In terms of understanding the major-party presidential candidates’ positions on drug and alcohol addiction issues, little of a substantive nature has changed since before votes were cast in the first primaries. Democrat Hillary Clinton’s intentions are best spelled out in a fairly detailed Initiative to Combat America’s Deadly Epidemic of Drug and Alcohol Addiction, which her campaign outlined more than a year ago (see ADAW, Sept. 14, 2015). On the Republican side, the clues to Donald Trump’s possible approach have been found mainly in individual comments about aspects of the drug crisis, given that the advocacy community has not seen a more formalized plan from the candidate that addresses addiction issues.
Members of the public policy community hesitate, however, to make sweeping predictions about what the future holds depending on the election’s outcome. They realize that as they have continued to push in recent weeks for more immediate results on Capitol Hill, the need will be there to work with whoever controls Congress and resides in the White House come January.
“So much has been going in the present, with issues such as 2017 funding and the IMD exclusion, that we haven’t really had time to catch our breath,” Andrew Kessler, principal of Washington, D.C.–based government relations firm Slingshot Solutions, told ADAW.
There is some ability to analyze aspects of the leading candidates’ fact sheets and/or comments, as well as components of the two major party platforms. On the most detailed level, advocates can process the various sections of Clinton’s proposal to spend $10 billion over 10 years to combat drug and alcohol addiction, with a breakdown of $7.5 billion for new federal-state partnerships and $2.5 billion to increase substance abuse block grant funding by 15 percent.
The five main subject areas in Clinton’s initiative (prevention, treatment and recovery, access to naloxone for first responders, training and consultation requirements for opioid prescribers and criminal justice reform) contain some indications of policy directions that a Clinton administration could advance. The treatment and recovery language, for example, discusses expanding the pipeline of trained service providers, mobilizing peer recovery coaches and fully enforcing parity laws “so that insurance practices are not a barrier to treatment.” The criminal justice section calls for more collaboration between public health and justice systems at various stages before, during and after incarceration.
Clinton’s initiative is largely reflected in the Democratic Party’s platform for 2016 as well, although that document goes into slightly less depth. Kessler says he was glad to see the Democratic platform specifically reference alcohol addiction as well as drug addiction.
The Republican platform is somewhat more focused toward combating the opioid crisis specifically. And this also has been a focus of some of Trump’s comments during the campaign, including those related to his belief that a wall between the United States and Mexico would stem the flow of opioids into the country.
On a general level, “We’re glad to see [addiction issues] in both platforms,” Kessler said. “It’s a high water mark for us.”
The Republican platform is more regulatory in nature, he said, with elements such as a statement that there will be efforts to work with the Centers for Medicare & Medicaid Services to ensure that physicians do not face repercussions from limiting prescriptions of opioids for some patients, Kessler said.
While Trump’s positions on some drug policy–related issues remain unclear (he indicated in an early 1990s interview that he was open to the idea of drug legalization, but stated in an appearance during the campaign that he now opposes legalization), advocates say some of his personal experiences convey an appreciation of the issue’s importance. He has talked in the past about the effect that the struggle and death of an alcoholic brother had on him. Also, former Miss USA Tara Conner has spoken positively of the support she received from Trump in her early recovery, said Mark Dunn, the public policy representative for the National Association of Addiction Treatment Providers (NAATP).
Dunn said that while NAATP and other associations do not endorse political candidates or engage in formal canvassing of their members in the election season, anecdotal information from NAATP members indicates at least some level of comfort with Clinton’s initiative in that it is spelled out.
He added that in the addiction treatment provider community, “I sense a heightened level of interest in the political process generally.”
Maintaining earlier momentum
Dunn said that during the presidential primary season, a concerted effort was made to focus the candidates on addiction-related issues, and “more than ever before, that was successful.” At events organized by the Addiction Policy Forum, candidates from both parties spoke out on issues, with some discussing in highly personal terms the battles that loved ones faced.
“They made it a little bit safer to talk about the issue,” Addiction Policy Forum Executive Director Jessica Nickel told ADAW.
With some of that momentum having slowed during the general election campaign, the Addiction Policy Forum has continued to work on multiple fronts. “We have continued to request more information from the Trump campaign on how the policy issues look on their end,” Nickel said. “We’re going to keep trying — there are still quite a few weeks before Election Day.”
The Trump campaign did not respond to an emailed request from ADAW regarding any existing or anticipated policy statements on addiction policy.
Also, at press time, the Addiction Policy Forum and others were pushing to have a question about addiction policy included in the town hall format presidential debate to be held on Oct. 9. Individuals and groups have been able to submit questions to be considered for the debate, with citizens voting on their preferences in order to indicate the level of public interest in the various topics. Kessler pointed out that as of midweek last week, a submitted question regarding marijuana legalization was getting slightly more than double the number of votes as a submitted question on the opioid crisis.
Although there are considerably more clues to the potential policy directions of a Hillary Clinton administration on addiction-related issues, some anecdotal information offers hope that these topics also could be elevated in a Donald Trump presidency.