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At the third Democratic debate on Saturday, all three presidential candidates called for smarter prescribing of painkillers as a way to combat a growing opioid and heroin epidemic in the United States.

Senator Bernie Sanders of Vermont said prescribers and drug companies “have to start getting their act together.” Hillary Clinton said “there are too many opioids being prescribed,” which pushes people to heroin. And Martin O’Malley, the former governor of Maryland, said simply, “We need to rein in overprescribing.”

The question about how to address the opioid crisis came the day after the Centers for Disease Control and Prevention published data showing a record number of people died from heroin and opioid overdoses last year. The scourge has hit states such as Massachusetts and Vermont particularly hard.


The candidates, who were debating at Saint Anselm College in Manchester, N.H., all called for expanded treatment options at a time when drug-treatment facilities are overstretched.

Sanders insisted that addiction should be treated as a disease, “not a criminal activity,” and that people seeking help shouldn’t have to wait months for an appointment. Clinton said that all law enforcement officers should carry naloxone, which can reverse the effects of an overdose. She also laid out plans for the federal government to offer $10 billion over 10 years to work with states to come up with plans to fight the epidemic.


The other health care topic at the debate Saturday night was the Affordable Care Act, one of President Barack Obama’s signature achievements. A question to Clinton noted that the law had extended coverage to millions of Americans, but that health care costs and deductibles had continued to outpace what many people could afford.

Clinton said she wanted to “build on the successes” of the law, including helping people with preexisting conditions find coverage plans and allowing children to stay on their parents’ plans until they are 26 years old. But she said it also had some “glitches” that needed to be fixed without specifying which aspects of the law she wanted to improve.

Instead, she reiterated her plan to give tax credits to help people afford out-of-pocket health care costs and enable Medicare to negotiate drug prices. She also called for more competition among insurance companies, even though some have started to pull back from the exchanges established by the Affordable Care Act.

“Out-of-pocket costs have gone up too much, and prescription drug costs have gone through the roof,” Clinton said.

Sanders, meanwhile, continued to call for a single-payer system, noting the United States spends more per capita on health care than countries like France and the United Kingdom. He also accused insurance companies and the drug industry of “bribing” the government to sustain the health care system as it is built now.

“Bottom line — this ties into campaign finance reform,” Sanders said.

But Sanders twice dodged questions about how much more people would have to pay in taxes to cover a single-payer system. He only said that with a single-payer system, people would no longer have to contribute to their private plans through their employers.

That, Clinton said, didn’t add up.

“My analysis is that you are going to have to get more taxes from middle-class families,” she said.