The overdose crisis claims over 100,000 lives each year in the United States, but has received very little attention from leading candidates Kamala Harris (D) and Donald Trump (R) during the presidential election campaign.
Whatever the outcome after November 5, the winner will face a continuing public health emergency. Proven lifesaving strategies are available. But to different degrees, the candidates’ sparse words on the topic have focused on continuing the drug war that led us here.
On her campaign website, Vice President Harris says she is “committed to ending the opioid epidemic and tackling the scourge of fentanyl.” She cites her background as a prosecutor and California attorney general, including her prosecutions of people for drug trafficking and seizures of large quantities of drugs under her leadership.
As vice president, she continues, she helped allocate $150 billion to target drug trafficking, but also billions more in “investments to states to fund lifesaving programs.” Harris also touts the FDA’s approval of naloxone products as over-the-counter medicine under the Biden administration, and mentions the slight national decline in overdose deaths in 2023.
As president, Harris promises she would sign the bipartisan border security bill, which includes drug-detection technology, and vows to “keep fighting to end the opioid epidemic.”
While Trump goes further than Harris, both connect the border with the drug supply in a misleading way.
Trump has even less to say on his official platform, and what’s there focuses entirely on escalating the drug war. “We will deploy the US Navy to impose a full Fentanyl Blockade on the waters of our Region—boarding and inspecting ships to look for fentanyl and fentanyl precursors,” it reads. There are no further details or proposals on opioids or overdose.
Trump promises to “crack down hard on the cartels that traffic drugs and people into our Country,” and to use the Alien Enemies Act to “remove all known or suspected gang members, drug dealers, or cartel members from the United States.”
While Trump goes further than Harris, both connect the border with the drug supply in a misleading way. The federal Department of Homeland Security estimates that 90 percent of intercepted fentanyl is stopped at legal border crossings, often hidden in vehicles driven by US citizens. The notion of millions of undocumented migrants trafficking a flood of fentanyl is a fantasy.
But there’s a cynical logic behind the campaigns’ emphases here. Immigration ranks among the top issues cited by voters in this election, according to Gallup and others. It’s especially motivating for Republican voters, a quarter of whom claim it is their top issue, but surveys have found that even significant numbers of Democrats support Trump’s plan for mass deportations, or that outright majorities of voters want to reduce immigration and tighten border security.
What little exchange has taken place between Trump and Harris on the issue has been unproductive. At a Wisconsin rally in September, Trump falsely claimed that his opponent would legalize fentanyl. “She’s so radical she even wants to legalize fentanyl right away,” he said.
In response to Trump’s taunts, Harris ramped up her own anti-drug rhetoric.
That was a distortion of the fact that Harris, when responding to an ACLU survey during her first presidential run in 2019, indicated that she supported decriminalizing—not legalizing—drug possession at the federal level. Harris has not made a public statement about decriminalization in this cycle, however.
In response to Trump’s taunts, Harris ramped up her own anti-drug rhetoric at a September rally in Las Vegas. “As president, I will double the resources for the Department of Justice to go after those transnational cartels and take action to stop the flow of fentanyl coming into our country, which is destroying entire communities,” she said.
She continues to support federal legalization of marijuana, however, saying, “I just think we have come to a point where we have to understand that we need to legalize it and stop criminalizing this behavior.”
If her harder tone on drugs and the border has been a form of political opportunism, tacking to the center in an attempt to win votes there, Trump’s partial embrace of marijuana legalization could be seen similarly. As a Florida resident, the former president has promised to vote in favor of that state’s ballot measure to legalize. He has not gone as far as Harris in backing federal legalization, though, and has argued in the past that it should be left to the states.
In June, when Trump faced President Biden in a televised debate, he was asked directly about overdose deaths, and what he would do to help people. He pivoted from a non-answer to the border.
“We were getting very low numbers. Very, very low numbers.”
“Jake, we’re doing very well at addiction until the COVID came along,” he said. “We had the two-and-a-half, almost three years of, like nobody’s ever had before, any country in every way. And then we had to get tough. And it was—the drugs pouring across the border, we’re… it started to increase.”
“We got great equipment,” he continued. “We bought the certain dog. That’s the most incredible thing that you’ve ever seen, the way they can spot it. We did a lot. And we had—we were getting very low numbers. Very, very low numbers.”
Those “very low numbers” were anything but—under the Trump administration, annual overdose deaths rose from 68,000 to over 95,000 by the time he left office. They continued to rise, until recently, under the Biden administration, reflecting the failures of both Democratic and Republican governments to address this crisis.
Both candidates took or supported at least some meaningful steps. The Biden administration saw the first-ever, brief mention of “harm reduction” in the president’s 2022 State of the Union Address. And it took actions like expanding access to naloxone, including by offering millions in grants to rural providers, and requiring all federal buildings to keep the medicine on site. Biden’s Department of Health and Human Services also eased restrictions on buprenorphine prescribing for people who use opioids, allowing more access than before to a lifesaving medication.
“While the Biden-Harris administration has taken important steps … their efforts have ultimately fallen short of the scale and magnitude this crisis demands.”
But it was nowhere near enough, as the continuing deaths demonstrate.
“While the Biden-Harris administration has taken important steps toward embracing harm reduction and expanding access to naloxone, their efforts have ultimately fallen short of the scale and magnitude this crisis demands,” Kassandra Frederique, executive director of the Drug Policy Alliance, told the Guardian.
Trump has not pretended to support harm reduction. But as president he did sign into law the SUPPORT Act, which invested billions into expanding community-based drug treatment and recovery services. It also required state Medicaid programs to cover FDA-approved medications for opioid use disorder.
As Politico reported, the bill hasn’t been renewed since it expired in 2023. The Democrat-controlled Senate hasn’t voted on a replacement, while the GOP-controlled House did pass a bill but failed to expand its provisions or include increased funding.
“Healthcare reform is going to be a big part of the agenda … No Obamacare.”
Another related, hugely consequential issue for people who use drugs and many others is federal health care policy—especially for millions who rely on either subsidized plans or Medicaid expansion to access medicines and other forms of care.
Last time in office, Trump and the Republican-controlled Congress attempted to deliver on his key campaign promise to “repeal and replace” Obamacare, or the Affordable Care Act. Only a last-minute thumbs down from the late Senator John McCain (R) protected health care coverage for tens of millions of people. An estimated 18.6 million adults on low incomes receive coverage because of the ACA’s expansion of Medicaid.
Trump has made contradictory statements about the ACA in this cycle, saying at one point that “it would have been good to just let it rot and let it go away,” but also claiming, “I saved it. I did the right thing.”
That’s rewriting history, of course—and to put any doubts to rest, House Speaker Mike Johnson (R) promised in October that “Healthcare reform is going to be a big part of the agenda,” simply telling an audience member: “No Obamacare.”
Harris has promised to maintain and strengthen the ACA.
Photograph by Phil Roeder via Flickr/Creative Commons 2.0
The Influence Foundation, which operates Filter, previously received a restricted grant from the Drug Policy Alliance. Filter‘s Editorial Independence Policy applies.
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