The Opioid Abuse Crisis Is A Rare Area Of Bipartisan Consensus

The U.S. is experiencing political polarization over many issues, including health. There are few examples where Democrats and Republicans in Congress, as well as those among the public who identify with the two parties, agree on a set of policies. One of these exceptions involves policies to address the opioid abuse crisis facing the country today.

Public opinion polls conducted in 2015 and 2016 examine this unusual bipartisan consensus. The two obvious questions are (1) why is such a consensus possible in an otherwise highly polarized political climate? And (2) what are the areas of bipartisan consensus on policies to address the opioid abuse problem?

Why is bipartisan consensus possible?

Public opinion polls point to three reasons why a bipartisan consensus is possible. First, a large proportion of both Democrats and Republicans know someone who has recently abused prescription painkillers. Second, Democrats and Republicans are about equally likely to consider the problem of prescription painkiller abuse to be serious in the state where they live. Third, the distribution of those who know someone who has abused prescription painkillers and who see abuse as a serious problem cuts across demographic divisions in a way that affects people in both parties.

For many Americans, the problem of prescription painkiller abuse has recently touched their lives. Just over two in five (41 percent) Americans said in 2016 that they personally know someone who has abused prescription painkillers in the past five years. Democrats (46 percent) and Republicans (44 percent) share this experience in almost equal proportion (Exhibit 1).

In addition, Americans report high levels of concern when it comes to the seriousness of prescription painkiller abuse in the state where they live. In 2016, more than half (51 percent) of Americans said abuse of strong prescription painkillers such as Percocet, OxyContin, and Vicodin was a serious problem in their state. About the same proportion (52 percent) of Americans said they believe heroin abuse is a serious problem in the state where they live. Democrats and Republicans are about equally likely to see each of these problems as serious.

Many Americans also worry about the addictiveness of strong prescription painkillers. More than three fourths of Americans in 2016 (78 percent)—including large majorities of both Democrats (81 percent) and Republicans (66 percent)—believed it was very or somewhat likely that a person taking a strong prescription painkiller will become addicted to it.

It is also important to note that the experience of knowing someone who has abused prescription painkillers and the perceived seriousness of the abuse problem in their own state cuts across several of the demographic differences that tend to make up the base of the two parties.

For instance, U.S. adults from both low-income (<$25,000 per year) and high-income ($75,000+) households are about equally likely to know someone who has abused prescription painkillers (40 percent vs. 46 percent) and to believe prescription painkiller abuse is a serious problem in their state (53 percent vs. 54 percent).

There are no significant differences in experience or level of perceived seriousness between regions of the country. In addition, those living in rural areas are about equally as likely as those in urban areas to believe prescription painkiller abuse is a serious problem (56 percent vs. 49 percent). Rural Americans are more likely than urban dwellers to have known someone who has abused (45 percent to 34 percent).

What are the areas of bipartisan consensus?

What should be done with people who abuse opioids?

The two parties often differ on criminal justice issues, but in the case of treatment versus incarceration for those who abuse opioids, majorities of both Democrats and Republicans favor treatment. In order to gauge public opinion on the trade-off between treatment and incarceration for those found possessing controlled substances, a 2016 poll asked the public whether people found possessing small amounts of one of three controlled substances—heroin, prescription painkillers obtained without a prescription, or crack cocaine—should serve jail time or be placed in a treatment program without jail time.

Few respondents favored incarceration. Less than one in 10 (8 percent) felt that adults caught with prescription painkillers obtained without a prescription deserve to go to jail, while one in seven (15 percent) favored imprisonment for those caught with heroin.

Even though tens of thousands of people in the U.S. remain incarcerated for non-violent drug possession offenses—distinct from drug trafficking and possession with intent to sell—nearly three in four (74 percent) adults in the U.S. favor treatment without any jail time for users of even the most widely disapproved drug, crack cocaine.

Large majorities of both Democrats (92 percent) and Republicans (81 percent) think that people caught possessing small amounts of either prescription painkillers obtained without a prescription should be placed in a treatment program without jail time. Similarly, large majorities of both Democrats (88 percent) and Republicans (74 percent) think that people caught possessing small amounts of heroin should be placed in a treatment program without jail time.

Who should finance opioid addiction treatment programs?

Given high levels of support for treatment, an important question is who Americans think should pay for such programs. In 2015, Massachusetts began requiring that all insurance policies and plans offered in the state to provide coverage for medically necessary inpatient acute treatment and clinical stabilization services as a way to reduce barriers to treatment for those addicted to opioids and other drugs.

Adults nationally were asked that year how they felt about state governments requiring private insurers to cover treatment services for opioid addiction. Respondents were informed that many health insurance plans provide only limited coverage for drug treatment programs for people addicted to prescription painkillers or heroin. At the same time, they were told that requiring private health insurers to provide more extensive coverage for these treatment programs might add to the cost of health insurance premiums for insured people. Results indicated an almost equal divide between those who favor (48 percent) and those who oppose (46 percent) policies that would require private health insurers to provide better coverage for treatment programs.

