Democratic presidential candidate Hillary Clinton unveiled her plan to combat substance and alcohol abuse earlier this week, penning an 800-word op-ed that appeared in the New Hampshire Union Leader, a newspaper based in a region reeling from a surge in heroin overdoses. Clinton said conversations with concerned voters on the campaign trail inspired her latest proposal.
If implemented, the former Secretary of State’s $10 billion plan would increase funding for the Substance Abuse Prevention and Treatment Block Grant by 25 percent and enforce insurance parity laws so that Medicare and Medicaid patients who enter rehabilitation programs could be reimbursed more easily. States would also receive money to implement plans of their own that encourage collaboration between public health agencies and law enforcement officials in the distribution of naloxone in cases of overdose. Additionally, the federal government would follow in the steps of some local and state agencies, diverting criminal justice resources toward treatment.
“It’s time we recognize that there are gaps in our health care system that allow too many to go without care — and invest in treatment,” Clinton wrote, signifying a shift in thinking among some medical professionals, lawmakers, and law enforcement officials about drug addiction, once considered a moral failing rather than a symptom of unmitigated mental illness. “It’s time we recognize that our state and federal prisons, where 65 percent of inmates meet medical criteria for substance use disorders, are no substitute for proper treatment — and reform our criminal justice system.”
Andrew Kolodny, chief medical officer at the New York-based drug addiction treatment center Phoenix House Foundation, praised Clinton’s plan to ThinkProgress, calling it better than anything the Obama administration has done thus far. “I’m surprised more candidates aren’t talking about this,” he said. (Republican candidate Rand Paul did, but he opted to imply that solely jobs keep people off of heroin.)
This proposal comes amid a surge in heroin overdoses in pockets of the country. Once relegated to inner-city communities, substance abuse has now devastated American suburbs and rural enclaves. Within a two-year span, heroin overdoses doubled, even as those for cocaine and other drugs declined. Researchers said painkiller addiction play a significant role in the spike, noting that 75 percent of heroin users often combined the substance with opioids, a trend that has concerned nine out of 10 doctors.
To combat the surge in heroin and opioid abuse, medical professionals cut back on painkiller prescriptions. The Obama administration also took action, announcing a three-part plan in February that would expand access to drug treatment approved by the Food and Drug Administration. Lawmakers followed up, introducing bills that, if passed, would guide doctors in safely prescribing opioids. In the span of a few months, nearly half of the U.S. states also passed laws granting wider access to naloxone, a drug that reverses the effects of potentially fatal opioid overdoses.
In the days after Clinton released her op-ed, lawmakers praised her substance abuse plan, saying it addresses various facets of what many called a public health disaster.
Democratic Senator Tim Kaine (VA) recounted conversations he had with people affected by the rise in heroin overdoses — parents, health professionals, law enforcement officers, and employers — saying “[Clinton’s] initiative to fight drug addiction would make a difference in communities in Virginia and across the nation.” Sen. Sheldon Whitehouse (D-RI) shared Kaine’s sentiments, saying Clinton’s plan had elements of the Comprehensive Addiction and Recovery Act, a bill he introduced earlier this year.
However, doctors like Kolodny emphasized that treatment should be used in concert with prevention efforts. “This is an excellent first start because one of the most important things to do is provide states and counties hit hard by the opioid crisis with resources they need. Hillary Clinton focused on expanding access to treatment but we also have to think about preventing cases of this disease. We need doctors to prescribe painkillers more cautiously,” said Kolodny, also director of Physicians for Responsible Opioid Prescribing.
Estimates have shown prevention of drug abuse to be more cost effective than treatment, with each dollar invested into an addiction program yielding between $4 and $7 in reductions in drug-related crimes, criminal justice costs, and theft. Other cost savings include declines in interpersonal conflicts, overdoses, and death.
Such treatment, however, has been hard to come by for some Americans. Only 11 percent of substance abusers actually receive treatment, according to data compiled by the Substance Abuse and Mental Health Services Administration. Those seeking help often face financial hurdles, depending on the type of insurance they hold. Addicts with private insurance are six times less likely to receive timely and consistent care than those with Medicaid. Even so, Medicaid programs in more than a dozen states don’t pay for long-term methadone treatment under the Essential Health Benefits framework, which defines benchmark plans for each state.
Increasing preventative measures may do some good for the federal government’s coffers. Each year, the nation spends more than $600 million addressing substance abuse, all of which goes to treatment, hospital care, and the criminal justice system. Since the height of the War on Drugs in the 1980s, the U.S. prison population increased sevenfold. Today, more than 80 percent of inmates in American prisons have drug-related convictions or committed crimes while under the influence of an illicit substance. Experts argue those arrests come from officers’ misinterpretations of criminal behavior that stem from drug use, including difficulty following instructions.
Retired law enforcement official Jack A. Cole said Clinton’s proposal doesn’t go far enough. Cole, a former New Jersey State police lieutenant, told ThinkProgress no substance abuse legislation will lower addicts’ contact with the criminal justice system if drugs aren’t legalized and regulated. Once that’s done, Cole said, the federal government can launch education campaigns to discourage use, similar to what has been done for tobacco.
“If we legalize and regulate these drugs, we know that can reduce crime, disease, addiction, and death while saving billions of tax dollars that have been funneled into this worthless war on drugs that has been rooted in racism,” Cole, a founding member of Law Enforcement Against Prohibition.
“Now that it’s happening in rural America, people no longer see it as an addiction, but a moral failing. While it’s good to hear Clinton say this, it doesn’t mean the federal government’s reaction will change. They give state, county, and municipal police departments grant money based on drug arrests made in the previous year so you’re talking about changing the way that police make a living,” Cole added.