Americans are dying of fentanyl overdoses in record numbers, and the Republican presidential candidates are talking tough about their plans to respond.
Many of the plans are startling, even violent: Florida Gov. Ron DeSantis has pledged to “use lethal force” by sending troops to attack cartel operations in Mexico. Former President Donald Trump has called for convicted drug dealers to be sentenced to death. Biotech entrepreneur Vivek Ramaswamy, meanwhile, has suggested taking a different tack: Decriminalizing nearly all drugs, including ayahuasca and ketamine.
But for all the candidates’ big rhetoric about the war on drugs — either ending it or escalating it — few of their stump speeches make any mention at all of addiction treatment.
“In the environment we’re in now, treatment is much more of a touchy-feely argument,” said Jon McHenry, a pollster for North Star Opinion Research, a Republican-aligned polling firm. “As opposed to: ‘We need to put guns and bodies at the southern border to stop fentanyl coming in.’ It’s just more of an in-your-face, campaign, cable news-friendly way to talk about it.”
The GOP candidates’ emphasis on the fentanyl crisis highlights the issue’s continued importance to American voters across the political spectrum. Clearly, however, contenders for the Republican presidential nomination think they’re better served by focusing on drug interdiction as opposed to drug treatment.
Experts say their calculation may reflect a broader trend: That Americans haven’t forgotten about the opioid crisis and want to hear political candidates address it, but have grown cynical of grand plans to scale up the country’s fractured treatment system.
“People are saying: Nothing’s working, you’ve got to try something different,” said Regina LaBelle, a former Obama and Biden administration drug policy official and director of the O’Neill Institute’s Addiction and Drug Policy Initiative. “So it’s manifesting in some cases in people saying that we need to send the military in to control the cartels. It sounds tough and decisive, and it is appealing to people who are really desperate and struggling for answers. But it’s obviously very dangerous.”
Whether or not their militaristic stances on border control and drug dealer crackdowns will ever become reality, Republican candidates appear to have largely settled on a powerful message: That the Biden administration’s border policies have failed not only when it comes to immigration, but also when it comes to the drug crisis.
During the first Republican presidential primary debate last month, DeSantis told a story of a mother whose son died of a fentanyl overdose after taking a single pill. Separately, he advocated for sending troops into Mexico in an attempt to stop drug trafficking — effectively suggesting that the U.S. invade a sovereign ally.
“The president of the United States has got to use all available powers as commander in chief to protect our country and to protect the people,” he said at one point. “So when they’re coming across, yes, we’re going to use lethal force.”
Trump, who did not participate in the debate, has advocated for using the death penalty on convicted fentanyl dealers.
Sen. Tim Scott of South Carolina used a question on fentanyl to pledge that, if elected, he would finish constructing Trump’s long-promised wall along the U.S.-Mexico border. His work on Capitol Hill has reflected a similar enforcement-focused strategy: He introduced a bill in June targeting money-laundering operations that facilitate drug trafficking.
Other political figures, like Rep. Lauren Boebert (R-Colo.) and former Rep. Tim Ryan (D-Ohio), have suggested classifying fentanyl as a weapon of mass destruction.
Among the Republican candidates, only the upstart former biotech executive Vivek Ramaswamy has come close to touting treatment in his campaign platform.
“I’m not a war on drugs person,” Ramaswamy said during a campaign appearance in June. Instead, he touted decriminalization of most drugs, as well as allowing people to use some illicit substances as “off-ramps” from opioid addiction — for example, making psychedelics like ayahuasca more widely available in an attempt to reduce fentanyl overdoses.
Such “off-ramps” do exist — but as regulated, government-approved medications like methadone and buprenorphine, as opposed to psychedelics like ayahuasca, which are chemically unrelated to opioids.
Even Ramaswamy’s unorthodox approach to drug policy and addiction treatment represents the exception, not the rule. In general, other Republicans have done little to tout their records on addiction treatment — even if they supported treatment in other jobs.
Though the fentanyl crisis proliferated largely on Trump’s watch, his administration did make strides on addiction treatment. Under Trump, the Department of Health and Human Services largely backed the use of medications to treat opioid addiction, and in his final days in office moved to make it easier for doctors to prescribe buprenorphine. And when a commission Trump empaneled early in his presidency issued a special report including 53 recommendations on how to address the opioid crisis, increasing access to high-quality addiction treatment played a central role.
Key figures involved in his administration’s effort, like former Vice President Mike Pence, have also not made addiction treatment a focus on the campaign trail. Nor has former New Jersey Gov. Chris Christie, who served on Trump’s commission and was supportive of increasing access to treatment during his time in office.
As governor, DeSantis has also put money toward evidence-based addiction treatment — and proudly touted the results, though through press releases via the governor’s office, rarely as a candidate.
Clearly, however, none of those candidates thinks their record on treatment is an asset — or at least, something worth including in a stump speech or their attempt at a 30-second debate soundbite.
“Those issues play differently with different audiences,” said McHenry, the Republican pollster.“I think interdiction is a way in that the modern Republican Party has found that’s more palatable to primary voters than: Hey, your kids need to go to jail for using this stuff.”
Progress is being made, LaBelle acknowledged, especially when it comes to increasing access to highly effective medications used to treat opioid addiction, like methadone and buprenorphine. Other tactics, including harm reduction strategies like syringe exchange and the use of fentanyl test strips, have become more widely accepted, even in some Republican strongholds.
But advocating for doubling down on treatment and arguing that record opioid death rates are holding steady, instead of rapidly increasing, is hardly a compelling political platform.
“For people who’ve been affected, that doesn’t feed their desire to do something definitive or look action-oriented,” she said. “That’s where the political rhetoric comes in.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.