Amid heroin crisis, GOP contenders reframe addiction as a health crisis

by @serfer6 February 1, 2016 5:00AM ET

Candidates confront opioid epidemic with calls for rehabilitation but balk at wider drug policy reform

Republican Party
A heroin user in St. Johnsbury, Vermont, prepares to shoot up in 2014.
Spencer Platt / Getty Images

A lethal batch of heroin, trafficked under the name Hollywood, surfaced in New Hampshire in late January after claiming at least eight lives in western Massachusetts. For Granite State officials, it’s the latest in a steady dose of dire news that has seen overdose deaths linked to opioids double in the last two years; drug related overdose deaths are expected to surpass 400 in 2015. Deadly overdoses now outnumber traffic deaths in New Hampshire, one of dozens of states to feel the impact as heroin extends its reach to suburbs and rural areas across the country.

The epidemic has seen New Hampshire, the host of the nation’s first presidential primary next week, turn drug abuse into a contentious issue during the campaign. Several Republican candidates have responded to the crisis with an about-face rarely seen since Richard Nixon launched the so-called war on drugs 45 years ago: a mainstream conservative movement calling for treating low-level drug use with health services instead of prison time. Last month in New Hampshire, GOP contenders unveiled several ideas — although few with detailed plans — to treat heroin addiction via rehabilitation, from placing more emphasis on drug prevention and targeting drug dealers instead of users to expanding recovery programs.

The suggestions floated in the state reflect a budding yet guarded national conversation around drug policy and criminal justice reform. In December’s omnibus spending measure, Congress included a repeal of the ban on federal funding for state needle exchange programs. The decision, which overturned decades of federal opposition to these programs, was championed by House Appropriations Chairman Hal Rogers and Senate Majority Leader Mitch McConnell, both Republicans from Kentucky, one of the states hit hardest by opioid addiction. Their backing was seen as a reaction to the HIV/AIDS outbreak that struck nearby Indiana last year, forcing Gov. Mike Pence to declare a health emergency and grudgingly lift a law barring health officials from distributing needles to intravenous drug users.

Deaths from drug poisoning, 2002-2014
Drug overdose deaths per 100,000 people, by U.S. county. The increase is largely driven by a surge in opioid overdoses.
increase in drug poisoning deaths, 2002-2014
Source: CDC Drug poisoning mortality statistics. Graphic by Alex Newman.

“There is widespread recognition that the war on drugs has failed and that the policies associated with that war have had a disastrous impact in a public health sense,” said Michael Collins, the deputy director of national affairs at the Drug Policy Alliance. “As the country encounters these problems — problems with heroin that have popped up in places like New Hampshire, Kentucky and Indiana — I think there is a sense that you cannot incarcerate yourself out of this problem.”

That idea, that punitive measures alone will not curb drug consumption, seems to making inroads among the Republican establishment. In Ohio, which in 2014 ranked second in the number of deadly drug overdoses (2,744), after California, Gov. John Kasich signed legislation last year that made the anti-overdose drug naloxone available without prescription. And Kentucky Sen. Rand Paul has introduced legislation that would make it easier for doctors to treat heroin users. He has also called for a revision of mandatory minimum sentencing laws that disproportionately imprison African-Americans and Hispanics.

Drug Policy Alliance

But as the discussion around opioid addiction evolves, most GOP presidential candidates have been hesitant to support wider reform of drug laws. Former Florida Gov. Jeb Bush, while voicing support for expanding drug courts nationwide, opposed a Florida medical marijuana proposal in 2014 that was narrowly defeated. Like him, most other GOP contenders are opposed to marijuana but say legalization decisions should be left to the states. And although Bush recently embraced the idea of lowering mandatory minimums, as governor, he signed legislation that increased minimums for juvenile offenders in Florida. New Jersey Gov. Chris Christie has criticized the White House’s new sentencing guidelines, which will release about 6,000 nonviolent drug offenders. He has vowed that, if elected president, he will enforce existing federal marijuana laws.

The Democratic presidential candidates, meanwhile, seem to have embraced the notion that supporting progressive drug policy is no longer a political liability. Vermont Sen. Bernie Sanders, for example, has called on the campaign trail for the removal of marijuana from the federal Controlled Substances Act and for allowing states to regulate marijuana without federal interference. And he has backed the Smarter Sentencing Act, which would reduce most mandatory minimums for nonviolent drug offenses.

