This Opioid Researcher Asks: ‘Who Are We Forgetting?’

For Rachel Clohan, the path to a career in economics began on her very first day in an Economics class. 

Rather than the dry syllabus review that is the boilerplate for so many first day undergraduate classes, Clohan’s economics professor wanted to talk about legal marijuana. It was the mid-2010s, and states across the U.S. were grappling with whether to legalize, decriminalize and adjust their approach to the Schedule I drug.

One student asked the instructor point-blank: Based on the research, do economists think marijuana should be legal? He said it was the wrong question. “Economists don't ask whether something should or should not be,” Clohan recalls the professor responding. “They ask whether something is, because only once we know how the current world operates can we decide whether we think it should operate that way.”

For Clohan, something about that unique worldview clicked. “I just liked that way of thinking,” she says. Rather than advocating for one response over another, economics, she says, presents a set of facts that people can use to draw their own conclusions.

After she graduates from Emory University, she’ll have the chance to pay that lesson forward. In the fall, she is set to begin a professorship at Southeastern Louisiana University.

And interestingly, Clohan is still examining the economics behind illicit substances.

Much of Clohan’s PhD research focused on the opioid epidemic, including how policies such as the introduction of naloxone, a medication that can reverse overdose, impacted mortality and treatment. Part of her dissertation examined the concept of “moral hazard,” a hypothesis that as certain behaviors become less risky, people will naturally increase the risks they take. Critics of naloxone argue that making the life-saving medication available could encourage people who use drugs to do so more recklessly, despite little empirical evidence supporting the theory. For her part, Clohan found no evidence to back a moral hazard in opioid use, and she hopes her conclusions will provide a clearer answer about the benefits of naloxone than past research.    

Both the initial spark of her interest in economics and her current research may have focused on substances, but for Clohan, people are at the core of her work. “I'm more interested in drug users than I am in drugs specifically,” she says. “My focus is more on trying to understand how policy affects people who are often overlooked or might not necessarily have a say in policies.” 

In the early days of Clohan’s PhD, that perspective was a guiding force. “[What] I would always come back to is who is potentially not represented?” she says. “Who's getting overlooked? Who are we forgetting?”

That interest is lifelong, cultivated through Clohan’s relationship with her brother, who was born with a neurodegenerative disorder that contributed to health challenges throughout his life. Clohan’s research aims to home in on those who may not have a voice or be able to advocate for themselves, and to try to understand how policies are impacting them.

“It just kind of wormed its way into how I read research,” she says.

She hopes that her research on the opioid epidemic can help create a bridge between economic conversations around naloxone and those occurring in public health. What she knows for sure is that something needs to change in terms of the approach to handling the crisis. When fentanyl — a synthetic opioid orders of magnitude more potent than heroin — emerged in the U.S., it changed the game for anyone who the epidemic touches.

In the case of naloxone, “people were really hoping that this would be the silver bullet for the opioid epidemic and that it would change the entire trajectory, and that wasn’t the case,” Clohan says. At the same time, the drug and its wider distribution have saved lives. Those wins matter — even if they seem small amid the broader scale of the crisis. But there is much more to do.

“When it comes to drug policy, there is hope, but we still have a lot of work to do if we're going to improve people's health and lives,” she says.