This election season, American voters have heard a lot about addiction. Unlike in times past, however, they are hearing from not only tales in tabloid newspapers or advice from health care providers but from Republican presidential candidates. In the midst of a national opioid and overdose epidemic, former and current candidates Governor Chris Christie, Governor Jeb Bush, Senator Ted Cruz, Donald Trump, and Carly Fiorina have all spoken publicly about losing friends, classmates, and family members to addiction.
The ubiquity of addiction throughout the GOP campaigns speaks to the sheer size of the problem: an estimated 21.5 million people aged 12 or older had a substance use disorder in 2014. The number of unintentional overdose deaths from prescription pain relievers has more than quadrupled since 1999; in many states, there are more people dying from overdoses than from motor vehicle accidents, suicide, or homicide.
In New Hampshire, where presidential hopefuls campaigned fiercely ahead of the primaries earlier this year, opioid overdose fatalities have doubled since 2013. Polls show a plurality of voters identified drug abuse as the most important issue facing the Granite State, topping jobs and the economy for the first time in eight years. As Democratic and Republican candidates took center stage in the state in February 2016, so too did addiction and drug overdose.
Voters must ensure candidates go beyond personal stories to propose evidence-based proposals to address substance use, overdose, and addiction in the United States. Outlined below are five key policy questions about addiction and overdose that candidates need to address in their platforms over the coming months.
1. Do You Understand Drug Addiction To Be A Disease?
Medical societies and scientific organizations are unequivocal that addiction is a disease and must be treated as such. A future president needs both a public health approach to addiction and a commitment to securing the federal funding to implement it. One example of such a proposal is the Sentencing Reform and Corrections Act (S. 2123), which aims to ease federal sentencing guidelines for drug-related crimes and expand successful programs for drug-related incarceration diversion such as Law Enforcement Assisted Diversion and Drug Treatment Courts.
Beyond moving anecdotes on the campaign trail, candidates need to commit to treating rather than criminalizing addiction with specific targets for drug treatment diversion programs, Good Samaritan law reform, and federal treatment dollars. Do you support this public health approach to addiction and will you secure federal funding to implement it?
2. What Is Your Plan To Ensure On-Demand Addiction Treatment Services?
Nationwide statistics show that only 11 percent of individuals seeking treatment for addiction are able to obtain it. Many patients are left to wait weeks or months before accessing limited treatment slots. Evidence-based addiction treatment with medications, counseling, and community support are cost effective. For every $1 spent on treatment, society saves $12 dollars through increased productivity as well as reduced health care and criminal justice costs.
There are many innovative proposals, including 24/7 substance use and mental health centers, supportive housing to assist people with addiction, and case management services that employ individuals in recovery themselves. Do you support these proposals, including those outlined in the Comprehensive Addiction and Recovery Act (S.524), which proposes to scale and fund these new treatment programs?
3. What Approaches Will You Take To Identify Emerging Trends In Drug Trafficking?
City and county public health officials track overdose deaths in their jurisdictions; local law enforcement track arrests; and numerous other state and national entities track patterns in trafficking. The Office of National Drug Control Policy, the Drug Enforcement Agency, and the Substance Abuse and Mental Health Services Administration are all key data sources at the federal level in addition to local and state indicators.
However, the siloed nature of these data prohibits officials from efficiently identifying alarming trends in the drug market, such as the recent exponential rise in the use of and overdose from the powerful narcotic, fentanyl. How will you aggregate disparate data sources so that key agencies can act quickly and collaboratively to trends in drug overdose and trafficking?
4. What Will You Do To Regulate The Price And Availability Of Naloxone?
In the midst of an epidemic of opioid overdose deaths, another key tool in combatting overdose is the distribution of naloxone to drug users, friends and family, and first responders. Naloxone, on the World Health Organization’s list of essential medications, is the antidote medication that reverses opioid overdose.
There is currently a congressional investigation into naloxone price increases. In Baltimore, the cost per dose has nearly quadrupled in one year, a trend seen in other jurisdictions just as they are attempting to equip paramedics, police officers, and other front-line workers with this life-saving medication. What will you do to make sure this antidote medication and other essential drugs are affordable and accessible?
5. What Is Your Policy Prescription For Prevention?
In 2014, there were 259 million prescriptions for narcotic medications prescribed — enough for each adult American. Medical societies have issued voluntary guidelines and some health departments have issued best practice letters to encourage judicious prescribing of opioids by doctors. Candidates can reform prescribing practices through medical education curricula and Prescription Drug Monitoring Programs to track opioid prescriptions across providers.
How will you implement policies to prevent the over-prescription of opioids, and commit federal dollars to a national prevention and stigma-reduction campaign? Studies show that national public education campaigns are effective in encouraging prevention; local jurisdictions have launched their own efforts, including the Above the Influence, Not Even Once, and Don’t Die campaigns. How will you support and grow these efforts nationally?
There have been significant steps taken to combat addiction and overdose over the course of the Obama administration. After tireless advocacy by clinicians and harm reduction service providers, Congress recently ended the effective ban on the use of federal funding for needle exchange. The White House’s request for $1.1 billion treatment dollars could also quadruple the funds available to address the opioid epidemic. All of this is contingent on electing a president ready to continue and build upon these initial efforts to confront the growing addiction and overdose crisis in the United States.
Voters ask candidates for definitive strategies on the economy, immigration, and foreign policy. Frontline providers and policymakers should leverage their own training to ask the presidential candidates for concrete plans to combat addiction as well. Alongside local and state efforts, these recommended national policy platforms could make an immense difference in the prevention, treatment, and de-stigmatization of addiction over the next four years.