As has been well-documented, the widespread prescription of opioids to treat pain and the subsequent diversion of said drugs for illicit uses created a sizable new population of users addicted to opioids.
Many of them turned to heroin, which became cheaper and more available, as the government cracked down on opioid prescribing.
The crisis has hit a number of states hard, including New Hampshire, Ohio, Pennsylvania, and West Virginia.
It has made the epidemic — among other issues related to substance abuse and addiction — a hot-button issue in this presidential election.
Curtailing heroin abuse
Heroin use in the US has grown exponentially in recent years. The UN's "World Drug Report 2016" estimated that the number of heroin users in the US reached about 1 million in 2014, almost three times as many as in 2003.
Trump’s plan to combat heroin use in the US is built around his plan to build a wall on the border with Mexico, which he blames as “the source” of America’s opioid problem.
The expansion of heroin use has coincided with a shift in the source of heroin — from primarily Southeast Asia in 1994 to almost completely Mexico and South America by 2012. Yet experts say the heroin crisis has been primarily fueled by the explosion in demand for opioids as a whole, caused primarily by widespread overprescribing of opioids by doctors.
In the few times Trump has talked about the issue — specifically in hard-hit states like New Hampshire and Ohio — he has said that he will "stop the inflow of opioids into the US." But he has failed to go into further details.
“We’re going to have borders again, and we’re going to work with you people to help you solve that very big problem,” Trump said during his primary-victory speech in New Hampshire in February, referring to plans to secure “the Southern border.”
Trump has not spoken about policies to reduce demand for opioids or other drugs in the US.
Fixing the overdose crisis
In 2014, deaths from drug overdoses reached a new high of 47,055, according to a January report from the US Centers for Disease Control and Prevention — more than the number of people killed in car crashes or from gun violence.
The overdoses haven’t slowed. Synthetic opioids — such as fentanyl and carfentanil, which are 50 and 5,000 times more powerful than heroin, respectively — have become increasingly popular since 2014. This summer saw a flood of overdoses — likely involving synthetic opioids — overtake Ohio, Indiana, West Virginia, and Kentucky.
While Trump has not addressed concerns over overdoses in his stated policies, he tweeted in August that “heroin overdoses are taking over our children and others in the MIDWEST. Coming in from our southern border. We need strong border & WALL!”
Trump hasn't addressed concerns over the skyrocketing price of naloxone.
Nearly 23 million Americans suffer from a substance-use disorder, while only about one-tenth of those addicted receive treatment, according to The Substance Abuse and Mental Health Services Administration (SAMHSA) 2013 National Survey on Drug Use and Health.
At a town hall in Columbus, Ohio, in August, Trump spoke at length about the drug-addiction issue. While he focused his remarks on the heroin issues and its ties to Mexico, he did touch upon the need for treatment, saying: “It’s very hard to get out of the addiction of heroin. We’re going to work with them, we’re going to spend the money, we’re going to get that habit broken.”
Trump has not said where or how that money would be spent in treatment, nor has he addressed issues related to prescribing, treatment in healthcare, or the treatment gap specifically.
Tthe 2016 Republican Party platform acknowledges the link between overprescription of drugs and the current opioid epidemic. It cites Republican-backed legislation that limits patients on certain Medicare plans to a single pharmacy and coming out in support of the Comprehensive Addiction and Recovery Act, which was signed by Obama in July. The platform also calls for CMS to ensure that physicians are not penalized for limiting opioid prescriptions.