As the 2024 elections grow closer, many Americans have drugs on the brain.
Some call for help with the growing wave of opioid addictions and overdoses in their communities. Others want to legalize marijuana, either for recreational use or as a medical treatment for chemotherapy side effects, anxiety, and other medical conditions. Still others have trouble affording their expensive prescription drugs.
Each of these drug policy issues could be a driving force at the polls in this year’s elections. Read on to learn about the history of drug policy in the United States, today’s biggest drug policy issues, and what the presidential candidates have to say on the matter.
Historical Context of Drug Policies
Throughout most of the history of the United States, drug policy has grown increasingly restrictive. However, state laws and public opinion are beginning to relax when it comes to some substances.
Major federal drug legislation did not begin in the United States until the 20th century. Individual states had begun to pass loose regulations in the latter half of the 19th century, mostly concerning drug labeling and requiring a doctor’s prescription for some medications.
Then the Smoking Opium Exclusion Act of 1909 banned the non-medical use, possession, and importation of opium. In 1914, the Harrison Narcotics Tax Act restricted the production, importation, and sale of opiates and cocaine.
The 18th Amendment to the U.S. Constitution banned the sale of alcohol in 1919. Alcohol prohibition was short-lived, and the 21st Amendment repealed it in 1933.
The War on Drugs
Rising drug use in the 1960s led to President Richard Nixon signing the Controlled Substances Act in 1970. This law regulates drugs under a “schedule” system, with Schedule I having the highest risk of abuse and no recognized medical use. Schedule V is considered to have the lowest abuse potential. Nixon then declared a “War on Drugs” in 1971 and created the Drug Enforcement Administration in 1973.
The War on Drugs expanded in the 1980s with the Reagan administration’s “Just Say No” campaign, which stressed the dangers of drug use. Mandatory sentencing laws made criminal penalties more severe and often disproportionately affected black Americans. The 21st century saw the start of sentencing reforms that relaxed some penalties and corrected inequalities.
Public opinion on drug issues has changed along with these laws. It seems to be shifting again in recent years – at least for some substances. Amidst a growing opioid crisis, a majority of Americans say drug addiction is a “very big problem.” However, attitudes toward marijuana are growing more relaxed.
Eighty-eight percent of U.S. adults say marijuana should be legal for medical or recreational use. A majority say it should be legal for recreational purposes, while about one-third support legalization for medical use only. Democrats are much more likely than Republicans to favor legalizing recreational marijuana. However, majorities within both parties say medical marijuana should be legal.
Key Drug Policy Issues
Four of the biggest drug policy issues today are the legalization of marijuana, high prescription drug prices, the opioid epidemic, and drug trafficking at the U.S.-Mexico border. Learn more below.
Marijuana Legalization
Marijuana – also called cannabis – remains illegal at the federal level, even as more and more states legalize it. A 2009 memo by the Obama Administration encouraged federal prosecutors not to prosecute people for cannabis distribution in states that have legalized it. The Trump administration rescinded that memorandum in 2018. Despite this, federal cannabis laws are still largely not enforced in legal states.
In 2022, President Joe Biden pardoned thousands of federal convictions for simple possession of marijuana. Many Americans remain in prison for marijuana possession.
This spring, Biden endorsed a recommendation by the U.S. Justice Department to loosen federal restrictions on marijuana. If finalized, this would move the substance from Schedule I to Schedule III. Rescheduling would allow for easier research and possible drug development. It would not legalize marijuana federally, but it could make legalization easier.
As of August 2024, 24 states have legalized cannabis for medical and adult recreational use. Another 14 now allow it for medical purposes. A handful of others have decriminalized it, which typically means that possession of a small amount does not carry a criminal penalty.
Two of the latest states to legalize recreational cannabis are Maryland and Ohio, where voters approved ballot measures last year. Lawmakers in two others, Delaware and Minnesota, passed bills in 2023 legalizing it. Kentucky enacted a law last year creating a medical cannabis program that will go into effect in 2025.
Prescription Drug Costs
Sixty-four percent of Americans say healthcare affordability is a “very big problem.” One key part of that problem is prescription drug prices. For example, the average price of insulin nearly tripled between 2002 and 2013. Prices again doubled between 2012 and 2016. Insulin and its analogs are necessary life-saving drugs for many people with diabetes.
This year, some drugmakers drastically decreased their list prices for insulin. This is largely driven by a provision of the 2021 American Rescue Plan Act that removed penalties for increasing drug prices faster than the rate of inflation. Still, the decrease may not be reflected in the out-of-pocket costs that patients pay, due to differences in insurance coverage.
