Historically, drug policy in the United States has been shaped by two major models: (1) the punitive model, privileging practices such as mass incarceration, militarization of drug control, and the criminalization of drug use and possession; and (2) the public health approach, associated with decriminalization, evidence-based and continuity-of-care orientations, and a focus on equity and human rights. The intersection of these models has produced regulatory fragmentation, whereby diverse agencies impose rules on treatment practices, medications, and licensing processes in ways that primarily reflect their own institutional interests. This fragmentation is further compounded by the U.S. federal design, where state-level regulations overlap with federal rules, deepening inconsistencies and resulting in what Wickersham and Basey (2016) aptly call a "regulatory fog."


This presentation analyzes the drug policy situation in Puerto Rico within the context of the opioid overdose crisis. It examines the health consequences of opioid policy fragmentation and its impact on access to treatment, emphasizing how fragmentation generates duplication of processes, lack of coordination, and delays in care. The discussion is framed within the coloniality of drug policies, highlighting how these dynamics perpetuate inequality and stigma. Finally, the presentation offers coordinates for a drug policy reform grounded in human rights, equity, and critical public health approaches.