How do the Presidential frontrunners plan to combat the opioid crisis?

pharmafile | February 12, 2020 | Feature | Business Services, Manufacturing and Production, Medical Communications, Research and Development, Sales and Marketing |  2020 Election, Bernie, Bernie Sanders, Donald Trump, Joe, Joe Biden, Trump 

The widespread addiction to extremely potent, legal painkillers has decimated the lives of millions across the United States. Overdoses from opioids have surpassed car crashes and gun violence as the leading cause of death in Americans under the age of 55. The epidemic has killed nearly 400,000 people since 2000 – more people than HIV at the peak of that disease – while its economic cost has been placed between $50 billion and $1 trillion.

Many pharmaceutical companies are currently being held accountable for the devastation they have wrought. Purdue Pharma, owned by the billionaire Sackler family, has been in the eye of the storm; its drug OxyContin has been one of the main culprits fuelling the crisis. When the company first started advertising it in the late 1990s, it misled the public by saying the drug was both safer and less addictive than other painkillers on the market when it was in fact more potent.

A side-effect of the widespread availability of opioids is that it fuels the use of illegal hard drugs. One study showed that people who abused painkillers like OxyContin are 19 times more likely to start using heroin. The study also found that 8 out of 10 people who use heroin abused opioids first. It is clear America’s addiction to illegal drugs is fuelled by legal drugs.

This crisis of addiction has also exposed widespread flaws in the US healthcare system. Doctors have consistently been incentivised to overprescribe these powerful and addictive opiates, either through bribes or other corrupt means, legal or otherwise. In essence, a considerable number of doctors have become salespeople for the drug companies, and often have knowingly contributed to the problem, acting in severe cases as no better than legalised drug dealers.

The five frontrunners in the upcoming 2020 US presidential election – President Donald Trump, Senator Bernie Sanders, Senator Elizabeth Warren, Mayor Peter Buttigieg and former Vice President Joe Biden – all have a history of attempting to tackle the crisis, with many outlining their future plans on the campaign trail.

President Donald Trump made fighting the opioid crisis a key campaign promise back in 2016; however, since then his administration has achieved relatively little on the issue. In October 2017, he declared a public health emergency over the opioid crisis, but a report by the Government Accountability Office back in October 2018 found that no further substantive action had been taken.

The report focuses on the public health declaration which enabled Trump three new authorities: to clear paperwork requirements for a survey of healthcare providers about addiction treatment, to allow states to move forward faster with programmes to address the opioid crisis, and to expedite support for research about opioid addiction and overdoses.

Despite these new powers he has not put them to much use, prompting criticism from prominent Democrats like Senators Sanders and Warren. Trump did sign the Support for Patients and Communities Act, which took largely regulatory steps to expand access to addiction treatment and research regarding opioid addiction and pain, and the Republican-controlled Congress did include $500 million in the Cures Act as part of the 2018 budget.

However, experts estimate that tens of billions more dollars are needed each year, with a study by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, putting the number at $78.5 billion back in 2013. The opioid crisis has only got worse, so it’s clear at this stage that even more funds than this estimate would be needed to fight it.

Simply put, Trump has promised a lot but has not tried to address the opioid crisis in any meaningful way so far. He has not made any promises yet about fighting it during a potential
second term.

Senator Bernie Sanders has been on a crusade against American Big Pharma for most of his political career. The Democratic Socialist Senator (who sits in the Senate as an independent) from Vermont has made fighting the opioid crisis a key part of both his 2016, and now 2020 Presidential campaigns.

Sanders is one of the leading politicians in fighting to bring those who had a role in creating the opioid crisis to justice. In 2018, he was the main sponsor of the Opioid Crisis Accountability Act. If passed, this bill would establish criminal penalties for pharmaceutical executives who run opioid producing companies that had a role in the crisis, including a minimum 10-year jail sentence. The bill also advocated for harsher penalties for opioid manufacturers in general. For example, a company would be fined 25% of their profits from opioid sales if they neglect to mention their product’s addictive properties.