The Opioid Crisis
The United States has faced an opioid crisis since the late 1990s, when doctors began prescribing these pain-relieving drugs more often. Overdoses related to commonly prescribed opioids steadily increased as patients became addicted. The federal government cracked down on the overprescription of these drugs starting in 2010. Some addicts turned to illegal narcotic drugs, and a wave of heroin overdose deaths followed.
Since 2013, deaths from fully synthetic opioids like fentanyl have skyrocketed. Some who overdose may not even be aware they have taken fentanyl. Illegal drug manufacturers and dealers are increasingly lacing other substances with fentanyl to make small amounts of drugs more potent. The upward trend in opioid overdose deaths began to level off around 2017 before surging again in 2020 during the COVID-19 pandemic. While growth has slowed, more than 81,000 deaths were recorded in 2022.
Opioids are highly addictive. Withdrawal symptoms for those who are addicted can be severe. This has led to an increased need for substance abuse treatment specifically for opioid users. Several states have responded to this need by increasing the budget allocation for drug treatment centers. Another popular state-level response to the opioid crisis is the creation of prescription monitoring programs that track the prescription of certain drugs. These programs are intended to prevent overprescription and drug abuse.
Drugs and the Southern Border
A related concern to the opioid crisis is drug trafficking at the U.S.-Mexico border. Most drugs that come into the United States at the southern border are smuggled at legal ports of entry. Marijuana seizures are common at illegal border crossings. Still, more dangerous drugs like cocaine, heroin, and fentanyl are commonly seized at ports of entry. People who are authorized to cross the border hide them in their vehicles or on their bodies. As the Southern Border has come into focus in the context of the 2024 presidential election, we expect discussions surrounding this issue to play out on the national stage.
Candidates’ Stances on Drug Policy
How will drug policy impact the 2024 elections? To help answer that question, we’ll look at each major candidate’s approach to drug policy.
Marijuana Legalization
Former President Donald Trump, the Republican nominee for President, has spoken in favor of medical marijuana. He has also said that marijuana laws should be handled at the state level. However, he made no moves as president toward formally allowing either medical use or state-level legalization.
Vice President Kamala Harris, the Democratic nominee for President, has changed her stance on marijuana over time. As a prosecutor in California, she was strict on cannabis offenses and opposed legalizing recreational use. Throughout her 2020 campaign for the presidency and still today, Harris has received harsh criticism for her actions as a prosecutor, viewed by many liberal Democrats as too harsh on non-dangerous offenses. Later, as a Senator, Harris introduced legislation to federally decriminalize and tax marijuana. As Vice President, she has called for reclassification of the drug, which is now underway. She has also spoken in favor of federal marijuana legalization.
Prescription Drug Costs
In 2020, the Trump administration created a voluntary, temporary program for some Medicare drug plans. Participating plans covered at least one insulin product of each dosage and type at a cost of $35 per month or less.
Through the Inflation Reduction Act, the Biden-Harris administration expanded this $35 out-of-pocket cap to apply to all Medicare drug plans and the insulin products they cover. It also capped Medicare patients’ costs for all drugs at $2,000 per year starting in 2024. Harris says she wants to extend these two caps to all Americans.
Using another provision of the IRA, the Biden-Harris administration has negotiated lower prices for ten of Medicare’s costliest drugs. The administration announced the new list prices this August, but they will not take effect until 2026.
The Opioid Crisis
As President, Trump signed the bipartisan SUPPORT for Patients and Communities Act. The Act was a package of legislation aimed at addressing the opioid crisis. It contained measures to remove barriers to medication-assisted treatment, especially for Medicaid recipients, and to make the overdose reversal drug naloxone more widely available. During his current campaign, Trump has taken a tough-on-crime stance. He has said that he wants drug dealers and smugglers to face the death penalty.
The Biden-Harris administration has improved access to drugs used for opioid addiction treatment and permanently required state Medicaid plans to cover medication-assisted treatment. Biden and Harris have advocated for harm reduction, and the administration has expanded grants to states and tribal communities to pay for naloxone.
Drugs and the Southern Border
Trump often blames illegal immigration for the country’s fentanyl problem. It’s worth noting that narcotic drugs are most often smuggled through legal crossings. He advocates for stronger border enforcement.
If elected, Harris says she will be tough on drug traffickers at the border and points to her experience prosecuting them as California’s attorney general.
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