Presidential Candidates on the Heroin and Opioid Crisis

February 6, 2016
 
The Medical Society queried all presidential candidates on four issues impacting Granite Staters' health and wellbeing. The following are answers from candidates who who responded and were still actively in the race at the time of this posting. NHMS encourages all physicians, PAs and students to review their responses and take the Bartlett Jacket Flip Challenge.
  
The people of New Hampshire are being harmed by addiction to heroin and other opioid drugs, alcohol and tobacco. We know that treatment for addiction works. What would you do as president to ensure that people struggling with addiction get the treatment they need for recovery?
 
Hillary Clinton- "On my first campaign trip New Hampshire last spring a retired doctor raised the rising tide of heroin addiction in the state and it's come up again and again. Substance use disorders touch Americans everywhere. This problem certainly did not appear overnight, but it is worsening, and the costs of not doing more are huge: reduced productivity, overloaded health care and criminal justice systems, and hundreds of thousands of human lives lost. That's why I've made confronting the substance use and addiction epidemic central to my campaign. The plan I've laid out incorporates many of the same measures proposed by your own state's leaders, including Governor Hassan and Senator Shaheen.
 
First, we need to boost federal-state partnerships that empower state and local leaders to tailor programs to their communities, encouraging states to implement preventive programming for adolescents about drug use and addiction, because we know early intervention is crucial to fighting this epidemic. I will ensure all first responders have access to naloxone, which can prevent opioid overdoses from becoming fatal, and require licensed prescribers to meet requirements for a minimum amount of training and consult a prescription drug-monitoring program before writing a prescription for controlled medications. My plan prioritizes rehabilitation and treatment over prison, calling for more collaboration and coordination between the public health and criminal justice systems to ensure continuity of care for those who suffer from substance use disorders.
 
And my plan takes immediate federal actions, including increasing the Substance Abuse Prevention and Treatment Block Grant; ensuring federal insurance parity laws are enforced; re-evaluating Medicare and Medicaid payment practices to ensure we're making treatment accessible; removing obstacles to reimbursement and helping integrate care for addiction into standard practice; and directing the attorney general to issue guidance on prioritizing treatment over imprisonment for nonviolent, low-level drug offenders."
 
Bernie Sanders- "Addiction to opioids - prescription pain medications like OxyContin and illegal drugs like heroin - is a serious problem we must address in this country. It is, simply put, a public health emergency. I have seen the devastation of opioid addiction in New Hampshire, in my home state of Vermont and around this country. Between 2000 and 2014, we saw an increase in opioid abuse in Vermont of 800 percent. In New Hampshire, there were 300 drug-related deaths last year. Tragically, opiate use too often leads to death or incarceration. This has to change.
 
I've talked to students, I've talked to veterans, I've talked to members of law enforcement and I've talked to professionals who help people living with addiction. And two things are abundantly clear - we need to focus on prevention and we need to focus on treatment.
 
Focusing on prevention means asking: Why are people turning to opioids, turning to heroin, in the first place? What should we be doing differently to keep that from happening? One big thing we can do, we must do, is to address income inequality in this country. We have to make sure hardworking people can find a job, that the job they find pays a livable wage, and a fair wage. Today, unemployment and underemployment remains far too high, particularly among our country's young people.
 
A focus on both prevention and treatment means that health care professionals across this country not only need to take steps to reduce unnecessary prescribing of opiates and work with public health officials to address this crisis, but also to provide access to treatment for those individuals who seek help for their addictions. If someone is addicted to opiates and they go to get help and they are told there is a six month or 1 year waiting list for treatment, that is not an acceptable solution.
 
We also need to give people options for treatment for both mental health diagnoses and to manage chronic pain. As the former Chairman of the Veterans' Affairs Committee in the Senate, I have met with veterans all over this country who need mental health and substance use disorder services. I have introduced legislation in the Senate to improve access to complementary and alternative therapies for veterans, so they aren't left with the false option of either being in excruciating pain or at risk for opioid addiction. Therapies like yoga and guided meditation can help manage pain and reduce stress with zero risk of addiction.
 
