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The big public health crisis most presidential campaigns are ignoring

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As many as 45,000 people could die from drug overdoses in the US this year, if the past few years' trend continues. That's more Americans than died at the height of the HIV/AIDS epidemic in the 1990s. It's a serious public health crisis. But if you listen to the many, many people running for president, it barely gets any mention.

The one notable exception: In early September, Hillary Clinton released a $10 billion plan to deal with drug abuse and addiction. But besides that, no major candidate, Democrat or Republican, has taken the issue very seriously. They haven't released their own plans. They rarely mention it on the campaign trail. The second Republican debate dealt with the problem for a few minutes, but produced nothing of substance (and actually some false claims from Carly Fiorina).

After the AIDS epidemic broke out, the federal government (rightly) dedicated hundreds of millions of dollars to deal with this new massive public health crisis — particularly through the Ryan White CARE Act and research efforts. And even though the early response, particularly from President Ronald Reagan, is heavily criticized to this day, it eventually became an issue that many politicians took seriously, with Presidents George H.W. Bush and Bill Clinton both acting on the crisis while they were in office.

Today, we see no similar effort to solve another public health crisis that's taking more lives.

Tens of thousands of people die from drug abuse each year

Nearly 44,000 people died from drug overdoses in 2013, and about 88,000 die each year from alcohol-caused problems like liver disease and car crashes, according to the Centers for Disease Control and Prevention. In comparison, there were more than 33,000 firearm deaths in 2013, and nearly 34,000 car crash deaths. And more than 41,000 Americans died from AIDS at the height of the HIV/AIDS epidemic in 1995.

Some of the drug and alcohol deaths occur from casual use — someone may drink for the first time in months, decide to drive, and get in a fatal car crash.

But excessive drug use is a cause in many cases. Years of drinking is much more likely to lead to liver damage. Extended cocaine abuse can similarly heighten the risk of heart disease. Long-term heroin users are at greater risk for an overdose — they use more to meet their greater tolerance for the high, but they don't develop as strong of a tolerance for the respiratory effects that lead to an overdose. And so on. It's these types of deaths that a comprehensive anti-drug plan could deal with.

There's a reason to give this more attention today, as well: Over the past few years, the number of opioid overdose deaths in particular has skyrocketed.

A rise in opioid addiction is driving many of the deaths

There is no single cause for drug use and abuse. But if one problem can be linked to the recent rise of drug overdoses, it's America's opioid crisis: More than half of drug overdose deaths in 2013 were linked to opioid painkillers and heroin.

Since the late 1990s, the number of people dying from opioid painkiller overdoses has steadily risen — with more than 16,000 deaths reported in 2013. What's worse, one study in JAMA Psychiatry found opioid painkiller users have moved on to heroin — another opioid that's deadlier and more addictive than painkillers — because heroin is cheaper and doesn't require a prescription. (A 2015 CDC analysis, for example, found people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.)

These numbers come into conflict with another medical issue: About 100 million Americans suffer from chronic pain, according to a 2011 report from the Institute of Medicine. But there's no good evidence that opioid painkillers can treat chronic pain, even though they're commonly prescribed for long-term issues. And drug policy experts widely agree that doctors are generally overprescribing the drugs, often without checking if a patient has a history of drug addiction.

A federal plan that tackles opioid abuse could address many of these deaths. By propping up drug treatment and rehabilitation services, for instance, you could get thousands of people off opioids before they die of an overdose. And this could actually save money: According to some estimates, drug treatment costs 12 times less than the outcomes of drug abuse, such as drug-related crime, criminal justice costs, theft, loss of productivity, and interpersonal conflicts.

The government has dedicated some money here and there — notably, a $2.5 million plan to fight heroin abuse and another $133 million program to combat opioid abuse. (Obviously, the federal government has also spent billions each year on the war on drugs. But those tough-on-crime measures have largely failed to clamp down on drug use and abuse, and many experts, including the International Narcotics Control Board, now prefer a public health approach — or at least a more serious public health approach paired with traditional law enforcement efforts.)

As Keith Humphreys, a drug policy expert at Stanford University, has pointed out to me, drug overdoses are a problem that likely will take billions more in public health funding to seriously address while a President Clinton, Sanders, Trump, or Rubio is in office, especially since some of the states dealing seeing the worst of the opioid crisis, like West Virginia, just don't have the resources to tackle the problem by themselves. So where's the public attention?