A philanthropic giant’s recent hire of a researcher with controversial theories on naloxone access is raising alarms among public health advocates who worry the move marks a shift in major donors’ approach to addiction treatment.
Arnold Ventures, one of the largest nonprofit funders of criminal justice reform projects and a major player in drug policy circles, announced last month that Texas A&M University economist Jennifer Doleac would take over its criminal justice portfolio in July, replacing longtime policy reform researcher and public official Jeremy Travis. The news reignited a Twitter firestorm over Doleac’s work, including research suggesting that making the opioid overdose treatment naloxone more accessible sparked a rise in opioid use.
That paper, along with writing suggesting that supervised injection sites fuel similar trends and some of Doleac’s other work related to race and crime, have advocates worried that relatively recent harm reduction policies like free and accessible naloxone or needle exchange sites will come under fresh fire, and that her hire more broadly marks a shift in Arnold Venture’s approach to the criminal justice space.
“The Arnold family has always been focused on this idea of data-driven criminal justice reform, but the hiring of Doleac signals an extremely narrow and ultimately troubling understanding of what counts as data,” said Alex Vitale, a Brooklyn College sociology professor focused on justice and policing reform.
STAT spoke to seven public health researchers and criminal justice or addiction care advocates who said they worried that Doleac’s hire represented a pendulum swing from projects focused on harm reduction and assistance to more restrictive policies like less naloxone access. Several spoke on background because of concerns about funding streams and relationships with Arnold Ventures, which is one of the most significant resources for criminal justice grants in the country.
The naloxone controversy began with an April 2018 paper Doleac co-authored with Anita Mukherjee, a University of Wisconsin-Madison economist, concluding that relatively recent policies that boosted naloxone access increased opioid-related mortality by 14 percent in the Midwest, prompted more opioid use and overdoses, prompted more internet searches for the antidote and marginally fewer searches for rehabilitation programs.
Doleac and Mukherjee wrote in a Brookings Institution blog later that year that “while naloxone saves lives in the moment — which is clearly a priority for policymakers and public health officials — broad access may increase rates of drug abuse and possibly even mortality.” They also cited a paper suggesting supervised-injection sites similarly fueled a rise in heroin use, touching on a controversial policy area; many public health researchers argue the sites don’t drive more use and vastly reduce risks like HIV transmission.
Public health experts swiftly criticized the causal link the researchers drew and argued more-accessible naloxone policies were still too new to collect data on their impact. Many also blasted a reference to so-called naloxone parties, where people intentionally overuse an opioid and are revived, a law enforcement legend about opioid use that has been debunked. References to those parties were removed in later editions of the paper.
Several researchers who spoke to STAT likened the assumptions in the naloxone paper to early theories that implementing broad seatbelt requirements would lead to more reckless driving.
At the heart of the issue, they say, is that the numbers-driven economics approach can rely on a narrow set of data to draw conclusions and ignore less quantitative factors or key community background. For instance, Doleac cited a rise in emergency room visits for opioid overdoses as evidence that overall opioid use was rising. Officials including Baltimore’s former health commissioner Leana Wen argued that ER visits could also reflect better education and outreach — and ultimately, more saved lives.
When it comes to studying the impact of addiction and criminal justice policy, economists will make data-driven conclusions “under the guise of objectivity,” said Eric Reinhart, a Harvard public health researcher. But the figures they rely on, especially numbers on naloxone use and overdoses, aren’t consistently reported. And when those figures are rooted in certain communities and policies, it is difficult to draw broad conclusions from them.
“My concern is that when you put somebody like that in a position of power, it shifts the field further and further to the right,” said Reinhart.
Neither Doleac nor Arnold Ventures responded to requests for comment. But Doleac defended her paper’s conclusions in a conversation with STAT shortly after the 2018 blowback.
“We took unusually long to post the working paper because we knew it would be so sensitive and [so that] we knew we got it right,” she said. “Before we posted, we got a lot of feedback from people who are expert in this field.”
Two months after Brookings published the post, it posted a response from public health researcher Colleen Barry and economist Richard G. Frank arguing that Doleac’s work “overlooked” an expanse of research and that “without incorporating an understanding of the diseases and the institutional contexts, rigorous research designs will yield misleading evidence.”
A week later, Doleac and Mukherjee’s post was amended to cite additional studies on supervised-injection sites and naloxone trends. Three additional paragraphs were added to the harm reduction section. “We recognize that these findings strongly contrast with previous work by public health researchers that suggested few, if any, trade-offs that result from these harm reduction policies … this is clearly an area that needs further study,” it said.
Since former Enron executive John Arnold founded Arnold Ventures in 2010, the nonprofit has put nearly $400 million towards criminal justice projects from studies on needle exchange sites and other harm reduction to police accountability, pretrial counseling, prison improvements and bail reform. Its stream of funding eclipses other prominent players in the field; Blue Meridian’s Justice and Mobility Fund, for instance, has committed $185 million, while Ford Foundation has a $7.5 million annual budget for criminal justice-related initiatives.
Some of the advocates who spoke to STAT voiced concerns that Doleac’s hire marked a swing back to more conservative criminal justice approaches amid right-wing criticisms of the Arnolds’ funding streams. For instance, a September Fox News article reported that the billionaire couple “quietly poured more than $45 million” into New York bail reform efforts while “critics [said] the reform contributes to rising crime.”
A spokesperson for Arnold Ventures told Fox at the time that their contributions were not to support the bail law but rather to understand its impact after it passed.
Two advocates in the criminal justice space who spoke with Arnold Ventures staff after the announcement told STAT that there is a perception among some employees that Doleac’s hiring could help neutralize concerns that the venture is leaning too progressive, alienating more moderate groups. But that hasn’t stemmed concern among criminal justice organizers who say Arnold Ventures grants have been vital in the space.
“Even as a formerly incarcerated person myself, I can be moderate on some of this,” said one advocate. “I’d have an appetite for someone who just happens to be more moderate…But that’s not what she is. She is just someone who’s hugely disconnected.”