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Recent outbreaks of vaccine-preventable diseases (e.g., mumps and meningitis) among young adults at higher education institutions (e.g., university, college, and junior college campuses) have proliferated nationally. Collectively, they illustrate a pressing public health concern regarding low vaccination rates among higher education populations contributing to outbreaks of communicable diseases. A primary cause of these outbreaks are lax requirements for student vaccinations among higher education institutions as a requirement for matriculation. A series of inconsistences and failures concerning vaccination law or policy requirements among select higher education institutions lends to profound public health and ethical repercussions for students and community members. Against the backdrop of rising rates or outbreaks of vaccine-preventable conditions among institutional populations, addressing these findings is vital to alleviate future outbreaks on campuses and surrounding locales.

On October 26, 2017, the Department of Health and Human Services (HHS) formally declared a national state of public health emergency (PHE) in response to the opioid epidemic. Since renewed multiple times, HHS' PHE assimilates emergency declarations among a handful of state, tribal, and local governments. Countless public and private sector entities have engaged in additional opioid emergency response efforts across the United States. These emergency declarations and measures collectively respond to the worst PHE confronting the country since the origination of this specific emergency classification in 2001. Americans across all socioeconomic groups are at risk of, or already addicted to, opioids in one form or another. Several hundred thousand Americans have lost their lives to prescription or illicit opioid misuse over the course of the epidemic. Nearly 130 more Americans die each day from opioid misuse. Millions are directly impacted by excess morbidity arising from opioid use disorders (OUDs). Most people know someone who is at risk of, or has succumbed to, opioid abuse. This epidemic is truly the juggernaut of PHEs. While emergency responses to date are purposeful and often well-intended, for manifold reasons they have also proven inadequate in authorizing and funding sufficient, efficacious responses. More significant approaches and greater investments are needed to prevent excess mortality and morbidity. Commencing with an assessment of the impacts of the opioid crisis, existing legal and policy responses, and failures to control the epidemic, a series of interventions are proposed to (1) stymie opioid-related overdoses and deaths in real time and (2) obviate deleterious impacts for future generations.

After more than two decades of escalating morbidity and mortality stemming from the opioid epidemic in the United States, early signs suggest that specific mitigating interventions are taking hold to lessen deleterious public health impacts. Still, treating pain remains the original genesis for considerable opioid uptake in the U.S. A primary alternative to opioidsis emerging: marijuana. Like opioids, marijuana and its varied derivatives have grown exponentially. Even though federal authorities still disapprove the drug for any purpose, 30 states now allow medical marijuana for a range of conditions, including palliative care despite thin proof of efficacy for treating many conditions. Critical issues of public health law and policy arise from the displacement of opioid drugs in favor of medical marijuana. While these two classes of drugs are similarly intended to manage pain, their legality and public health impacts are highly divergent and subject to public misperceptions of their safety and effective use. Promoting marijuana over opioids is risky given substantial uncertainties over short- and long-term impacts of its widespread use. Even as the nation slowly exits the long tunnel of the opioid crises, it may be heading into a fog of extensive, additional public health repercussions.

Despite years of significant legal improvements stemming from a renaissance in public health law, Americans still face major challenges and barriers in assuring their communal health. Reversals of legal reforms coupled with maligned policies and chronic underfunding contribute to diminished public health outcomes. Underlying preventable morbidity and mortality nationally are realities of our existing constitutional infrastructure. In essence, there is no general obligation of government to protect or promote the public’s health. Under principles of “constitutional cohesion,” structural facets and rights-based principles interwoven within the Constitution protect individuals and groups from governmental vices (i.e., oppression, overreaching, tyranny, and malfeasance). Structural impediments and rights infringements provide viable options to challenge governmental efforts inapposite to protecting the public’s health. Through corollary applications framed as auxiliary, creative, and ghost righting, courts are also empowered to recognize core duties or rights that the Constitution may not explicitly denote but assuredly contains, to remedy identifiable vices. Notably, ghost righting charts a course for recognizing a constitutional right to public health that Americans are owed, and government must respect, to assure basic public health needs.