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The Democratic debates neglected one of America’s biggest public health crises

The opioid epidemic hardly came up at all.

The candidates gather on the first night of the CNN Democratic presidential debate.
The candidates gather on the first night of the CNN Democratic presidential debate.
Justin Sullivan/Getty Images

We’ve now had four nights of Democratic debates — and in all that time, we’ve learned next to nothing about what any of the candidates want to do about America’s opioid epidemic, one of the worst public health crises facing the country.

Throughout the debates, the opioid epidemic was only mentioned in asides, used as a vehicle to make a broader point rather than an issue unto itself. Joe Biden and Beto O’Rourke brought up opioids to criticize the health care industry. Cory Booker brought them up to blast incarcerating people who use drugs. Andrew Yang did so to vaguely talk about how the economy is sending people into despair. No one explained how they plan to fight the crisis head on.

That’s not because the crisis is over. In 2017, America hit a new record for annual drug overdose deaths at 70,000 — a figure so high it contributed to the third year in a row in declining or stagnating life expectancy. Some preliminary data suggests that 2018 was a tiny bit better, with a 5 percent decline in drug overdose deaths. But that would still make 2018 the second-worst year of all time for drug overdose deaths. And even in 2018, deaths linked to synthetic opioids like fentanyl were still on their way up (while prescription opioid deaths declined just enough to make up for it); if that trend holds, 2019 could very well be worse.

It’s also not because the crisis is politically irrelevant. New Hampshire will be one of the first states to pick a candidate in the Democratic primary — and it’s also been one of the hardest hit by the crisis. Ohio and Pennsylvania, two swing states in the general election, are also among the hardest hit. An analysis by historian Kathleen Frydl even found that the Ohio and Pennsylvania counties that flipped from Barack Obama to Donald Trump in the 2016 presidential election were hit particularly hard by opioid overdose deaths.

And it’s not because President Donald Trump has owned the issue. Although Trump gave some lip service to the crisis on the 2016 campaign trail, his administration’s response has been generally weak. He’s committed only a few billion dollars here and there in additional funding, which is far from the tens of billions experts say is needed. And the bulk of his focus has been on policy proposals — like executing drug traffickers or building a wall — that most experts say would do nothing to combat the epidemic. This should be another issue to hit Trump on.

What makes the neglect of this issue on the debate stage even more frustrating is some of the Democrats actually have plans. Elizabeth Warren has the most comprehensive proposal, dedicating $100 billion over 10 years to addiction treatment — the kind of investment that experts argue is necessary. Amy Klobuchar has a less detailed plan to spend $100 billion on addiction and mental health services over 10 years. Even John Delaney has a plan, although it would only boost funding in the billions instead of the tens of billions.

But you haven’t heard about any of that on the debate stage.

Stigma drives apathy toward the opioid epidemic

So why didn’t the opioid epidemic come up at the debates?

Maybe some of this is on the moderators, who didn’t ask about solutions to the opioid crisis. But the candidates had lengthy opening and closing statements this week that could have raised the issues. And, at any rate, the candidates had no problem changing the topic whenever they wanted to throughout the nights.

The structure of the debates probably didn’t help either. In each debate, 10 candidates had two hours to run through a wide array of issues, from health care to gun violence to foreign policy. They had as little as 10 or 15 seconds to explain themselves on each issue. So some things just got left out.

But I worry that the real problem is one that has plagued solutions to the opioid crisis for so long: stigma.

When I went to Vermont a couple of years ago to check out how the state was scaling up its addiction treatment system, I planned to ask the people involved about the challenges. I expected the common answer to be money — building up treatment takes resources, and policymakers had to dig up those funds. To my surprise, the people involved told me that the much bigger problem was stigma: A lot of policymakers, and much of the public, just didn’t want to spend money helping “those people.”

I’ve seen this in response to my own reporting on the opioid crisis, through emails describing overdose deaths as “survival of the fittest” and that people who use drugs should “pay the price of their criminal choices and criminal actions.”

It’s this type of attitude, experts have told me, that helps explain why so little has been done at the federal level about the opioid epidemic.

Some of the people running for president acknowledge this. When I asked Warren why her colleagues in Congress haven’t done more about the issue, she simply cited “stigma.”

On the Democratic debate stage in June and July, I worry we saw that stigma-driven apathy in action.

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