In terms of addressing some of the causes of the crisis, this bill would also set limits on the amount of opioids prescribed in a single state or community. This is in response to drugs being overprescribed for treatments that do not need opiates in the first place. Unfortunately, the bill was not passed in 2018, and neither was a similar one that was brought forward in 2019.

Sanders’ broader healthcare policy proposals also aim to tackle the crisis. He has stated that his push for ‘Medicare for All’ (a European-style socialised healthcare system) would include coverage for mental health and substance abuse treatment, including for prescription drug abuse. This will include dramatically expanded community health-centres to provide aid to people suffering. Sanders’ plan places a focus on treatment and prevention, making significant funds available for this as well as funds for recovery.

His criminal justice reform plan also has elements that will help fight the epidemic, which includes addiction to both legal and illegal opioids. He has backed supervised consumption sites and needle exchanges, as well as emphasising the need to move away from locking up people with drug addictions.

Sanders also backed Senator Warren’s bill, the Comprehensive Addiction Resources Emergency Act of 2019, which would commit $100 billion over ten years to drug addiction treatment and harm reduction programmes.

Sanders’ ideas are some of the most far reaching in the current presidential field, and are much more in line with what experts say is required to fight the opioid epidemic than what the Trump administration has done thus far.

Senator Elizabeth Warren, like Sanders, is proposing far more radical steps than the current administration to tackle the epidemic. As previously mentioned, it was Warren who introduced a bill that would commit $100 billion to fighting the crisis. This became known as the CARE Act, which Warren introduced with the late Representative Elijah Cummings.

The CARE Act is modelled on the Ryan White CARE Act, which was passed in 1990 to help fight the HIV/AIDS crisis. It provided significant and guaranteed funding to help state and local governments combat the growing epidemic.

Warren’s bill outlines in detail how much money will be allocated in the overall strategy in tackling the crisis. $500 million of the funding will be given to providing patients, public health departments and first responders with access to naloxone, a lifesaving nasal spray used to treat overdoses. $4 billion would be provided for states, territories and tribal governments; $2.7 billion for the hardest hit counties and cities, including $1.4 billion to counties and cities with the highest levels of overdoses; $1.7 billion for public health surveillance, research, and improved training for health professionals and $1.1 billion for public and non-profit entities on the front lines of the crisis.

However, there has been criticism of Warren’s Act. Leo Beletsky, Northeastern Law and Health Sciences Professor and an expert on the US opioid crisis, believes it creates a similar problem that the Ryan White CARE Act caused: because these bills were focused on treatments for specific health problems, it means people who need similar treatment can be excluded. Beletsky said: “You don’t want to create a system where if you’re using opioids, you have access to certain services and if you’re using meth, you don’t.”

Currently, the CARE Act is in legislative limbo. Elijah Cummings passed away on 17 October 2019, and with Warren’s presidential campaign taking up most of her time, it has not got much attention as of late. However, Warren will probably give the bill more attention when she either becomes President or returns to her full-time duty as a senator.

In outlining the CARE Act, Warren also touted her Corporate Executive Accountability Act, which would make sure that the executives of major pharmaceutical companies that have driven the opioid crisis would face criminal penalties.

Like Senator Sanders, Warren has backed supervised consumption sites and has outlined steps to tackle the criminalisation of substance abuse. In an August post on her campaign website, Warren said these steps would save $12 in future crime and healthcare costs for every dollar that the government invests.

Pete Buttigieg, former Mayor of South Bend in Indiana, also offers progressive solutions to the opioid crisis. Due to his lack of political experience at a federal level, he does not have much of a history of pushing for it as policy, but his proposals are in a similar vein to Senators Sanders and Warren.

In his own city of South Bend he has called for expanding naloxone access and opioid treatment medications. South Bend has also filed a lawsuit against opioid manufacturers in 2018.

In terms of his presidential campaign, Buttigieg laid out his vision for tackling the opioid crisis in August. The Mayor’s take on it is a little different than his competitors as he focuses on it as a mental health issue. He wants to tackle mental health as a public health crisis with the federal government financing the efforts that focus on prevention and detection. It is estimated the total cost would be $300 billion over 10 years.

