Substance Use Disorders: Just Talking Points, or an Opportunity for Real Reform?

Topics: Substance Use, Illicit Drugs, Prescription Drug Misuse, Politics and Policy, Elections, 2016

by Ashley Fuoco Antonelli, senior writer

Substance use disorders have been getting more attention lately.

For example:

  • Last month, lawmakers -- citing data that show the number of heroin users in the country has tripled since 2012 -- called heroin use "a public health crisis."
  • Policymakers have begun working with experts on ways to address the growing heroin epidemic.
  • HHS has announced it will devote an additional $100 million for community health centers in 11 states to address substance use disorders.
  • The Obama administration on Monday announced an initiative that aims to curb growing heroin use in the U.S.

According to CDC, heroin overdose deaths have increased by 28% since 2010. Since 2002, most demographic groups have seen an increase in heroin use. Meanwhile, a joint CDC and FDA report found there were as many as 8,200 heroin overdose deaths in 2013, twice as much as in 2011. The report cited lower costs of the drug as a likely reason for the increase.

However, the strongest factor for eventual heroin use is misuse of prescription opioids, the report found. The report noted that individuals who misuse the painkillers are 40 times more likely to also use heroin. Overall, 75% of all new heroin users first misused prescription opioids. Meanwhile, a separate study, published last month in Mayo Clinic Proceedings, found that one in four individuals who are prescribed opioid painkillers for the first time end up using such drugs for long periods.

Despite this rise in use and overdose deaths, a recent report from the National Alliance on Mental Illness found that patients are denied substance use disorder care more often than other forms of care. For example, Medicaid programs in at least 17 states do not cover long-term methadone treatment.

Where the Candidates Stand

Lawmakers have introduced various bills intended to expand treatment for substance use disorders, but there's a stronger indication of just  how serious the issue has become: A number of presidential hopefuls have addressed the topic.

However, most candidates have discussed moving away from a focus on combatting illicit drug use and instead bolstering treatment for substance use disorders. In fact, candidates have not yet proposed concrete plans to address the issue if they are elected.

Here's a breakdown of who's said what so far.

New Jersey Gov. Chris Christie (R): Christie recently participated in a roundtable discussion at a treatment facility, during which he called substance use disorders "a treatable problem" that "we need to start talking about ... like an illness." Further, Christie has touted an expanded substance use disorder treatment program in New Jersey that aims to reduce the stigma surrounding the issue. During a campaign stop in New Hampshire, Christie said he has always believed that a substance use disorder is "an illness" and that individuals with such issues deserve "a second chance."

Former Secretary of State Hillary Clinton (D): Clinton has notified her supporters that substance use disorders and mental health will be key issues in her campaign. In fact, her campaign has begun to draft policies that could be used to address the issue. According to a campaign aide, Clinton decided to focus on the issue of opioid misuse after individuals brought up the issue at campaign stops. During a campaign stop in Iowa, Clinton said she wants to "end the stigma against talking about the issue" and "do everything [she] can in [her] campaign to raise it." Further, while Clinton applauded the Affordable Care Act for expanding coverage for substance use disorder treatment, she also said additional policies need to be reformed, both at the state and federal levels, "to ensure communities have the resources needed to address the issue."

Former Hewlett-Packard CEO Carly Fiorina (R): Fiorina has called for the decriminalization of drug addiction and said states should change the ways they handle individuals with substance use disorders. On a call with reporters earlier this year, Fiorina said, "You have a lot of young people who are getting access to drugs and then they are getting arrested frequently -- it's just a bad, bad cycle." She cited reforms some states have made, but did not offer any specifics what such reforms might look like on a national level.

Ohio Gov. John Kasich (R): Kasich, during Fox News' GOP candidate debate this month, defended his decision to expand his state's Medicaid program, citing the funding the state is now receiving to help treat individuals with substance use disorders. He touted efforts in the state to treat prison inmates and others who are facing addiction issues.

Former Maryland Gov. Martin O'Malley (D): O'Malley has called for federal and state grants to help states launch "comprehensive drug treatment" programs. While O'Malley has a history of being tough on drugs as a governor, he has also worked to decriminalize the possession of some substances and increased spending on treatment for substance use disorders in Maryland. In addition, O'Malley has called for the expansion of treatment for substance use disorders for prison inmates.

Sen. Rand Paul (R-Ky.): Paul's home state of Kentucky has been at the epicenter of a hepatitis C outbreak stemming from injection drug use in the Appalachian region, which has officials bracing for a related HIV outbreak. Kentucky officials worry the state is on track to see a situation similar to one in Indiana, where the state recently experienced the worst HIV outbreak in its history. To address such issues, Paul was among a bipartisan group of lawmakers earlier this year to introduce legislation (S 1455) called the Recovery Enhancement for Addiction Treatment, which aims to expand specialized care for opioid addiction. Paul said when introducing the bill that "the government's solution of locking up people with addiction is not solving the problem," adding that the measure would "remove a roadblock to getting people the help they need to break the cycle of addiction and get on a path to recovery."

Former Texas Gov. Rick Perry (R): Perry earlier this year applauded reforms in Texas that expanded treatment for individuals with substance use disorders. He cited the creation of local drug courts and "diversion programs that treat alcoholism and drug addiction as a disease."


Sen. Bernie Sanders (I-Vt.): Sanders has advocated for the expanded use of drug courts, which can in some cases help individuals with substance use disorders receive treatment instead of going to prison for drug-related offenses. Further, Sanders has said treatment for substance use disorders should include both "medical and mental health interventions."