This post was originally published on July 10, 2019 and updated on October 17, 2019. It has been amended to only include the candidates who were present for the Democratic debate held on Tuesday, October 15.

Celebration of Recovery from Alcohol or Drug Addiction

As communities across the country continue to struggle with the consequences of addiction and the opioid epidemic, voters in the 2020 presidential race are sure to press the Democratic presidential candidates for their plans to address the issue. The opioid epidemic played a role in the 2016 election and correlations have been drawn between support for Donald Trump’s candidacy and counties with high rates of drug and alcohol misuse, and suicide mortality. Many of the Democratic presidential candidates have not issued detailed policy proposals on the topic, however their position on the issue can be gleaned from statements made at campaign events, at the debates and from their record in office. Below is an overview of public statements and position papers released to date by the Democratic candidates for president.

Federal Officials

Former Administration Officials: Vice President Biden has a long history on drug policy and was the driving force behind the 21st Century Cures Act which authorized $1 billion in funding for state responses to the opioid epidemic. Vice President Biden discussed the opioid epidemic at a University of Pennsylvania forum where he emphasized holding pharmaceutical executives criminally liable, improving treatment standards, and increasing addiction research.

Former HUD Secretary Julián Castro (TX) has not issued a specific proposal to address addiction or opioid use disorders. However, he visited a recovery center in Laconia NH and addressed the issue during his visit. During the fourth presidential debate, he agreed when Senator Harris (CA) said that drug manufacturers that fueled the crisis should be imprisoned.

U.S. Senators: Senators Elizabeth Warren (MA) and Klobuchar (MN), have released comprehensive plans to address addiction and opioid use disorders. Senator Warren’s CARE ACT, modeled on the Ryan White CARE Act, would authorize $100 billion in funding over a 10 year period. The CARE ACT would fund the full continuum of care and funding would come from a tax on the richest 75,000 families in the United States. In addition, Warren’s proposed Corporate Executive Accountability Act expands criminal liability for corporate executives.

In May, Senator Amy Klobuchar unveiled a $100 billion proposal to address addiction and mental health conditions. The proposal would be funded partially from a tax on opioid prescriptions and from the pending opioid litigation. Senator Klobuchar’s plan emphasizes enforcement of mental health parity laws, increasing early screening for mental health conditions, mandatory use of prescription drug monitoring programs (PDMPs) by health care providers, and increasing the number of treatment beds.

Senator Cory Booker (NJ) has stated that he supports evidence-based approaches to the opioid epidemic to include peer recovery coaches, syringe services programs, and overdose prevention (aka safe consumption) sites. He was also the prime sponsor of the Alternatives to Opioids (ALTO) in the Emergency Department Act which established a pilot program to decrease opioid prescribing in emergency departments and was included in The SUPPORT Act.

Senator Kamala Harris’s (CA) legislative efforts have focused on the pharmaceutical industry’s responsibility for driving the opioid epidemic. In 2018 she introduced The Accountability in Opioid Advertising Act, intended to reduce misleading advertising and marketing tactics by opioid manufacturers. (This legislation was not re-introduced in the 116th Congress.) She also introduced the Comprehensive Addiction Reform, Education, and Safety Act in 2018. Senators Kamala Harris (CA) and Bernie Sanders (VT) are co-sponsors of the Opioid Crisis Accountability Act, a bill that would assess a general fine on all opioid manufacturers or distributors, strengthen marketing and distribution laws and impose penalties for illegal practices. The bill would also establish criminal liability for pharmaceutical executives. Companion legislation in the House is co-sponsored by US Representative Gabbard (HI), another Democratic presidential contender. Senator Harris’s public statements have focused on opposition to the “War on Drugs” and her experience as a progressive prosecutor. On her campaign website, Senator Harris promises to prosecute opioid makers for profiting off a crisis that they helped cause. 

Senator Bernie Sanders (VT) (along with Senator Harris) introduced the Opioid Crisis Accountability Act to hold the pharmaceutical industry accountable for the opioid epidemic. His campaign website also has a fact sheet describing the opioid issue and highlighting his support for opioid legislation in Congress, harm reduction efforts (including overdose prevention sites), Medicare for All, and expanded treatment access.

U.S. Representatives: Congresswoman Tulsi Gabbard (HI) introduced the Opioid Crisis Accountability Act in the House. Her campaign website contains a page dedicated to the opioid epidemic, her record on the issue, and support for specific reforms. 

Former Congressman Beto O’Rourke also calls for holding the pharmaceutical industry accountable, and ending the “War on Drugs”.

State and Local Government Officials

Mayor Buttigieg has addressed the opioid epidemic in his own city. Mayor Buttigieg highlighted the issue of opioid involved overdoses in his 2018 State of the City address and called for expanding naloxone access and opioid treatment medications. South Bend, Indiana filed a lawsuit against opioid manufacturers in 2018. He has released a comprehensive plan to address the opioid crisis, which includes policies aimed at reducing stigma around mental health and addiction services, expanding naloxone access, and universalizing access to medication-assisted treatment.

Other Candidates

Andrew Yang previously announced his support for decriminalizing possession of small amounts of opioids and increasing funding for treatment through fining pharmaceutical companies. Yang’s website currently includes a comprehensive plan on fighting the opioid crisis, which would involve the implementation of the following policies: drastically increase funding to treatment programs for opioid users through fines levied against the companies that marketed these drugs; federally decriminalize small quantities of opioid use and possession (anything under 5-10 days of personal use); make treatment programs much more available and affordable to anyone found with small quantities of these drugs; and provide grants for their own treatment programs to states that decriminalize small quantities of opioid use/possession.

Tom Steyer criticized pharmaceutical companies for profiting off of opioid sales and spurning the opioid crisis in his campaign announcement. In 2017, he supported a California bill that would require drug manufacturers to provide notification of price increases.

The Democratic candidates may vary on specifics, however their approach to the opioid epidemic has some common features. Almost all of the candidates have stated publicly that the pharmaceutical industry must be held accountable for its role in the opioid epidemic. The candidates have also taken a public health approach to the issue, emphasizing increased access to treatment. To date, efforts to crack down on heroin and illicit fentanyl trafficking have not been a central part of any of the campaign’s messaging.