Heroin becomes talking point for presidential campaigns

Hillary Clinton said she never expected to be questioned about her drug-addiction policies so early in her presidential campaign.

She recalled a meeting in New Hampshire: “The very first question was, ‘What will you do about the heroin epidemic?’” Clinton said.

Clinton turned for advice to Vermont Gov. Peter Shumlin, a fellow Democrat who dedicated his entire State of the State speech in 2014 to opiate addiction and treatment.

These days on the campaign trail, Clinton is the one starting conversations about the heroin epidemic.

“This is not politically popular,” Vermont Gov. Peter Shumlin said to a crowd that gathered in Laconia, New Hampshire, earlier this month for an hour-long discussion of opiate abuse with Clinton.

Discussing opiates in northern New England is, however, politically smart.

It’s a topic that Vermonters have grown accustomed to discussing. Now, presidential candidates are dipping into the conversation.

“I think that is very much a reflection of the New Hampshire primary process. We are having regular and frequent conversations with the candidates,” said Loretta L.C. Brady, a trauma and addiction researcher and professor in clinical psychology at Saint Anselm College in Manchester, New Hampshire.

“We’ve gotten so shaken by these events that we’re not being silent,” Brady said.

In a recent poll, New Hampshire residents said drug abuse and heroin are the second-biggest problem facing the state.

“It’s not surprising it’s a bigger issue this year, because it’s a real issue for people in the state,” said Andy Smith, who conducted the poll at the University of New Hampshire.

Vermonters list drugs and opiate addiction as the third-highest priority, behind the economy and taxes, according to a Castleton Polling Institute survey.

As drug issues come up on the campaign trail, “it’s actually quite heartening,” said Barbara Cimaglio, deputy commissioner of the Vermont Department of Health.

“I’ve been around long enough to remember when we first paid attention to substance abuse at this level, and it unfortunately goes way back to the 70s,” Cimaglio said. “It’s about time.”

Vermont becomes a model

Shumlin said conversations with addicts prompted him to focus on treatment.

“What we did was very simple,” Shumlin said. “We reformed our criminal justice system. That’s exactly what Hillary wants to do for America. We brought in third-party assessors who got folks when they were busted, when they were down, when they were most likely to move into treatment.”

After speaking with Shumlin over the phone, Clinton unveiled a $10 billion plan to address substance abuse and addiction over the next decade, using Shumlin’s work as a model.

Specifically, the Clinton campaign says the plan was inspired by Shumlin’s prioritization of treatment over incarceration and his work to expand the use of the anti-overdose drug naloxone.

“You have to remember, as the governor said, that this is a disease,” Clinton told the crowd in Laconia, New Hampshire. “This is a chronic condition that has to be interrupted and treated and prevented if possible.”

Shumlin was upbeat after the New Hampshire event.

“I’m proud of Vermonters,” the governor said.

From empathy to policy 

Concern over opiate addiction crosses party lines, though candidates may differ on funding sources or regulatory schemes.

Dave Sunderland, chairman of the Vermont Republican Party, said Vermont’s efforts have been “well-intentioned,” but more needs to be done.

Sunderland argues the Shumlin administration has not focused enough on jobs and economic opportunity as a prevention strategy, though Shumlin said in his 2014 speech that “our best prevention against drug addiction is to create jobs and opportunity for all Vermonters.”

Republican and Democratic presidential candidates have opened up about how substance abuse has affected them personally.

“I buried a child to drug addiction,” Republican presidential candidate Carly Fiorina said at a Sept. 16 debate on CNN, referring to the death of her stepdaughter, who died after struggles with alcoholism and drug abuse.

Fiorina’s story prompted the most Google searches of any moment of the Sept. 16 debate, according to the Washington Post, showing that her words resonated with viewers.

Vermont’s own Democratic presidential candidate, Sen. Bernie Sanders, I-Vt., argues that the U.S. “War on Drugs” has failed.

Like Clinton, Sanders has called for the anti-overdose drug naloxone to be more widely available. Like Republican presidential candidate Chris Christie, Sanders has called for increased funding for drug courts that guide people into treatment rather than prison.

Clinton’s substance-abuse plan would boost the Substance Abuse Prevention and Treatment block grant, the money Vermont relies on for expanding treatment infrastructure. She would also offer 80-percent federal matching grants for states that invest in plans for prevention and treatment.

“Do you know what a difference that would make to this battle in Vermont right now?” Shumlin said. “It would be huge.”

Clinton wants to change regulations, allowing nurse practitioners to prescribe treatment drugs and allowing physicians to take on higher caseloads of patients in medication-assisted treatment.

Bob Bick, CEO of Howard Center, the substance abuse and counseling agency based in Burlington, disagrees with the idea of expanding physician caseloads.

“The intention of the (Vermont hub-and-spoke) model was to normalize the treatment of this illness within the context of a primary care medical setting,” Bick said.

Large numbers of patients receiving medication-assisted treatment would make some doctor's offices look more like substance abuse clinics, Bick said, running contrary to Vermont's vision of treating addiction like other conditions.

Andy Smith, the pollster and associate professor of political science at the University of New Hampshire, says Republicans and Democrats appear to be close to each other on the issue of drug addiction.

That works, Smith said, because most voters don’t examine the policy details of each campaign.

“It doesn’t really matter what the plans say,” Smith said. “All they have to hear is that candidate X cares about drug abuse.”

Drug abuse was not a major issue in the 2008 or 2012 presidential campaigns, Smith said.

He has noticed a different tone in drug policy discussions compared to the 1980s, when leaders focused on crack cocaine in American cities.

“Heroin use now is broader on the economic and social spectrum than it has been in the past,” Smith said, "and I think that’s causing politicians or allowing politicians to have a more sympathetic audience when they talk about this.”

Brady, the clinical psychology professor, said she will listen for presidential candidates who understand that addiction recovery is a process, and who highlight evidence-based strategies.

“It’s going to depend on us as voters to decide whether this is going to be an issue that really gets carried,” Brady said. “I don’t know whether this is the thing that people are voting on, but I think it matters to people to hear candidates coming out clearly.”

Contact April Burbank at 802-660-1863 or aburbank@freepressmedia.com. Follow her on Twitter at www.twitter.com/AprilBurbank