Jeb Bush Campaign Press Release - Drug Abuse: A National Epidemic

Our country is in the midst of a massive heroin epidemic, compounded by sharp increases in the abuse of prescription painkillers. Currently, this "opioid" abuse crisis is affecting some regions of the country more than others, but the problem is spreading, particularly in less populated areas of the country. Heroin use has doubled in just the last 10 years, and deaths related to heroin have nearly quadrupled to 8,257 last year. In 2014, more Americans died from drug overdoses than during any other year on record.

Huge increases in the availability of cheap, highly potent heroin, with Mexican drug cartels involved in the production, trafficking, and distribution of heroin and other illicit drugs is contributing significantly to this problem. The Mexican cartels have dramatically increased their production of heroin. Most heroin available in the United States is smuggled across the border by the Mexican cartels. A cousin of Joaquin "El Chapo" Guzman, the fugitive head of the Sinaloa cartel, was recently convicted in New Hampshire on federal drug trafficking charges. While the conviction was related to cocaine, it illustrates the reach of the Mexican cartels, which have distribution networks throughout the United States.

Beyond the Mexican cartels, abuse of prescription painkillers, such as hydrocodone and oxycodone, is a contributing cause of the epidemic of heroin and fentanyl abuse, and a major concern in its own right. A staggering four in 10 Americans know someone who has been addicted to prescription painkillers. In 2012, the Centers for Disease Control (CDC) found that more than two million Americans were abusing prescription opioid painkillers. Deaths in the United States due to prescription opioid painkillers have more than tripled over the last 15 years. Half of the young people addicted to heroin started with a prescription painkiller. Four out of five heroin users previously used a prescription painkiller for non-medical reasons. The epidemic affects both genders, persons of all races, all ages and all income levels.

While the heroin/prescription pain killer crisis is nationwide, New Hampshire is one of its epicenters. There were more than 300 drug overdose deaths in New Hampshire in 2014, with 99 of those deaths related to heroin (compared to 12 murders in the state). In one New Hampshire city, first responders treated individuals ranging from age 16 to age 69. The anguish and suffering for New Hampshire families is at an all-time high.

Background: Failing current efforts

In 2010, the Obama Administration articulated a strategy from the Office of the National Drug Control Policy (ONDCP) with seven goals for reducing illicit drug use. In a progress report this year, ONDCP noted that the federal government spends more than $26.3 billion on drug control programs annually. The Government Accountability Office (GAO), an independent government watchdog tracking progress towards these goals, recently testified before Congress that the Obama Administration had made progress toward just one of these goals over the last five years, while "none of the goals in the Strategy have been fully achieved." Meanwhile, prescription drug abuse and heroin-related deaths have skyrocketed. The Obama "strategy" has been a failure.

Of its total drug control program spending, the federal government invests nearly $12 billion a year on drug abuse prevention and treatment, but these efforts are divided among more than 76 programs in 15 different federal agencies. According to one study, at least 40 percent of these programs are not coordinating with other federal programs, leading to duplication and inefficiency in the fight against illicit drug abuse.

Of the $12 billion spent on prevention and treatment, Medicare/Medicaid and the Substance Abuse and Mental Health Services Administration (SAMHSA) invest the most. SAMHSA spends $2.2 billion out of its $3.4 billion total budget on substance abuse prevention and treatment. And despite all of this spending, 24 million Americans now use illicit drugs, an increase from 6.7 percent in 1990 to 9.2 percent in 2012.

Congress has focused on increased funding for current efforts to fight the epidemic. The omnibus spending bill recently passed by Congress includes more than $100 million in additional funding to fight the opioid epidemic. These funds will strengthen drug control efforts through the Drug Enforcement Agency, the CDC, substance abuse treatment programs and drug courts. While this funding is an important step, real change must include reforms to ensure we do not just add more money to reinforce the failure of the status quo.

Proposal: A comprehensive strategy

Some government leaders label the drug epidemic just a criminal justice issue, and some try to make it just a health care issue. Both approaches oversimplify this complex challenge. The demand for abused and illicit drugs must be addressed in tandem with arresting the supply of these drugs. Governor Jeb Bush believes we need a strategy that:

1. Prevents drug abuse and addiction before it begins;

2. Strengthens criminal justice;

3. Secures the border to stop the flow of illicit drugs; and

4. Improves drug abuse treatment and recovery programs.

Heroin and opiate-based pain pills are interrelated, and it is imperative to reduce both the demand and supply if treatment and recovery programs are going to work. Presidential leadership is essential if the country is going to dramatically reduce drug abuse. As Governor, Jeb Bush used a combination of strategies to help reduce heroin use in Florida by approximately 50 percent among youth. As President, Jeb Bush will re-elevate the Director of the Office of the National Drug Control Policy (ONDCP) to a cabinet-level job and empower the ONDCP Director to coordinate the multi-disciplinary components of a national drug control strategy. The Director will evaluate and streamline current efforts, coordinate activities across the federal government, collaborate with the states and measure progress toward clearly defined goals.

