The impact of opioid abuse on Alabama isn't exactly a wedge issue in the state's current election cycle.

The state's Republican governor and attorney general, and their Democratic challengers, all rank opioid abuse and its various social and economic costs as one of the major challenges facing the state. And while this hasn't historically always been the case with drug issues, there seems to be agreement this time that compassion and treatment are as important to progress as enforcement and punishment.

But still there are differences among the candidates about what more can be done.

When AL.com readers recently voted on which election issues are important to them, opioids ranked fifth among 18 issues - ahead of such issues as K-12 education, the economy, and crime and public safety. The poll garnered more than 9,500 total votes.

The baseline for Alabama's response to opioid abuse is the State of Alabama Opioid Action Plan, developed by the state's Opioid Overdose & Addiction Council.

Republican Gov. Kay Ivey's campaign website lists the creation of the council as one of her top accomplishments.

"The opioid epidemic is ravaging Alabama families, and while it isn't a political issue, I am doing everything in my power to stop it," Ivey said in response to an AL.com inquiry. "I've already signed into law several meaningful reforms proposed by the Council. I'm encouraged by the progress we're making, but our work is far from over."

The Action Plan was designed to "stabilize the issue in the short term while offering important long-term strategies." It lays out four main goals -- prevention, intervention, treatment and community response -- and for each of them lists strategies, some of which have multiple objectives. Some require legislative action and/or additional funding; some do not. At least one measure, to toughen penalties for possession, distribution and trafficking of Fentanyl, was passed.

When the plan was unveiled in January, Ivey released a statement saying that "We must find a solution to the opioid crisis in our state, as this epidemic is literally tearing families apart. I look forward to working with the Council and the Legislature to consider these recommendations and to make meaningful reforms which will help us address this problem once and for all."

Her challenger has called for more.

Walt Maddox, the Democrat running against Ivey, has said that if elected he would create a cabinet-level position for an official to oversee substance abuse issues and also would expand Medicaid through an executive order on "day one."

At his website, Maddox says that the Medicaid expansion "will increase the availability of and access to treatment and counseling that we so desperately need." The cabinet-level position, meanwhile, will "separate substance abuse out from under the Department of Mental Health, and facilitate a balance between treatment and historically disproportionate punishment.

"The opioid epidemic is also a time for society to look inward and reflect on how our past reaction to problems, like the crack cocaine scourge of two or three decades ago that disproportionately affected African American communities, was to enhance law enforcement and criminal penalties," Maddox said on the site.

"The 'war on drugs' was never an effective strategy to treat substance abuse. Today we see a more compassionate, treatment-based approach to fighting opioids, which are devastating white and black communities alike. It's terrible that it takes a growing tragedy in white communities to help us see the truth of what's been happening in all our communities for many years, but the fact is that substance abuse has always been first and foremost a public health problem that cannot be solved by the criminal justice system alone. We've not always treated it that way, and that must change."

Attorney General

One proponent of the state's opioid action plan is Attorney General Steve Marshall.

Marshall has been tackling the issue of opioid abuse through the courts, where an Alabama lawsuit against opioid manufacturers has been chosen as a test case among states that are suing. More than 30 other states back Alabama's position.

The outcome of Alabama's case could lead to a national settlement on costs associated with the opioid epidemic.

"I think the court recognized that Alabama is in a unique position," Marshall said of the judge's decision to make the state's suit a test case. The state's sky-high prescription rates show that it's among the hardest hit, he said.

When the attorney general's office filed its lawsuit against several manufacturers in February, the office stated Alabama ranks first in the nation for the number of painkiller prescriptions per capita, resulting in almost 30,000 residents over age 17 becoming dependent upon heroin and prescription painkillers. Opioid painkillers and heroin are blamed for an 82 percent rise in overdose deaths2006 to 2014 in Alabama, according to the attorney general's office.

Marshall stressed in an August interview that the lawsuit "is not the opioid strategy for Alabama." That's the Opioid Action Plan, he said.

Marshall also has held "Faith Forums" across the state to promote church-based activism against violent crime and opioid abuse. At one such event in Mobile, Marshall said "There's no difference between my mission and the church's mission" on such topics, because both promote justice and want to improve the general wellbeing of society.

In September, Marshall visited Mobile for the opening of a new addiction treatment center. Referring to opioids' role in his wife's death, Marshall said "this is a personal issue for me going forward and will continue to be a personal issue for me as attorney general."

"Badges and guns matter in this issue," Marshall said. "But for us to make tremendous strides going forward, we've got to deal with those individuals right now who are suffering from these addictions to be able to get help."

Joe Siegelman, the Democratic candidate for Attorney General, likewise has singled out opioids as a major issue facing the state. "It's hard not to put opioids at the immediate front of my list," he said.

Siegelman wasn't critical of the state's action plan, but said the state needs leaders who will "execute it with the urgency it demands." He questioned why Marshall waited until early this year to file suit against opioid manufacturers, waiting until after numerous other states had done so, despite warning signs such as Alabama's persistently high per-capita prescription rate. ("I look forward if elected to fully prosecuting this lawsuit," he said.)

Siegelman said he doesn't see any silver bullet. He said that after studying courts in Alabama as well as other states' responses, he generally believes that diversion efforts -- such as drug courts that steer defendants to treatment rather than funneling them into prison -- need to be more robust. And efforts to crack down on an oversupply of drugs shouldn't prevent the people who really need them from getting them.

"We've got to see this is a public health crisis as well as a criminal one," he said.

He wasn't opposed to Maddox's Medicaid expansion view, he said. "Anywhere we can find additional resources to tackle this issue, I'm in favor," he said. He added that because the costs of addiction are so vast, both in social terms and in the burden on the criminal justice system, money spend on solutions likely will result in savings elsewhere.

One example: In July, the Alabama Department of Human Resources reported that it was dealing with a rising tide of children taken into custody due to parental addiction. The exact extent to which opioid use was a factor wasn't entirely clear, but experts on the issue say many people who develop an addiction to prescription painkillers then resort to heroin and other street drugs.

Taking time

Marshall said it was hard to give a percentage, as to how far along the state was to full implementation of its action plan. There have been some straightforward accomplishments such as the law on Fentanyl, he said, but other areas are more complex, such as considering how the opioid issue affects veterans. "We probably have implemented 5 of the 20-plus recommendations," he said. "But yet, I think the ones that we've worked on were the five priorities that we felt like were going to meet the most immediate need. It may not be the most visible."

The council that drafted the plan found that state leaders needed more information before they could truly understand the problems, let alone fix them. "Part of our problem has been that we don't have very good data in Alabama, or at least we don't aggregate data in a way that we can study it and analyze it and know not only how we got to where we are, but also where we're going as far as making progress an implementation of the report," he said. Correcting that situation may not be very visible, he said, but it's important.

"What I would simply tell you is that Alabama is a lot better off today than we were a year ago," Marshall said, "that we have made tremendous strides in terms of being able to have a direct, specific plan going forward and we're continuing to work that implementation."

This story is one in a series of in-depth reports exploring key issues on Alabama voters' minds as they approach the Nov. 6 general election. The topics were determined using polling from the Public Affairs Research Council of Alabama and informal polls of AL.com readers. For more coverage of issues facing the next governor, go to al.com/election.