CONCORD, N.H.— Hillary Clinton calls the scourge of heroin and opioid addiction a "quiet epidemic." Donald Trump marvels that overdoses are a problem in picturesque American communities.
"How does heroin work with these beautiful lakes and trees?" he said recently in New Hampshire. "It doesn't."
Both presidential candidates agree drug addiction is a major problem in America, but only Clinton has offered a detailed plan to tackle it as part of her campaign. The Democratic nominee has outlined a $10 billion plan to give states more money for prevention, treatment and recovery programs. Trump has long centered his plan on stopping the flow of illegal drugs by building a wall along the southern border.
More recently, he has called for expanding enforcement as well as treatment programs, but he has offered no specifics on costs.
Heroin and opioid addiction is at a nationwide peak — the Centers for Disease Control and Prevention reports 78 Americans die from a drug overdose every day. It's particularly felt in states such as Ohio and New Hampshire, frequent stops on the presidential campaign trail, where overdoses from heroin and other drugs, like the powerful synthetic version of the painkiller fentanyl, have skyrocketed in recent years.
Here is a summary of their proposals:
CLINTON: Her $10 billion proposal calls for boosting federal spending in five areas: prevention, treatment and recovery, first responders, prescribers and criminal justice reform. Over 10 years, Clinton calls for sending $7.5 billion to states, which could receive up to $4 in federal dollars for every $1 of state money they spend on the problem. States would need to show concrete proposals in one of the five areas to receive the money. The remaining $2.5 million would go toward the federal Substance Abuse Prevention and Treatment Block Grant program.
TRUMP: Trump has not proposed any specific spending.
STOPPING THE SUPPLY
CLINTON: Clinton's $10 billion plan does not include drug enforcement efforts aimed at stopping drugs from entering the U.S.
TRUMP: Trump's statements on the drug crisis focus on stopping the flow of drugs into the United States. He's said the wall he plans to build on the country's southern border, a key piece of his immigration plan, will keep drugs out. The Drug Enforcement Administration says 79 percent of the heroin it analyzed in 2014 came from Mexico.
Trump also has accused China of contributing to the problem, proposing to make it harder for Chinese dealers to ship deadly drugs into the United States. A Drug Enforcement Agency report released this summer says Chinese labs are mass-producing fentanyl and marketing it to North American drug trafficking groups.
Fentanyl is a synthetic drug that can be prescribed and used to treat pain. But illegal production of a more deadly version has been on the rise. Trump says the DEA should limit production of Schedule II opioid painkillers, like oxycodone and fentanyl.
Trump also is promising to end sanctuary cities that he says are harboring illegal immigrants that may be dealing drugs.
PREVENTION, TREATMENT AND RECOVERY
CLINTON: Clinton's plan is focused on boosting access to treatment and recovery programs. State efforts could include building more beds in hospitals and residential treatment facilities, training more health care providers and recovery coaches, subsidizing child care for people in treatment and enforcing parity laws that require insurance companies to cover substance abuse treatment.
Clinton also wants to promote greater use of medically assisted treatment, which can halt drug cravings and create adverse reactions to taking drugs. The Democrat would push for stricter prescribing laws and requiring states to use prescription drug monitoring systems to prevent doctor shopping. Developing an addiction to painkillers is a frequent path toward using heroin or other opioids.
Clinton would also boost evidence-based prevention programs in schools and make naloxone, the overdose reversal drug, more widely available. Some states have already made naloxone available over the counter so family members and friends of addicts can purchase it. She's also stressed a need to improve and integrate mental health and substance abuse care, as the two often occur together.
TRUMP: While campaigning in New Hampshire on Oct. 15, Trump for the first time outlined ideas for treatment and recovery. Like Clinton, he pledges to expand access to naloxone and make it easier for doctors to prescribe "abuse-deterring drugs." Trump says the Food and Drug Administration is too slow to approve medications that can stop cravings and that doctors face too many restrictions in prescribing them.
He's also proposing more incentives for states and local governments to establish drug courts, although he hasn't outlined a dollar figure.
CRIMINAL JUSTICE REFORM
CLINTON: Clinton says she will ask her attorney general to issue guidance telling states to prioritize treatment over incarceration for low-level offenders. She supports the drug court programs that many states have created. She says she'll also push states to consider alternatives to incarceration for low-level offenders, such as going through drug court programs that focus on treatment.
TRUMP: Trump has not offered any specific policy on low-level or non-violent drug offenders. He is pledging, however, to "aggressively prosecute traffickers of illegal drugs." In his Oct. 15 speech, he praised running mate Mike Pence for instituting stricter mandatory minimum sentences for drug offenses as governor of Indiana and suggested he'd pursue a similar policy federally.
EDITOR'S NOTE - One in an AP series examining the policy prescriptions offered by the major candidates for president.
By Kathleen Ronayne - AP/Oct. 24, 2016
Photo: Wall Street Journal
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Clinton and Trump's Positions on Drug Addiction Issues and Policies