Over three days in early October, Chicago saw 74 heroin-related overdoses. In Massachusetts, drug overdoses kill more people than car accidents and gun violence combined. Throughout the country, the numbers are similarly disturbing, and unfortunately not surprising. Over the past decade, opioid-related overdoses and deaths have skyrocketed and the numbers continue to climb. Deaths resulting from prescribed opioid pain relievers increased threefold between 2001 and 2013; heroin-related deaths increased fivefold during the same period. While other countries also suffer from crippling drug addiction, in the United States, less than 5% of the global population gobbles up more than 80% of the world’s opioid products.
While President Obama is beginning to speak out on this issue, this time next year the country will be on the verge of electing a new president. How our new leader chooses to address this crisis will be one of the defining characteristics of his or her presidency. Will criminalization of addicts continue to be prioritized over treatment? Will more doctors be able to prescribe potentially life-saving drugs like naloxone? I spoke with Congressman Tim Ryan of Ohio, the co-chair of the Congressional Addiction, Treatment, and Recovery Caucus and co-sponsor of the Comprehensive Addiction Recovery Act (CARA) in the House, about how he thinks the next leader of the free world should approach this devastating problem.
Hillary Clinton’s plan to address the addiction crisis is far more comprehensive than anything her competitors have outlined. The $10 billion plan would increase, and ultimately remove completely, the “caps” on the number of patients doctors can treat with buprenorphine, methadone, and naltrexone, also known as “medication-assisted treatment” (MAT). Numerous studies have shown that MAT decreases the likelihood of an addict relapsing by mitigating some of the painful withdrawal symptoms and blocking cravings.
“Medication-assisted treatment has to be an essential component of any approach we take [to combat the opioid crisis],” Congressman Ryan said, and gave Clinton credit for focusing on it. Facilitating medication-assisted treatment is also an essential component of CARA, the bill he has co-sponsored in the House. “Put simply,” Congressman Ryan said, “there is more demand for these drugs than there are people who have access to them. If we keep the pipeline [of medication-assisted treatment] small, we’re never going to get access to as many people who need it.” Developed with input from the Centers for Disease Control and other addiction treatment professionals, Clinton’s plan also offers financial incentives for state and local efforts to address the addiction epidemic in their communities.
As for the other major Democratic candidate, Bernie Sanders has made statements in support of treatment instead of jail time for heroin addicts and stated the need for a price reduction of naloxone. As of press time, however, Sanders hadn’t offered a plan to treat the epidemic.
Following Clinton in his willingness to support legislation around the opioid crisis is, perhaps surprisingly, Rand Paul. The Republican junior senator from Kentucky has been fairly vocal about opiate addiction. A study in contrasts, Rand has both sponsored bipartisan legislation in the Senate to combat the opioid epidemic, as well as uttered unbelievably ignorant nonsense about the problem on the campaign trail. In September, Rand was quoted as saying, “People always come up to me and say, ‘We got heroin problems and all these other problems.’ You know what? If you work all day long, you don’t have time to do heroin.”
The sentiment that opioid addicts are simply lazy, Congressman Ryan says, speaks to a fundamental misunderstanding of the issue. “That’s a really immature comment,” Ryan said of Paul’s statement. “What about the middle-aged guy who gets hurt at work and then is prescribed opiates to help with pain, and gets hooked on it? There’s a real lack of appreciation for how quickly, innocently, and helplessly someone can get addicted to [opiates].”
There’s hard data to back up Ryan’s refutation of Senator Paul’s claims. The 2013 National Survey on Drug Use and Health found that nearly 70% of adult drug users were employed either part- or full-time. While the legislation Senator Paul proposes is an excellent step forward, he’d do well to not imply that the thousands of people who have died in his state as a result of opioid overdoses were simply lazy.
Carly Fiorina seems like a natural advocate of addiction treatment, noting in the second Republican debate that she “lost a child to addiction.” Unfortunately, the death of her stepdaughter on alcohol and prescription medicine hasn’t prompted her to offer any comprehensive plan to treat addiction. Following her statement about her daughter’s death, she noted that she believed that “marijuana is a gateway drug” and implied that cannabis was more dangerous than alcohol, a claim with no empirical evidence to support it.
Chris Christie is dangling near the bottom of the polls, thanks to the Bridgegate scandal and the usurpation of his role as aggressive loudmouth by the even bigger aggressive loudmouth, Donald Trump. Still, Christie should be commended for breaking ranks with the majority of his Republican counterparts in advocating for rehabilitation over criminalization for those struggling with addiction.
Joining Christie in the bottom of the polls with a halfway decent attitude about opiate addiction is Ohio’s John Kasich. In a move that upset the Republican base, Kasich expanded Medicaid under The Affordable Care Act. Kasich explained that doing so would help more addicts and mentally ill individuals get treatment.
The Republican frontrunner, Donald Trump maintains that he’s never done a drug and he doesn’t drink, citing his brother’s fatal alcoholism as the reason. His policy hasn’t been so steadfast, however, in 1990, he asserted that all drugs should be legalized. Since launching his campaign, the Donald has fallen in line with the Republican Party silence/criminalization stance.
Jeb Bush and Ted Cruz also have familial experience with addiction, Bush’s daughter, Noelle, went to treatment for the disease in 2002 and 2003. That experience hasn’t done much to affect his policy, however, he adamantly supports the War on Drugs, criminalization of all drugs, and recently said that the heroin epidemic was “not a national issue.”
Both Cruz’s parents struggled with alcohol, he noted in 2014. His family overcame these hardships, Cruz says, through his father’s faith in Jesus Christ. Tragedy befell Cruz in 2011, when his half-sister died from an overdose of prescription pain medicine. Unfortunately, while Senator Cruz has supported reducing sentencing minimums for non-violent drug offenders, statements about addiction treatment are conspicuously absent from his debate transcripts and stump speeches.
Marco Rubio paid lip service to the opioid epidemic though he used the crisis as a way to justify the standard Republican position of marijuana criminalization. “One of the stories that has not been as reported nationally, is the fact that many of the people who today are dependent on heroin, is because they became dependent on prescription opiates,” Rubio said, though there’s little to no scientific evidence to support his claim. Ben Carson and Mike Huckabee haven’t said much on the subject (What? Did you think one of them was a neurosurgeon or something?), preferring to talk about the importance of tackling active shooters or securing the Mexican/U.S. border.
Silence on this issue, however, demonstrates not political prudence, but a deep lack of foresight. The country is sick. Hundreds of loved ones are dying from opioid overdoses everyday. A president who does not address this issue with a comprehensive plan will go down in history as severely negligent. All of which leads me to one question: Tim Ryan 2020? Count me in.