Dantuluri examines the ongoing prescription stimulant shortage driven by the Drug Enforcement Administration’s quota restrictions and an ineffective and fragmented system of drug governance. We extend this analysis to carceral health systems, which operate under similar logics of control in managing risks, diversion, and liability around medications for opioid use disorder. In drawing these parallels, we explore how perceptions of risk, suspicion, and restrictive oversight can produce scarcity, reinforce stigma, and elicit judgments around “deservingness” that may ultimately widen treatment gaps. We conclude with actionable recommendations that align with public health ethics to promote equitable access to evidence-based treatment.

A perceived barrier to effective treatment of pediatric-onset multiple sclerosis (POMS) is access to disease-modifying therapies (DMTs). An online Canada-wide survey of POMS DMT prescribers was used to identify patterns in, and barriers to, DMT access. Nineteen prescribers provided responses. Overall, DMT access via private versus government drug plans was variable. First-generation (e.g., beta-interferon) DMTs were more accessible via government plans versus second-generation DMTs (e.g., ocrelizumab). Most DMTs were available through private insurance plans. B-cell depleting therapies were the most difficult to access. Variability in DMT access for POMS raises concerns about health equity and care optimization.