Democratic presidential hopefuls stand on stage ahead of the third Democratic primary debate of the 2020 presidential campaign season. | Frederic J. Brown/AFP/Getty Images

The opioid epidemic didn’t get a single mention at Thursday night’s debate.

On Thursday night, the top 10 Democrats running for president gathered for the third round of debate. None of them brought up one of America’s biggest public health crises: the opioid epidemic.

This was a continuation of what happened in the previous debates, where the candidates and moderators also neglected the opioid crisis — only mentioning it in asides as a vehicle to make a broader point rather than an issue in its own right. In those past debates, Joe Biden and Beto O’Rourke brought up opioids to criticize the health care industry. Cory Booker brought them up to blast incarcerating people who use drugs. Andrew Yang did so to vaguely talk about how the economy is sending people into despair. No one explained how they plan to fight the crisis head-on.

That didn’t change on Thursday, with no mention of the opioid crisis or drug overdoses throughout the night.

That’s not because the crisis is over. In 2017, America hit a new record for annual drug overdose deaths at 70,000 — a figure so high it contributed to the third year in a row of declining or stagnating life expectancy. Some preliminary data suggest that 2018 was a tiny bit better, with a 5 percent decline in drug overdose deaths. But that would still make 2018 the second-worst year of all time for drug overdose deaths. And even in 2018, deaths linked to synthetic opioids like fentanyl were still on their way up (while prescription opioid deaths declined just enough to make up for it); if that trend holds, 2019 could very well be worse.

It’s also not because the crisis is politically irrelevant. New Hampshire will be one of the first states to pick a candidate in the Democratic primary — and it’s also been one of the hardest hit by the crisis. Ohio and Pennsylvania, two swing states in the general election, are also among the hardest hit. An analysis by historian Kathleen Frydl even found that the Ohio and Pennsylvania counties that flipped from Barack Obama to Donald Trump in the 2016 presidential election were hit particularly hard by opioid overdose deaths.

And it’s not because President Donald Trump has owned the issue. Although Trump gave some lip service to the crisis on the 2016 campaign trail, his administration’s response has been generally weak. He’s committed only a few billion dollars here and there in additional funding, which is far from the tens of billions experts say is needed. And the bulk of his focus has been on policy proposals — like executing drug traffickers or building a wall — that most experts say would do nothing to combat the epidemic. This should be another issue to hit Trump on.

What makes the neglect of this issue on the debate stage even more frustrating is many of the Democrats actually have plans. Elizabeth Warren has a comprehensive proposal to put $100 billion over 10 years toward addiction treatment and harm reduction services, which multiple other candidates have actually endorsed. Pete Buttigieg put out his own in-depth plan for addressing mental health and addiction, which includes a $100 billion investment in both over 10 years. So did Amy Klobuchar. (Even off the stage, John Delaney, who didn’t qualify for the debate on Thursday, has a plan, although it would only boost funding in the billions instead of the tens of billions.)

But you haven’t heard about any of that on the debate stage.

Stigma drives apathy toward the opioid epidemic

So why hasn’t the opioid epidemic come up at the debates?

Some of this is on the moderators, who didn’t ask about solutions to the opioid crisis. But the candidates had lengthy opening and closing statements this week that could have raised the issues. And the candidates had no problem changing the topic whenever they wanted to throughout the nights.

The structure of the debates probably didn’t help either. In each debate, 10 candidates had two or three hours to run through a wide array of issues, from health care to gun violence to foreign policy. They had as little as 10 or 15 seconds to explain themselves on each issue. So some things just got left out.

But I worry that the real problem is one that has plagued solutions to the opioid crisis for so long: stigma.

When I went to Vermont a couple of years ago to check out how the state was scaling up its addiction treatment system, I planned to ask the people involved about the challenges. I expected the common answer to be money — building up treatment takes resources, and policymakers had to dig up those funds. To my surprise, the people involved told me that the much bigger problem was stigma: A lot of policymakers, and much of the public, just didn’t want to spend money helping “those people.”

I’ve seen this in response to my own reporting on the opioid crisis, through emails describing overdose deaths as “survival of the fittest” and that people who use drugs should “pay the price of their criminal choices and criminal actions.”

It’s this type of attitude, experts have told me, that helps explain why so little has been done at the federal level about the opioid epidemic.

Some of the people running for president acknowledge this. When I asked Warren why her colleagues in Congress haven’t done more about the issue, she simply cited “stigma.”

On the Democratic debate stage these past few months, I worry we saw that stigma-driven apathy in action. And so the opioid epidemic hasn’t gotten the attention it deserves.

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This article was originally published at Vox.com