I support expanding programs like the one in Manchester, New Hampshire that offers peer-to-peer counseling because I have seen how effective it can be for someone in treatment to get help from someone who has walked in their shoes and come out the other side of addiction.
 
Progress is possible. In my home state of Vermont, we have seen the devastation of opioid abuse but we've also seen success. The people of Vermont have benefited from $3.8 million in funding from the federal government to deliver substance abuse prevention and addiction treatment for at-risk youth. And, between 2010 and 2014, we have quadrupled the number of people getting help through programs that use medication to assist in treatment. And for many, many people, those treatments are helping.
 
But the medications that help with treatment are expensive, and many cities and states are experiencing sticker shock. I've contacted mayors, county officials, governors and attorney's general to encourage them to stand up to these drug companies to combat these high prices. We are facing a public health emergency and the drug companies are profiting. But we can stand up to them. With a supported and well-trained health care workforce, expanded access to prevention and treatment services, and a united message to pharmaceutical company CEOs, we can address our opiate epidemic and ensure access to life-saving treatments in New Hampshire and around the country."
 
Chris Christie- "While the challenge of drug addiction has taken on new national prominence in recent months, Chris Christie has been advocating for helping the drug addicted reclaim their lives for nearly two decades. As Governor of New Jersey, Chris Christie has backed up his rhetoric about changing the conversation on drug addiction by enacting concrete reforms to help non-violent drug offenders reclaim their lives.
Governor Christie championed the use of drug courts in New Jersey, which give first time, non-violent offenders, the opportunity to get the treatment they need rather than serving jail time.
 
Christie implemented a statewide program to help reduce the number of heroin-related deaths by training and equipping police officers and first responders to administer the antidote Narcan to overdose victims.
 
Governor Chris Christie signed the bipartisan Overdose Protection Act into law, which provides legal protection to people who are in violation of the law while they are attempting to help a drug overdose victim.
 
In his 2016 State of the State Address, Governor Christie announced the closing of a NJ prison to create the state's first ever fully dedicated substance abuse disorder treatment facility for prison inmates. He also announced a landmark financial commitment of $100 million to bolster drug treatment."
 
John Kasich- "The battle against drug addiction has been a top priority for Gov. Kasich. His approach is to create a coordinated campaign that tackles the problem from all angles. He will embrace this approach at a national level as president. You can find more details about this work here. The highlights include:
  • Targeting drug trafficking - closing pill mills and seizing record amounts of illegal drugs;
  • Addressing prescription drug abuse with prescribing guidelines for physicians and better utilization of our Rx monitoring system;
  • Increasing access to addiction treatment;
  • Targeting prevention - rolling out the new Start Talking campaign in schools; and
  • Improving access to naloxone, a life-saving overdose antidote."
 
Jeb Bush - "I recently released a drug control strategy, specially addressing opioid and illicit drug abuse. I believe some government leaders label these epidemics just a criminal justice issue, and some try to make them just a health care issue. Both approaches oversimplify these complex challenges. The demand for abused and illicit drugs must be addressed in tandem with arresting the supply of these drugs. I believe we need a drug control strategy that prevents drug abuse and addiction before it begins; strengthens criminal justice; secures the border to stop the flow of illicit drugs; and improves drug abuse treatment and recovery programs.
 
My entire strategy can be viewed at http://www.jeb2016.com/. The plan specifically addresses treatment needed for recovery by increasing accountability for existing federal prevention, treatment and recovery resources. The Substance Abuse and Mental Health Services Administration (SAMHSA), whose mission is to advance the behavioral health of the nation, currently invests over 60 percent of its budget on prevention and treatment. However, GAO has evaluated SAMHSA' s stewardship of federal dollars, particularly on mental health programs, and found poor oversight of current programs and limited coordination of efforts across the federal government. As President, I will conduct a rigorous evaluation and overhaul of existing programs to ensure funding supports evidence-based programs for states and to consistently measure and monitor results. Funding should support proven models, including community­ based programs with peer counseling and recovery communities that provide ongoing support to individuals and families. In addition, I will review and streamline current programs across the federal government to reduce duplication of efforts and maximize impact."