Democratic Presidential Candidates on Addiction and the Opioid Epidemic

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This post was written by Regina LaBelle and Leigh Bianchi.

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. Most 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 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, beginning with the two candidates with detailed plans.

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.

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 Julian 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.

U.S. Senators: Senator Michael Bennet (CO) (along with Senators Harris and Sanders) introduced 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. This legislation is co-sponsored by Senators Sanders (VT) and Harris (CA). Companion legislation in the House is co-sponsored by US Representative Gabbard (HI), another Democratic presidential contender. Bennet has also sponsored the Alternatives to Opioid in the Emergency Department Act with Senator Booker (NJ), legislation that was included in the 2018 SUPPORT Act.

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 Gillibrand (NY) has proposed the John S. McCain Opioid Addiction and Prevention Act which would limit opioid prescriptions for acute pain to a seven-day supply. She also supports prosecuting pharmaceutical industry executives for their role in the opioid epidemic.

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 and was a co-sponsor of the Opioid Crisis Accountability Act. Her public statements have focused on opposition to the “War on Drugs” and her experience as a progressive prosecutor.

Senator Bernie Sanders (VT) (along with Senators Bennet and 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 Former Congressman John Delaney has issued a rural healthcare plan that includes expanding tele-health and mental health services to address the opioid epidemic. He has also called for holding the pharmaceutical accountable for its role in the opioid epidemic.

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”.

Congressman Tim Ryan (OH) has an extensive record in Congress on mental health and addiction issues. He is co-chair of the Congressional Addiction Treatment and Recovery Caucus and was instrumental in passage of the Comprehensive Addiction and Recovery Act (CARA) in 2016. He has co-sponsored the Mainstreaming Addiction Treatment Act which would eliminate the waiver requirement for buprenorphine prescribing. He also was a prime sponsor of CARA 2.0 in 2018.

State and Local Government Officials

Governors: Governor Bullock of Montana, previously Montana’s Attorney General, has overseen Montana’s opioid response and prioritized the issue as chair of the National Governors Association.

Former Colorado Governor John Hickenlooper’s campaign released a plan focused on issues facing rural America. The plan’s section on the opioid epidemic calls for creating a grant program for first responders and expansion of naloxone availability; a national prescription drug disposal program; and a national prevention advertising campaign.

Governor Jay Inslee of Washington state has overseen implementation of a statewide overdose response plan. As a member of Congress, Inslee was instrumental in passing the Secure and Responsible Drug Disposal Act to increase disposal options for unused prescription drugs. He has said that overdose prevention sites are a local issue.

Mayors: Mayors de Blasio and Buttigieg have also addressed the opioid epidemic in their own cities. 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 plan to expand the National Service Corps and provide public service opportunities to address “key challenges” such as addiction and mental health. 

Mayor de Blasio’s opioid response plan for New York City is called HealingNYC and included plans to expand naloxone and treatment availability, increase mental health clinics in public schools, and reduce opioid prescribing. New York City has also filed suit against the pharmaceutical industry. De Blasio has signed legislation to expand naloxone distribution and proposed a pilot program to open overdose prevention sites in New York City.

Other Candidates

Andrew Yang supports decriminalizing possession of small amounts of opioids and increasing funding for treatment through fining pharmaceutical companies.

Marianne Williamson supports decriminalizing drugs and increased access to 12-step programming on television and online.

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.

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