Left, right, and meeting in the middle: Addressing addiction is something we can agree about

ABSTRACT

The United States faces an addiction health crisis. Presidential election cycles in the United States are cause for creation of political party platforms. These platforms provide general stances and specific policies on a variety of issues. We undertook a review of the addiction policies of the 2016 Republican and Democratic platforms. Despite differences in focus, we found more similarities than differences between the two. We call upon those in political power to use every evidence-based policy at their disposal to promote addiction treatment and prevention.

KEYWORDS:

• Addiction crisis
• addiction policy
• Democratic
• policy review
• Republican
• United States Election 2016

The United States is facing an addiction crisis. The most recent National Survey on Drug Use and Health indicates that 9.4% of Americans aged 12 or older used an illicit drug in the past month, up from 8.3% in 2002. Furthermore, 22.7 million Americans needed addiction treatment in 2013, but only 2.5 million of these individuals actually received such treatment.¹ Illicit drug use is increasing in older Americans, driven in part by the rise in opioid use, which has been properly recognized as an epidemic.^1,2 The crisis must be addressed effectively, and the concerted efforts of stakeholders are required. The United States federal government is one such stakeholder that can greatly influence prevention and treatment approaches. For example, the Mental Health Parity and Addiction Equity Act of 2008 prevents health insurers from imposing certain restrictions on addiction treatment, and a recent change in Department of Health and Human Services regulations will increase the number of patients a physician may treat with buprenorphine at any one time from 100 patients to 275.

Addiction interventions are sorely needed. Proposed policies to confront these public health crises are strategically advocated for and enacted by national, state, and local governments. The role of the federal government in addressing complex national problems such as addiction is highlighted during presidential election years. The next president's administration, often guided by their party platform, is in a prime position to address this public health crisis.

What is a party platform? In the United States, each political party nominates a candidate who is tasked with promoting their party's version of effective government. A formal party platform document is issued at each party's national convention. The platform represents the party's ideals and unifies these into a proposed governance plan.³ Each party has a platform writing committee that is headed by a chairperson who works with co-chairs and state delegations to recruit a diverse and representative mix of national and local party activists, special interest groups, and state delegates.⁴ Although the process is not transparent, the first draft is usually put together by a drafting subcommittee. This is followed by national public hearings where other committee members can propose amendments. Lastly, the full committee votes on the final platform. Despite the lengthy drafting process, many of the committee member roles are viewed as ceremonial, with chairs and leaders making most final decisions. This makes it difficult for individual members to gain approval for proposed amendments.⁴ There is also a concerted effort by the leaders to construct platforms that are appealing to the electorate and do not present statements that may be too controversial or divisive.³

Still, a party platform includes the party's general stance and specific policy proposals on a range of topics of national interest, including health care–related topics. Thus, comparing and contrasting party platforms should provide voters with useful information as they decide who they will vote for come Election Day. Investigators have developed methods for systematically comparing party platforms and other forms of political text,^5–8 although such reviews have never been carried out with regards to addiction issues to our knowledge.

Because the Democratic and Republican party platforms are ratified prior to the national election in November 2016, we undertook a comparison of the Democratic and Republican parties' stances on addiction issues. Below, we describe how each party discusses addiction topics and highlight similarities and differences in these areas.

The 2016 platforms share many addiction policy similarities.^9,10 Both platforms acknowledge the seriousness of the current problem and the need to remedy it. The platforms cite statistics about the recent rise in illicit drug use, make general statements about expansion of treatment access, and mention recovery methods. The Democratic platform states, “We must confront the epidemic of drug and alcohol addiction, specifically the opioid crisis and other drugs plaguing our communities, by vastly expanding access to prevention and treatment, supporting recovery, helping community organizations, and promoting better practices by prescribers.”⁹ The Republican platform includes a similar statement: “Heroin and opioid abuse touches our communities, our homes, and our families in ways that have grave effects on Americans in every community.”¹⁰