Clinton was silent on drug law reform during her eight-year tenure as a senator from New York. Although she recently called for an end to the era of mass incarceration, her stance has shifted throughout her career. As first lady, she campaigned for the Violent Crime Control and Law Enforcement Act, according to the Marshall Project, a nonprofit that covers the U.S. criminal justice system. The measure, which provided billion of dollars for prison construction and established mandatory life sentences for third felony convictions, is credited with extending the era of mass incarceration.

Drug Policy Alliance

Race helps frame the opioid debate. The latest outbreak is seen as a white problem, and the data support that claim. A study published in JAMA Psychiatry in July 2014 showed that nearly 90 percent of recent heroin users were white. And about 75 percent of new users came from rural or suburban areas, many in states that are GOP strongholds. For some critics, the newfound Republican stance on opioids smacks of political opportunism. Political survival, they point out, demands that presidential hopefuls solidify support among voters in white, suburban areas, precisely where the heroin epidemic has flourished.

“Given that we have a drug problem now perceived as a white problem, although no one articulates it that way, there is a greater openness to thinking about the problem more broadly, to showing compassion,” said Marc Mauer, the executive director of the Sentencing Project, a group that advocates for reduce incarceration rates. “By comparison, in the 1980s, when crack emerged on the scene, it was very much perceived as a black drug. In that case, Congress and state legislatures raced in record time to implement very harsh, punitive policies.”

In an apparent push for the African-American vote, Sanders and Clinton have recently criticized those measures for disproportionately affecting minorities. She has not endorsed marijuana legalization, but she recently told a black audience in South Carolina that she would like to loosen restrictions on the drug to prompt federal research. He has proposed the federal decriminalization of cannabis, saying he would allow states to experiment with legalization.

The GOP’s recent emphasis on rehabilitation and treatment for heroin users contrasts sharply with Republicans’ reactions to previous drug epidemics. At the height of the hysteria over crack cocaine, which was perceived as a drug largely consumed by blacks, Congress approved the Anti–Drug Abuse Act in 1986. The law slapped low-level offenders with mandatory minimum sentences that matched or were at times harsher than penalties for dealers and put in place sentencing guidelines for crack that were much harsher than those for powder cocaine: Those distributing 5 grams of crack could receive the same sentence, five years in federal prison, as those distributing 500 grams of powder cocaine. That hundredfold disparity stood until 2010, when Congress passed the Fair Sentencing Act, reducing it to 18-fold.

The mood in Congress has begun to shift in the last two years. Falling crime rates — and concerns over the economy and terrorism — have helped build momentum for federal criminal justice reform. Among the bills working their way through Congress, the Sentencing Reform and Corrections Act, sponsored by Sen. Charles Grassley, an Iowa Republican, is viewed as the most likely to reach President Barack Obama’s desk. The measure would reduce mandatory minimums for drug and weapons convictions and apply them retroactively, although it has been criticized by some advocates because it doesn’t eliminate any mandatory minimums and applies only to federal prisoners, or about 10 percent of U.S. inmates.

Some experts, while encouraged by a new openness to address reform, caution that the bills being offered do not recognize the scale of the problem. The tough-on-crime era that epitomized the anti-drug hysteria of the 1980s and 1990s has seen the federal and state prison population balloon by roughly 800 percent since 1980, to 2.4 million people, with U.S. incarceration costs estimated at $80 billion annually. Advocates call for more attention to and money spent on public health measures, such as syringe exchange programs, and for Good Samaritan laws, which offer immunity to people who report overdoses. And legislators must examine a system that incarcerates black people for drug offenses 10 times as frequently as whites.

“Mass incarceration evolved over 40 years, and it’s not going to change overnight through one piece of legislation at the federal level or state level,” Mauer said. “It’s going to require a fairly broad re-evaluation of where we’re allocate our resources, what our policing looks like, prosecutorial and sentencing policies. More drug courts is nice, but the problem is much bigger than that, so we want to have a robust conversation all around, and we hope we’ll be hearing more of that as the campaign moves along.”