We are still in a world of pain and wondering what will happen with health care. So let’s go over a few facts again. 

The opioid epidemic may be about to get worse. Under the new Republican administration, the Affordable Care Act and other policies to support families are under fire. To understand the impact Republican policy changes could have on the opioid epidemic we sought to learn more from someone who has studied it. Eliza Schultz is a Research Assistant for the Poverty to Prosperity program at the Center for American Progress. One of Eliza’s recent reports (with Katherine Gallagher Robbins) is How Republican Budget Cuts Would Make the Opioid Epidemic Even Worse. The report takes a more inclusive perspective on the impact of the opioid epidemic by addressing how it affects families and communities. When I spoke with Eliza she expanded on the opioid epidemics connection to family and community, what policymakers should be doing, and the threats to well-being that these Republican policies create.

Q: I know that you do policy research. So how did opioid addiction come up as a topi­­c––and how did you recognize it as a family and community issue (as opposed to a personal one)?

ES: Opioid use has escalated into a full-blown crisis in the United States—more than 30,000 people died from overdoses in 2015, and, in some pockets of the country, particularly rural ones, it’s ushered in mass trauma—so it’s hard to ignore. It’s been covered so widely in the media and on the campaign trail, but what makes this coverage noteworthy is that, for the first time, the consensus is that the epidemic has been spurred by factors outside the control of people struggling with addiction, like economic insecurity.

Historically, drug use has been framed as a personal failure. Take, for example, the crack-cocaine epidemic of the 1980s. The reaction was to incarcerate people, which, of course, decimated families and communities, compounding whatever havoc the drugs themselves wreaked. It’s fair to say racism played a huge role in these different responses because now that the face of a drug epidemic is white, the country is more sympathetic. This moment presents an opportunity to understand drug addiction in general—not just the opioid epidemic, and no matter who is most affected—not as a personal failure but as a symptom of larger issues, like the lack of good jobs, and address those root causes.

To me, it’s hard not to recognize substance abuse as an issue that impacts families and communities. A phenomenon like opioid use does not happen in isolation to individuals—it inevitably affects the people around them. Adequate solutions to drug epidemics need to acknowledge and support those families and communities. Mass incarceration did precisely the opposite.

Q: What should policymakers do to address issues raised in your study?

ES: Well, the first key step is to do no harm. Under the American Health Care Act, health care costs will jump to the tune of $1,400 on average, but Americans who face the biggest cost increase—about $5,000 annually—are those ages 55 to 64, the same cohort that has seen the biggest rise in fatal opioid overdoses. We also know that rural communities—which, again, are disproportionately impacted by the opioid epidemic—face severe unmet needs for medical care, with more than 30 million people in counties that have not one licensed provider of medication-assisted drug treatment. The Affordable Care Act has helped to address that gap in services, in part because it incentivizes providers to serve rural counties. Under the current replacement plan, the existence of those 1,300 community health centers—many in rural areas—is threatened. Similarly, we can’t afford to roll back Medicaid expansion, or institute per capita caps, as the replacement bill proposes. All that will do is leave low-income people without insurance, or with significantly worse coverage.

As for a proactive agenda to address opioid addiction, a robust safety net is essential. Dr. Anna Lembke, chief of addiction medicine at Stanford School of Medicine, attributed part of this epidemic to the fact that, in the absence of adequate economic supports, painkillers have become a stop-gap for people with not only physical problems, but also psychological and economic ones.

Q: There’s serious potential for repeal of ACA and elimination of supports for families faced with opioid addiction. What can be done for the foster care system that, as you report, is heavily impacted by opioid addiction?

ES: By way of background, substance abuse now accounts for why about one in three children end up in foster care, and that figure is on the rise, in large part because of the opioid epidemic. State foster care systems have not been able to keep up with the increased demand, forcing states to turn to outside organizations for assistance. While it’s great that a lot of non-profits and religious institutions have stepped up in some parts of the country, reliance on volunteer organizations to plug holes like those in state foster care systems is so far from an adequate long-term solution. These systems need more financial support, but, unfortunately, the primary revenue sources for foster care are under attack. It’s hard to wrap my mind around how an administration can vow to support a population and then threaten to make budget cuts that really just exacerbate the problem at hand.