This is one important opioid-related policy area where Democrats and Republicans disagree. A majority of Democrats (55 percent) favor state governments requiring private insurers to cover treatment services, compared with only 39 percent of Republicans.

In 2016 Americans were asked how they felt about the amount of money the government was spending on treatment programs for people addicted to prescription painkillers. The largest group of respondents (41 percent) said government spending is too low, while 28 percent considered it to be about right. Only one in seven (14 percent) believed government spending on opioid addiction treatment programs is too high. A plurality of both Democrats (45 percent) and Republicans (37 percent) consider government spending on treatment programs for people addicted to prescription painkillers to be too low.

Who is mainly responsible for the problem of opioid abuse?

Americans divide primary responsibility for the growing problem of prescription painkiller abuse almost equally between users and physicians. In 2016 the public was asked who they believe is mainly responsible for the growing problem of prescription painkiller abuse — people who take prescription painkillers, doctors who inappropriately prescribe them, pharmaceutical companies that sell them, or the U.S. Food and Drug Administration (FDA), which approves these drugs before they can be sold.

Nearly two in five (37 percent) said users are mainly responsible, while a similar number (34 percent) said physicians were primarily accountable. Relatively few (10 percent and 7 percent, respectively) believed pharmaceutical companies or the FDA bore primary responsibility.

Both Democrats and Republicans cited users of prescription painkillers and doctors as the two groups mainly responsible for the problem of abuse, although in a different order, well ahead of both pharmaceutical companies and the FDA. Republicans (49 percent) are most likely (and more likely than Democrats, 32 percent) to blame doctors who inappropriately prescribe painkillers. The two parties—36 percent of Democrats and 37 percent of Republicans—are about equally likely to blame users themselves.

How do Americans feel about new prescribing guidelines for opioids?

The 2016 poll asked about two proposed measures for curbing opioid prescribing. When asked about guidelines that recommend physicians prescribe no more than a three-day supply of strong prescription painkillers for acute pain, except in the case of trauma or surgery—a strategy proposed by Massachusetts Governor Charlie Baker in October 2015—more than two-thirds (69 percent) of adults said they agreed with this proposal. Majorities of Democrats (68 percent) and Republicans (64 percent) agreed.

When asked about guidelines that recommend physicians attempt alternative measures such as physical therapy and non-narcotic painkillers before prescribing opioids—a recommendation from the Centers for Disease Control and Prevention (CDC)—nearly three-quarters (73 percent) of adults said they agreed. Large majorities of both Democrats (73 percent) and Republicans (69 percent) agreed with this proposal.

It is important to note, however, that when pressed about the potential implications of these guidelines, some respondents expressed concern that these policies could be too restrictive. More than half (55 percent) said they were very or somewhat concerned that new guidelines will make it too difficult for people who need prescription painkillers for medical reasons to get them. Democrats (57 percent) and Republicans (53 percent) shared this concern in about equal proportion.

Finding Common Ground

Our review of polling data suggests that the problem of opioid abuse is one of few bipartisan issues in the U.S. today. Widespread personal contact with those who misuse prescription painkillers may explain why this issue transcends typical political boundaries. More than two in five adults say they know someone who has recently abused prescription painkillers and a majority of Americans say heroin and prescription painkiller abuse are serious problems in the state in which they live.

Results from public opinion polls in 2015 and 2016 indicate a clear path of consensus for moving forward, as Democrats and Republicans agree that treatment should come before incarceration for people caught in possession of, but not selling, small amounts of prescription painkillers obtained without a prescription or heroin; and that careful prescribing guidelines should be promoted to curb excessive opioid use without impinging on the medical needs of patients.

In addition, a plurality of both Democrats and Republicans believe government funding for opioid addiction treatment programs is currently too low. The only politically salient topic on which Democrats and Republicans disagree concerns whether or not state governments should require private insurers to cover addiction treatment services—a policy adopted by only the State of Massachusetts, thus far—even if this means increased insurance premiums.

This unprecedented level of agreement indicates low levels of political risk for elected officials on both sides of the aisle who seek to enact policy solutions in response to the problem of opioid abuse. Given high levels of concern across the nation, our results indicate a political environment ripe for bipartisan policy cooperation in Congress.

Exhibit 1. Public perceptions of opioid abuse and opinions on related policies, by party identification (in percent)

Experience With And Perceived Seriousness Of The Problem

Areas Of Agreement

Area Of Disagreement

^a = Statistically higher proportion than self-identified Democrats, p < 0.05.

^b = Statistically higher proportion than self-identified Republicans, p < 0.05.

Source: Stat/Harvard T.H. Chan School of Public Health poll, 2016, except * = Boston Globe/Harvard T.H. Chan School of Public Health poll, 2015.