1. Prevent drug abuse and addiction

• Invest as children grow and develop: Drug abuse and addiction prevention efforts must start in early childhood and be reinforced throughout middle and high school. That starts with dedicated parents and strong communities. It should be emphasized through locally-driven education system strategies (and many states are already taking the lead to promote drug education in schools). And current federal efforts must be better coordinated, improved with evidence-based models, coordinated with states and — most importantly — closely monitored for results. Strategies should include public and social media approaches with positive role models highlighting the dangers of drug abuse and addiction.
• Engage local community and private sector leadership: Federal and state governments must play a critical role in preventing and fighting prescription drug abuse, including the use of public education campaigns. However, the government cannot solve it all; the private sector must also be committed to joining this fight to achieve success. Coalitions organized by local communities should involve health, local law enforcement and social services professionals to play key roles in developing solutions targeted to unique threats that differ across urban and rural areas. In addition, critical private sector efforts include better training of health care practitioners, including physicians, nurses and dentists, and a review of current clinical guidelines for opioid prescribing. Americans make up approximately five percent of the world's population, but consume about 80 percent of the world's opioid supply. Organized medical associations, such as the American Medical Association, must engage so clinicians are properly trained to manage pain without overprescribing.
• Encourage Abuse Deterrent Formulations (ADF opioids) of prescription painkillers: Innovative pharmaceutical companies have invested in and developed opioid-based medications that reduce the risk of addiction and deter abuse (though may not fully prevent it). For example, an ADF may limit the drug's release if the pill is inappropriately cut, chewed or ground. As President, Jeb Bush will continue to encourage these innovations through the Food and Drug Administration (FDA) approval process. In addition, his FDA will reduce generic opioids on the market that lack the abuse deterrence technology when an innovative company develops a formulation of the same drug with ADF. While ADF opioids are not a silver bullet, they can play an important role in a comprehensive strategy.

2. Strengthen criminal justice

14. Support law enforcement efforts: More than $14.8 billion in federal resources support federal, state and local law enforcement in the fight against drug trafficking and use. However, the percentage of federal drug control resources invested in supply reduction through law enforcement has dropped by six percent since 2007, while the supply of heroin from Mexico has substantially increased. Specific spending levels should be determined each year with law enforcement officials, but President Jeb Bush will ensure federal law enforcement agencies have the resources to target illicit drug pipelines and supply chains.
15. Coordinate the High Intensity Drug Trafficking Area (HIDTA) Investigative Support Centers: The HIDTA program is a federally-funded effort coordinating federal, state, and local law enforcement agencies conducting drug-trafficking investigations. GAO has reviewed current efforts and found that they are not well-coordinated, leading to duplication, overlap of responsibilities and lack of focus. For example, different HIDTA partners write the same intelligence reports and investigate the same links between criminal organizations. As President, Jeb Bush will require all federal agencies involved in HIDTAs (including the Department of Justice, the Department of Homeland Security and ONDCP) to develop a process to coordinate efforts across agents in the field, monitor their progress towards drug control and evaluate results. This will reduce duplication of efforts across involved agencies and conserve staff and budgetary resources.
16. Identify and shut down "pill mills": Pain clinics are health care facilities focusing on the management of chronic pain through a suite of legitimate medical treatments (both prescription and over-the-counter). Unfortunately, some of these clinics (often referred to as "pill mills"), motivated solely by financial interests, are enablers of prescription drug abuse and addiction. In contrast to legitimate pain clinics, pill mills typically fail to maintain medical records, accept only cash payments and fail to screen for substance abuse issues. President Jeb Bush will support policies distinguishing pill mills from legitimate pain clinics and provide technical support to states in their role of exercising effective oversight of pain clinics. Florida Attorney General Pam Bondi's work serves as a model on this issue. Florida was an epicenter of pill mills in 2010, but today the number of registered pain management clinics in the state has been reduced by approximately 60 percent. Her successful strategies include stronger state regulation of pain management practices, better oversight of physician dispensing habits, and a statewide Prescription Drug Monitoring Program (PDMP).
17. Enact smarter federal sentencing laws: Drug dealing is harmful to society and should be punished, but current federal drug sentencing laws are antiquated and often counterproductive. Prison time served by drug offenders has increased and nearly 50 percent of federal inmates are serving drug-related sentences, but — at the same time — illegal drug use has also increased. There should be stiff consequences for drug lords, cartels and drug traffickers, while ensuring nonviolent drug offenders obtain the necessary treatment and more quickly return to their communities without serving excessive mandatory minimum sentences. This approach, whose champions include Senators Mike Lee (R-UT) and Dick Durbin (D-IL), will result in fairer drug abuse sentencing and will generate billions of dollars in savings (from reduced burden on federal prisons) to invest in drug prevention, treatment and recovery programs.
18. Strengthen and expand access to drug courts: Drug courts provide an alternative to the traditional justice system so that nonviolent drug offenders are screened for risk, and then given the option to obtain treatment and recover under close court monitoring and supervision for at least a year. This restorative solution model involves multi-disciplinary coordination, including participation from the judiciary, the prosecution, mental health specialists, social services and treatment professionals. According to the GAO, drug courts result in a 26 percent lower rate of recidivism. Florida led the nation in creating drug courts; and as Governor of Florida, Jeb Bush tripled the number of drug courts in the state. As President, Jeb Bush will ensure this critical program is adequately funded to broaden access in every state.