Buttigieg says his plan will make sure that 75% of people who need treatment will receive it. For those with addiction it will include ‘medication-assisted treatment’, or MAT. This sees patients take alternatives that satisfy their cravings without producing a high.

Buttigieg has also called for removing incarceration as a punishment for drug possession for personal use, believing this policy has made the addiction problems far worse. While he doesn’t believe in total decriminalisations of all drugs, he does believe that jail time is in no way a solution to anyone suffering from addiction, including from hard drugs like meth or opioids like OxyContin. Buttigieg also wants to expand the access to naloxone and create more needle exchange programmes at a federal level.

Former Vice President Joe Biden’s approach is far less progressive than Sanders, Warren or Buttigieg and he also faces more criticism for his role in exacerbating America’s drug problem during his career in the Senate.

Biden was of course part of the Obama administration during a time where the epidemic reached its worst levels, with deaths rising 71% a year from 2013 to 2017 and claiming 130 lives per day. The Obama administration did take steps to tackle the crisis, which included making addiction-fighting medicine widely available and cracking down on financial incentives for doctors to prescribe certain opioids. However, it is hard to determine how much Biden was involved in these decisions.

Biden has received the most donations from pharmaceutical lobbyists and has faced criticism for praising them. In September, he said that “great drug companies” are out there, except for a couple of “opioid outfits”. Many, like Senator Sanders, see this as Biden defending a system that created the opioid crisis, instead painting it as simply a few rogue companies.

Biden does not support a socialised healthcare system, but his healthcare plan does lay out more funding and easier access to drug addiction treatment and his criminal justice plan would expand this to people in prison. On the campaign trail he has spoken about pulling back opioid prescriptions and holding drug companies to account for their role in the opioid crisis.

However, unlike nearly every other candidate in the field, Biden has been directly involved in policies that have contributed to the ravaging of America by the crisis.

Although not directly related, Biden choose to make the War on Drugs a big part of his Senate career. In 1986, Biden introduced the Emergency Crack Control Act, which was eventually folded into the Anti-Drug Abuse Act, and passed into law in 1988. Part of the bill was designed to impose stiff penalties on people operating ‘crack houses’, but the language of the bill has been used to halt solutions to the opioid crisis. The law makes it illegal to “knowingly open, lease, rent, use or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing or using any controlled substance.”

Now throughout the US federal prosecutors are arguing that owners and operators of overdose prevention sites would be in violation of Biden’s crack-house statute. In Philadelphia, health workers had laid the foundation for the nation’s first overdose prevention site but this was prevented by federal prosecutors using this law that Biden was one of the architects of.

In 1994, Biden was the architect of another bill that would further the War on Drugs and have a knock-on effect on America’s opioid crisis. This bill implemented a ‘three strikes and you’re out’ policy for non-violent drug offenders. The ‘out’ was a maximum sentence in prison. This harsh policy was accompanied by stripping Pell Grant funding to give college education to prisoners to help their rehabilitating.

Biden’s history of creating draconian laws to punish those with drug addictions puts him at odds with most of the other candidates. Hillary Clinton was slammed in 2008 and 2016 for her role in this hugely controversial bill signed by her husband; Biden has fallen prey to this criticism too, although not to the same extent. Despite some token promises on the campaign, Biden has not provided any clear vision of what tackling the opioid crisis would look like in his administration. Based on his record, it is unclear if he would be open to the solutions advocated by Sanders and Warren and backed by experts.

It is clear the debate around tackling the opioid crisis is leaning towards a more widespread radical approach. With Warren and Sanders in particular, it is seeking to bring those responsible to justice while making treatment far more accessible both economically and through its availability. Mayor Buttigieg wants to frame it as a mental health crisis, where the overall policy to addicts, of both legal and illegal drugs, should be one of treatment. Donald Trump has offered no substantive policy, despite having the power to make tangible changes, and Biden’s record of punishing addicts, rather than rehabilitating and treating them, casts doubts on how effectively he would tackle the opioid crisis as President.