articles for this Special Issue are discussed in detail in the Introduction to the Issue.

Keywords:

• SLB roles
• discretion
• comparative policy analysis
• opioid crisis
• COVID-19
• United States

Notes

1. The designation of “essential” carves out exceptions to “stay at home” orders. Essential organizations and their employees continued providing services to the public, many of these in-person/on-site, while non-essential enterprises and workers went on “pause”, working from home or closing operations.

2. Drug Enforcement Agency (DEA), Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS).

3. Office of Addiction Services and Supports (OASAS), Office of Mental Health (OMH), Department of Health (DOH).

4. Also referred to as “street-level management” (see Gassner and Gofen 2018).

5. For a list of controlled substances see: https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf

Additional information

Notes on contributors

Elizabeth Pérez-Chiqués

Elizabeth Pérez-Chiqués is a research professor at the Centro de Investigación y Docencia Económicas’ (CIDE) Division of Public Administration and a fellow at the Rockefeller Institute of Government in New York. Her research examines government corruption, public personnel management, and policy implementation. Her work has appeared in Public Administration, Studies in American and Political Development, and Journal of Health Policy, Politics and Law. 

Patricia Strach

Patricia Strach is a professor in the Departments of Political Science and Public Administration & Policy at the University at Albany, State University of New York and a fellow at the Rockefeller Institute of Government. Her research examines public policy and mass politics. She is the author of Hiding Politics in Plain Sight: Cause Marketing, Corporate Influence, and Breast Cancer Policymaking (Oxford 2016), All in the Family: The Private Roots of American Public Policy (Stanford 2007), and articles appearing in Political Research Quarterly, Journal of Policy History, Polity, and American Politics Research.

Katie Zuber

Katie Zuber is a doctoral lecturer in the Political Science Department at John Jay College of Criminal Justice, City University of New York. Her research interests focus on the relationship between law and social movements. Her work has been featured in the Law and Society Review, Journal of Health Politics, Policy and Law, and Justice System Journal.