In advance of the 2024 presidential election, The Chronicle is breaking down each candidate’s stance on priority issues, examining their platform and political history to keep voters in the Duke and Durham community informed. This week, we take a look at opioids:
The surge of deaths from substance abuse and the ongoing opioid epidemic has become a salient issue in the upcoming election.
The use of opioids spiked in the 1990s as a result of intense marketing of newly developed drug formulas. Though, at the same time that prescription opioid sales were growing exponentially, so were overdose deaths, creating a national epidemic that has since driven political discourse.
According to the Centers for Disease Control and Prevention, over 500,000 people in the U.S. have died from overdosing on opioids since 1999. In 2023 alone, the CDC estimates that opioid overdoses resulted in 81,083 deaths nationwide.
Former President Donald Trump and Vice President Kamala Harris have outlined plans to combat the substance use epidemic, but their approaches and track records on the issue differ.
Here’s what you need to know about opioids this election cycle.
The opioid epidemic in North Carolina
The nationwide opioid and substance use epidemic has deeply affected North Carolina. Over 36,000 North Carolinians died from drug overdose between 2000 and 2022, and unintentional opioid overdose deaths have more than doubled in the state in the last decade alone.
A 2017 poll conducted by Elon University found that nearly one in three North Carolinians have been personally affected by the opioid epidemic — whether it be a friend, family member or themselves. When asked if they believe their communities are equipped to combat the opioid crisis, 42.5% of respondents said no, 28.5% said yes and 28.2% were unsure. A plurality of respondents — 44.8% — felt they saw “too little” on the news about opioid use, while 38.9% thought coverage was “about right” and 10.6% thought there was “too much” coverage.
North Carolina is set to receive $1.5 billion over 18 years to combat the crisis as part of a $56 billion nationwide settlement between state pharmaceutical companies, distributors and state attorneys general — including N.C. Attorney General Josh Stein, who co-directed the settlement effort. Counties and municipalities will receive 85% of the money owed to the state, including $21 million for Durham County.
The Duke community has been directly affected by the opioid crisis, highlighted most recently by the fatal overdose of a first-year student at the University of North Carolina at Chapel Hill in 2023 in Kilgo Quad. The University has since installed emergency kits containing the opioid overdose reversal drug Narcan in residence halls on East and West Campus.
Kamala Harris
The Democratic nominee has a long history of working to combat the opioid crisis as a prosecutor, legislator and federal official.
As California's attorney general and a U.S. senator, Harris has supported efforts to regulate pharmaceutical companies and expand opioid addiction support in the health care system.
In September 2016, Harris sued pharmaceutical companies Indivior and MonoSolRX for antitrust violations involving Suboxone, an opioid addiction treatment. She charged the companies with illegally blocking competition to the drug, resulting in nearly $1 billion in “undeserved profits.” Per her 2020 campaign platform, Harris secured millions of dollars for California residents in such cases.
Harris also prosecuted drug traffickers who operated in California during her time as attorney general. In 2015, she directed the arrest of five traffickers and the seizure of over $2 million of methamphetamine, one year after she busted a narcotics ring based in the Central Valley.
As a senator, Harris supported multiple bills involving opioids. Notably, she was an original co-sponsor of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, which was signed into law in October 2020 and included a provision directing the Department of Veterans Affairs to study how opioids contributed to veteran mortality and suicide.
She co-sponsored several related bills that did not become law, including the Opioid Crisis Accountability Acts of 2018 and 2019, which were designed to take action against pharmaceutical companies that falsely advertised opioids as having no addiction-forming qualities; the Comprehensive Addiction Resources Emergency Act of 2019, which would have established programs and grants to address opioid addiction; and the Combating the Opioid Epidemic Act of 2018, which would have funded opioid research and public health efforts.
Harris also introduced the Accountability in Opioid Advertising Act in 2018, which would have directed the FDA to prioritize review of advertising for opioids and substance use disorder (SUD) treatments. The bill ultimately died in committee.
For her current presidential bid, the Democratic nominee is relying on the accomplishments of the Biden-Harris administration to bolster her record on opioids.
In his 2024 State of the Union address, President Joe Biden named the opioid and SUD epidemic as one of the primary pillars of his Unity Agenda — a policy plan that promotes “solving big challenges that unite all Americans.”
The administration presided over a drastic increase in fentanyl and cocaine seizures at the U.S.-Mexico border, forged agreements with foreign countries — including China and India — on anti-narcotic action, and invested $8 billion in the Department of Health and Human Services’ (HHS) Overdose Prevention Strategy.
