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Addiction thrives when people and communities don’t. That’s the essential lesson of a recently released Brookings Institution study that has deep implications for how our nation will address its opioid crisis. We assume that life expectancy will continue to improve in the United States. Yet this study found that the death rate of non-Hispanic whites between the ages of 45 and 54 who don’t have a college degree has increased by half a percent every year from 1999 to 2013.

What’s going on? One key contributor that the researchers cite is a rise in the number of “deaths of despair” — deaths from drugs, alcohol, and suicide — that can be traced to waning economic opportunities and a frayed social fabric. In other words, deaths that spring from lack of hope, purpose, and opportunity.

The study comes at an opportune but uncertain time. In late March, the Trump administration launched a commission to evaluate prevention, treatment, and recovery options for people who abuse opioids. Last week, reports surfaced that the administration is considering a 95 percent cut to the Office of National Drug Control Policy, which could restrict access to data needed to develop a coherent strategy. Hopefully, as the commission takes shape, it will draw lessons from the Brookings Institution study, from a recent report on substance misuse by former Surgeon General Vivek Murthy, and from those who have been working for decades to prevent substance abuse in low-income communities and communities of color.


Here’s the main lesson: The commission needs to think big if it wants to successfully prevent opioid abuse. That means addressing the causes of despair that can lead to substance abuse and death. We need to look at who profits from opioid abuse, how these substances flood into neighborhoods, and what factors underlie the hopelessness, economic injustice, and disempowerment that drive people toward substance use.

Many rural counties that have seen a surge of opioid overdoses and premature deaths have been hard hit by deindustrialization, as large employers replace blue-collar workers with machines and outsource jobs. In many communities of color, the flight of the aerospace, automotive, and other industries, along with chronic disinvestment in education, housing, and public infrastructure, have undermined health and well-being for generations. Combine these conditions with increased access to and availability of drugs — pharmaceutical and street, legal and illegal — and the result is that it is easy for people to turn to substance use to manage despair.


The opioid commission must take seriously the task of finding solutions that foster hope and opportunity. These solutions need to fire up the engines of local economic development and job training in ways that are applicable in every disenfranchised community — including African-American, Latino, Asian, Native American, Arab, whites without college degrees, and others — that grapple with social isolation, despair, and overexposure to opioids and other harmful substances such as methamphetamine, cocaine, and alcohol.

Solutions can be leveraged from multiple sectors by addressing fundamental needs such as quality, affordable housing; safe streets; access to healthy food; clean, well-maintained parks; and stable jobs. The commission should also take the bold stance of investing in high-quality public education for all, which can increase job readiness, literacy, and a positive future for youths and adults.

We need to create systemic opportunities for people to be engaged and empowered in their communities and in civic life as a whole. It certainly isn’t easy, but there are local examples ready to be spread and scaled.

In California, members of the Violence Prevention Coalition of Greater Los Angeles are working with high schools to increase school connectedness, improve attendance rates and kids’ engagement with school, and close the achievement gap. In rural Farmington Valley, Conn., the Resilience Grows Here coalition runs a community garden for veterans with PTSD to connect with one another and their civilian neighbors. Or take Ohio, where Nationwide Children’s Hospital in Columbus has contributed $8 million to improving local housing and building a career development center and Cincinnati Children’s Hospital is investing $11 million in community development, including new affordable housing and loans for home rehabilitation.

Local and grassroots solutions that have helped curb misuse of prescription drugs include prescription drug give-back programs; training pharmacists and doctors to offer patients smaller quantities of pills per order; shutting down illicit pain clinics; and encouraging doctors and dentists to prescribe non-addicting drugs for pain, instead of opioids. Both government and corporations must take responsibility for halting the supply chains that flood certain communities with harmful substances that diminish productivity and opportunity for all.

At its core, substance abuse is a health issue with roots in economic fairness and social justice. Only by addressing multiple drivers of the opioid epidemic — declining community conditions, inequitable systems, and harmful drug marketing and prescribing practices — can we get ahead of the epidemic, save lives, and lift up our communities.

Manal Aboelata is the managing director of Prevention Institute, a national public-health nonprofit based in Oakland, Calif. Larry Cohen is the institute’s founder and executive director; Sheila Savannah is its director.