3. Secure the border to stop the flow of illicit drugs into the United States

1. Secure the border: In August, Governor Jeb Bush offered a border security plan with six concrete steps to strengthen border security. These will make a critical difference in interdicting the flow of illicit drugs into the United States, given that most heroin enters the United States from Mexico. The plan includes a forward-leaning Border Patrol with the flexibility to deploy resources to meet threats, using new technologies to achieve continuous surveillance of the border, bolstering border infrastructure, withholding federal law enforcement funds for cities undermining federal immigration laws and making sure we detain and deport illegal immigrants who are serious criminals. The full plan can be found here.
2. Work with partner nations to address the source of illicit drugs: While the current ONDCP Strategy makes vague references to drug control efforts of major drug source and transit countries, there are few measurable action items to address it. Under President Jeb Bush, the United States will take an active role in training partner countries' law enforcement officials to interdict illicit drugs and press the issue in high-level diplomatic conversations. These efforts should be targeted at countries with high rates of poppy cultivation and heroin production, such as Mexico, Colombia and Afghanistan. For example, President Jeb Bush will assist the Mexican government in dismantling and destroying the major drug trafficking organizations based in Mexico.

4. Strengthen drug abuse treatment and recovery

Because prescription painkiller abuse is closely related to heroin use, treatment and recovery efforts should address both epidemics.

1. Strengthen Prescription Drug Monitoring Programs (PDMPs): States run PDMPs to monitor and analyze electronic prescribing and dispensing data. They help identify inappropriate prescribing, abuse of controlled substances and patients who visit multiple doctors to abuse painkillers. However, these programs are not linked across states, and a drug abuser can drive across the border from Massachusetts to New Hampshire to obtain a new supply of prescription painkillers from a physician unaware of the patient's addiction. Under President Jeb Bush, these state databases will connect across state lines. Governor Jeb Bush has also promoted allowing electronic health care records to be shared among physicians and hospital systems (to make them "interoperable"): The full plan can be found here.
2. Promote innovation for a suite of treatment and recovery tools: Buprenorphene and methadone can help wean an individual from addiction to painkillers; naltrexone can block effectiveness of painkillers for abusers; and medical professionals and first responders need naloxone to save lives in emergencies by reversing the effects of severe overdoses. These are important tools in the fight against drug abuse and addiction, but more are needed. As President, Jeb Bush will promote innovation to fight against prescription drug abuse and heroin use. Governor Jeb Bush released his plan to promote innovation broadly through the FDA in October.
3. Increase accountability for existing federal prevention, treatment and recovery resources: SAMHSA, whose mission is to advance the behavioral health of the nation, currently invests over 60 percent of its budget on prevention and treatment. However, GAO has evaluated SAMHSA's stewardship of federal dollars, particularly on mental health programs, and found poor oversight of current programs and limited coordination of efforts across the federal government. President Jeb Bush will conduct a rigorous evaluation and overhaul of existing programs to ensure funding supports evidence-based programs for states and to consistently measure and monitor results. Funding should support proven models, including community-based programs with peer counseling and recovery communities that provide ongoing support to individuals and families. In addition, he will review and streamline current programs across the federal government to reduce duplication of efforts and maximize impact.

Conclusion

Drug abuse and addiction hurts Americans from all walks of life. It is a complex problem that requires a multi-disciplinary, multi-faceted solution. Existing federal efforts must be better coordinated, streamlined and monitored for results. This will take real leadership that makes solving the problem a top priority. We know how to make a difference in this fight, and with the right leadership and solutions, we will.