In May, the HHS announced over $1.5 billion in additional funding for response measures to the opioid epidemic, supporting a broad spectrum of treatment and prevention options. Shortly after, the HHS announced the first decrease in annual overdose deaths in over five years. This was followed up by continuous and quicker-than-expected drops in monthly overdose deaths.
In 2023, Harris led a meeting with attorney generals from multiple states and the District of Columbia and representatives from federal offices to coordinate fentanyl trafficking and overdose care work.
Additional efforts by the administration have included expanding access to naloxone, the overdose reversal drug also referred to as Narcan, and investing comparably more in addressing the crisis than the Trump administration.
On Overdose Awareness Day this year, Harris promoted the administration’s work helping to reverse over 600,000 overdoses and investing over $160 billion “to stop the flow of illicit drugs and stop record amounts of fentanyl from crossing [the nation’s] borders.”
According to her 2024 platform, Harris promises to build on these successes and revive the bipartisan border security bill, which would combat fentanyl smuggling by investing in drug detection technology but failed in May.
Donald Trump
Opioids were a primary focus of Trump’s 2016 campaign and first presidential term, and addressing the crisis remains a central component of his agenda.
In 2017, at the height of the opioid epidemic, Trump declared the crisis a public health emergency. Over the next four years, his administration implemented multiple initiatives and committed billions of dollars to the fight against opioids.
Much of the administration’s work on the subject came as part of Trump’s Initiative to Stop Opioid Abuse, first announced in 2018. The three-pronged approach involved campaigning to reduce opioid overprescription and educate Americans about the dangers associated with the highly addictive class of drugs, reducing the supply of drugs by cracking down on international and domestic opioid trade and investing in “evidence-based treatment and recovery support services” for those struggling with addiction.
Trump signed the SUPPORT Act in October 2018, a sweeping piece of legislation that focused on cracking down on the fentanyl trade, increasing the range and accessibility of treatment options and implementing other measures to support families struggling with opioid abuse and addiction. The administration also expanded Medicare and Medicaid coverage to include opioid treatment programs.
While the administration touted reductions in opioid prescriptions and increases in treatment as a result of its efforts, reception and results were mixed.
While prescription opioid deaths slowed, fentanyl deaths dramatically increased, and coverage rollout was slower than expected. Additionally, the Office of National Drug Control Policy failed to collect and provide several metrics to assess if the administration’s strategies were working. The administration’s response was also criticized for failing to focus on other aspects of addiction beyond preventing deaths and for struggling to reach minority groups, who were less likely at the time to be prescribed naloxone.
The nation’s progress during 2018 was reversed the next year, as overdose deaths hit a record high and public officials became increasingly concerned about rising death rates due to the COVID-19 pandemic. The nonpartisan watchdog organization American Oversight concluded in 2020 that the administration’s policies were relatively ineffective in curbing the opioid epidemic.
Trump has spoken frequently about fentanyl and taking down cartels this election cycle, in contrast to his Democratic opponents’ comparatively limited focus on the issue in public messaging. Notably, he criticized the current administration’s approach during his June debate with Biden, stating that drug smuggling has significantly increased since he left office.
Trump’s campaign platform states he will push for the death penalty for drug traffickers. He also calls for further crackdowns on China to limit fentanyl imports and more support options for those struggling with addiction.
The official RNC platform ties the opioid crisis closely to immigration policy. The GOP calls for military mobilization to “secure” the U.S.-Mexico border and combat cartels by implementing a “full fentanyl blockade” — deploying the Navy to inspect ships in U.S. waters. The platform also calls for expelling “known or suspected … drug dealers” as part of a broader campaign against “illegal alien gang violence.”
Other candidates
Independent candidate Cornel West has proposed “War on Drugs Reform,” which would pivot away from punishment for drug-related offenses and instead promote “support and treatment” measures, though specific programs are not mentioned. West has previously blamed Biden for a 1990s bill that contributed to increased drug-crime-related incarcerations among Black Americans and has called on Harris to decriminalize MDMA, psilocybin mushrooms and ibogaine, in addition to marijuana.
Green Party nominee Jill Stein supports increased access to drug treatment, nationalization of the pharmaceutical industry and various legal measures to decriminalize drug possession and support drug offenders and abusers in their recovery.
Libertarian Party candidate Chase Oliver has promised to end the “failed War on Drugs,” push for drug decriminalization and reform “drug approval processes.”
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Ahilan Eraniyan is a Trinity sophomore and a staff reporter for the news department.