Clinton and Trump: On Plans To Fight Heroin and Prescription Drug Addiction
Authors note: Just Believe Recovery does not have a political affiliation. This article is for informational purposes only, and any opinion put forth by the author (or correctly/incorrectly inferred by the reader) does not reflect the views of this organization.
If there’s one thing both candidates agree on, it is that heroin and prescription drug addiction is a major problem in the U.S., reaching epidemic proportions.
Clinton calls it a “quiet epidemic,” although those of us in the field of addiction have long felt it is not so quiet.
As part of her campaign, Clinton offers a fairly detailed plan to battle the scourge – to the tune of $10 billion. This money would go to states for prevention, treatment, and recovery programs, as well as other initiatives aimed at addressing the problem. This is similar to Obama’s vision, which resulted in a $1.1 billion proposal, but is apparently still tied up in legislative inaction somewhere.
Conversely, Trump’s plan has traditionally consisted of curbing the influx of illicit drugs coming up from Mexico through the border. However, recently he has called for expanding the enforcement of drug imports, as well as approaches to decrease prescription drug addiction, but with no cost specifics as of yet.
Clinton’s $10 billion plan includes an increase in federal spending in five areas: prevention, treatment/recovery, first responders (i.e. EMT), prescribers (i.e. physicians), and criminal justice reform.
The proposal would allocate $7.5 billion to U.S. states over 10 years – however, states would be required to have solid proposals in at least one of the five areas in order to receive money. The federal Substance Abuse Prevention and Treatment Block Grant program would be set to receive the remaining $2.5 billion.
The plan, however, does not include drug/law enforcement initiatives intended to keep illegal drugs from the entering the country. In fact, she wants states to prioritize treatment over incarceration, particularly for low-level offenders. With the nation’s prison overcrowding problems, this not out of line with popular thinking.
Her lessened concern for law enforcement also reflects the general consensus (and indeed, the facts support it) that the current epidemic is largely fueled by prescription drug addiction, a fact which increased security and borders can’t alter. From my understanding, it’s an approach that attempts to go beyond the traditional “war on drugs” thinking, and instead at least tries to offer solutions for those addicted and needing treatment.
Expansion of Treatment & Recovery Programs
Moreover, Clinton’s plan is more focused on improving access to treatment and recovery programs. At the state level, this could result in more beds in hospitals and inpatient treatment centers, as well as additional training for health care providers.
It may even go so far as to subsidize child care for persons in treatment, and simultaneously force insurers to cover it. She’s also seeking improvements and better integration of mental health and substance abuse treatment.
Her plan also includes greater patient access to medically assisted treatment, such as prescription drugs meant to decrease cravings and withdrawal symptoms. Some might call it trading one drug for another, but at this point, it’s about harm reduction, a concept Trump actually seems to agree with (see below.)
There would also be a push for tougher prescribing practices, and a requirement for states to use their prescription drug monitoring programs (most have them in place, but are not obligatory.) By preventing painkiller addiction, this could put a dent in heroin and fentanyl addiction and overdoses. By some estimates, 75-80% of new heroin users first suffered from prescription drug addiction.
Clinton’s plan would also include educational improvements, such as implementing evidence-based prevention programs in schools.
Finally, naloxone, an extremely effective anti-overdose drug would be made widely available. The life-saving antidote has been slowly becoming available over-the-counter in some areas, so that friends and relatives of opioid addicts can purchase it.
As noted, Trump has not offered any estimates on spending, or how much his vision will cost.
For the first time in his campaign, this past month Trump has begun to talk about solutions for treatment and recovery. He agrees that access to naloxone needs to be increased, and that doctors should be encouraged to prescribe abuse deterrent medications (harm reduction!)
Additionally, he has criticized the Federal Drug Administration for delays in approving drugs which can ease cravings, which is not an uncommon nor unreasonable concern.
Trump has also stated that the DEA should limit production of opioid painkillers to help prevent prescription drug addiction. And indeed, they are doing just that beginning in 2017 – enacting an overall decrease of 25%.
He has intimated a number of times that he would like to build a wall on the U.S. Southern border to deter immigration. This would presumably also curb the influx of drugs coming up from Mexico, although it might not necessarily prevent shipping methods. Indeed, according to the Drug Enforcement Agency, nearly 80% of the heroin seized in the U.S. in 2014 came from Mexico.
He also has stated that China is contributing to the problem, and wants to makes it harder for Chinese dealers to ship drugs into the U.S. And he’s not wrong – the DEA released a report this past summer that fingers China as a major producer of fentanyl and other synthetic drugs at an alarming rate. These drugs are subsequently being obtained and trafficked by dealers in North America.
Fentanyl, which is a prescription drug indicated to treat severe pain, may be up to 100 times more powerful than morphine. However, most of the fentanyl ending up on the streets is illicitly manufactured in clandestine labs.
He’s also calling for incentives for states and localities to implement drug courts. Unlike Clinton, however, he doesn’t appear concerned with the mass incarceration of low-level, non-violent drug offenders. He did however, praise Mike Pence for implementing stricter mandatory minimum sentences for drug offenses in Indiana, and suggested he might pursue something of that nature at the federal level.
While Clinton’s plan is older, more comprehensive and nuanced, I’m happy to see Trump come around and issue his opinions and visions specifically for the opioid drug epidemic. Moreover, as it applies to contributing factors inside the country, versus a problem that merely requires borders to halt.
I don’t disagree with his thoughts that better policies should be put in place to prevent drugs such as heroin and fentanyl from entering the country – I just don’t agree with all of his solutions. And Clinton may be neglecting that major aspect of the drug epidemic.
And since the DEA is decreasing allowances for prescription drug manufacturing, coupling that with a plan for blocking heroin and fentanyl from import could change a lot. But decreasing the drug supply does not decrease demand, and you can only do that with prevention and treatment. In other words, if he gets the presidency, he’s going to have to do a lot more thinking about expanding treatment and recovery programs – something that Clinton has been very active about.
Finally, I think that Trump still believes incarceration is a solution to curbing drug addiction and dealing. Many disagree, and it bothers me that he might seek to increase penalties for drug offenders, especially when our prisons are already overflowing.
Final Note: My opinions on this issue do not reflect a preference for either candidate. Rather, as someone who researches and writes within the field of addiction, my commentary is intended to reflect my personal knowledge and experience as applied to each candidate’s approach.
~ G. Nathalee Serrels, M.A., Psychology