The big picture: The economic roots of the substance use crisis often get obscured, but they are crucial to address, according to an article by two Brown University researchers/professors.

The details: They explain that poverty pushes people into conditions where overdose risk is heightened and also pushes people to participate in the dangerous and unregulated drug market.

Financial hardship: People may use drugs or participate in the unregulated drug economy to keep their heads above water financially, getting caught up in a cycle of addiction and financial hardship.
Employment: Research has shown there is a link between unemployment, opioid use, and overdose. Losing a job puts people at high risk for overdose, as do certain occupations (e.g., construction, food preparation and service sectors, maintenance, transportation and moving).
Disruption: Increased drug use and overdose rates often occur after a disruptive event (e.g., COVID, loss of a job, eviction).
Criminal legal system: Once someone is caught up in the criminal legal system, poverty and overdose risk are further perpetuated.
Treatment: People may be caught up in fraudulent treatment providers, while legitimate OTPs are being gobbled up by private equity without an expansion of treatment.

The main point: When there is no housing available, treatment remains out of reach, and jobs are hard to come by, there will continue to be visible homelessness and drug use.

What’s coming: The authors note that this could get worse, as unemployment, cost of living, rents, and homelessness are increasing, many will soon face increased health care costs or be cut from Medicaid, and addiction services are under attack and facing budget cuts and changing federal priorities.

But: The article highlights that even in this climate, in which there is pushback against public health approaches and an embrace of punitive responses in response to visible homelessness and drug use, there are steps that can be taken.

Benefits/assistance: Congress can pass legislation to eliminate the SNAP drug felony ban. Cities and states should pursue any policy that provides financial assistance.
Housing: Localities can do more on housing, such as eviction moratoriums, investing in affordable housing and providing rental assistance, ensuring people with criminal records are not discriminated against in housing, etc.
Treatment: To expand access to treatment, states can change their Medicaid policies to allow for coverage of MOUD.