In addition, both parties support the reform of our criminal justice system and providing alternatives to incarceration. The Republican party describes the need to divert “first-time, nonviolent offenders to community sentencing, accountability courts, drug courts, and veterans treatment courts.”¹⁰ Likewise, the Democratic party expresses a need to “Build on effective models of drug courts, veterans' courts, and other diversionary programs that seek to give nonviolent offenders opportunities for rehabilitation as opposed to incarceration.”⁹ The Republican platform specifically mentions the use of faith-based programs for addiction rehabilitation. However, as a whole, both parties support rehabilitation and reintegration into society, rather than punishment. Similarly, both platforms relate very strongly in preventive measures, drug education, and the role of families in these areas, despite their slightly different approaches. The Democratic platform emphasizes the need to “educate our youth, as well as their families, teachers, coaches, mentors, and friends, to intervene early to prevent drug and alcohol abuse and addiction.”⁹ The Democratic platform further espouses “School-based drug education programs that have been shown to have meaningful effects on risky behavior, community-based peer mentorship and leadership programs, and after-school activities that deter drug use and encourage life skills.”⁹ The Republican platform also expresses the importance of family in preventing drug abuse by affirming the benefits for “children raised in a two-parent household” who are “less likely to use drugs and alcohol.”¹⁰

Both platforms recognize that the cost of addiction does not fall equally on all Americans. Although they focus on different concerns—Republicans on the impact of prescription opioid misuse on rural communities,¹⁰ Democrats on racial disparities in conviction and sentencing in the War on Drugs⁹—both positions are supported by the data. African Americans run a greater risk of arrest and incarceration than their Caucasian counterparts, despite being no more likely to deal drugs and little difference in self-reported use.¹¹ Although not limited to prescription painkillers, rural America does suffer disproportionately from addiction. After adjusting for population density, rural areas have greater levels of prescription opioid–related abuse, injury, and death than urban ones.¹² Demographic issues are only briefly highlighted, but the decision to elevate these specific issues could have important implications for allocating enforcement and treatment resources post election.

One significant area of discord between the two party platforms is the legalization of marijuana. The Democratic platform believes marijuana use should continue to be permitted in accordance with changing state law. “The states should be laboratories of democracy on the issue of marijuana, and those states that want to decriminalize it or provide access to medical marijuana should be able to do so.”⁹ As states make this decision, the federal government should also “remove marijuana from the list of “Schedule 1' federal controlled substances and appropriately regulate it, providing a reasoned pathway for future legalization.”⁹ The Republican platform emphasizes the need to maintain current federal restrictions. It does not endorse state legality, as this allegedly creates confusion and undermines the effectiveness of federal law.¹⁰

Addiction is a serious problem in the United States. On this point, the data and the parties are in agreement. It may come as no surprise, though, that although both parties agree on the problem, they sometimes propose very different remedies. There is also outright disagreement on some topics, such as marijuana. However, in contrast to the polar dichotomy between party views on abortion, bank bailouts, or welfare offerings, there is an interesting discovery in our review: the similarities between the two parties outweigh the differences regarding addiction interventions.

In many ways, the variety of proposed solutions is ideal. Like clinicians who treat individual patients, we believe that politicians should consider a wide range of treatment (policy) options. Different proposals do not have to be—and should not be—mutually exclusive. In policy, as in addiction treatment, one size does not fit all. We call upon those elected and seeking election to explore every method at their disposal to confront the opioid misuse and addiction public health crisis, and for a humble willingness to adjust methods based on evidence. With this, we can avoid governmental responses like those in the past that have exacerbated old problems and created new ones: enforcement policies that compound the social cost of addiction, educational efforts that leave the public distrustful of authority, and health care policies that leave patients without proper treatment. Furthermore, those of us who are equipped to do so must raise our voices in the public sphere, not to suggest a national “course of treatment” for addiction, but to educate others and support a national conversation by which we can hold our elected officials accountable.

In addressing addiction, we continue to struggle to manifest a successful response to a problem that affects and involves public health, law enforcement, international policy, and the health and well-being of our shared social fabric. The overwhelming similarities between the two parties' 2016 platforms with regards to addiction leads one to wonder why this is the case. Both major political parties agree that addiction-related problems are devastating our nation, and that we must promote prevention and treatment efforts rather than punishment. Given this big picture agreement, the moment seems ripe politically for comprehensive, effective addiction-related policy approaches. Regardless of who is elected in November, the editorial team at Substance Abuse hopes for bipartisan effort in this area. In terms of specific programs and policies, we hope these can be based not on party ideology or political maneuvering, but on the best available published peer-reviewed scientific evidence. That's a platform we can get behind.

Author contributions

A.N. and A.G.: conception and design. A.N., J.C., S.S.: research. A.N., J.H., J.C., S.S., A.G.: composition.

Acknowledgments

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the authors affiliated institutions, the Department of Veterans Affairs, or the United States government.

The authors declare that they have no conflicts of interest.