Addiction as a Social Justice Issue

Note: The following piece was co-authored by Providence Associates Jane Fischer and Suzie Ray as part of our 17th JUSTus Podcast.

Addiction doesn’t exist in a vacuum. It is deeply tied to systems of inequality, discrimination and access. Addiction, also known as substance use disorder, is defined as patterns of compulsive substance use that cause significant distress or impairment.

Addiction is the taking of large amounts of substances or using substances longer than intended or prescribed. Signs and symptoms of addiction include intense craving or urge to use, spending a great amount of time trying to obtain or use, neglecting responsibilities in order to use, continuing to use the substance regardless of negative consequences and experiencing extreme withdrawal symptoms when not using the substance.

Communities of color, low-income neighborhoods and marginalized groups often face higher rates of addiction but fewer pathways to treatment and recovery. Structural barriers like inadequate or no healthcare, housing instability, criminalization and lack of mental health support make it harder for those most affected by addictions to get the help they need.

Addressing addiction is not just about treatment. It is about access, equality, equity, dignity and ensuring everyone has a fair chance at recovery and a better life. Addressing addictions is in jeopardy from the Trump Administration’s “One Big Beautiful Bill.”

H.R. 1 – One Big Beautiful Bill

The One Big Beautiful Bill, as it is referred to, was introduced by Representative Jodey Harrington. According to the new analysis from the Congressional Budget Office, this legislation would increase resources for middle and top earners at the expense of lower-income Americans.

Services to the poor and vulnerable are targets of the U.S. Budget Bill. We must remember that Catholic principles of the social gospel (Catholic Social Teachings) focus on caring for the poor and vulnerable, as well as dignity, access, equality and fairness. 

Reading through this bill raises one red alert after another for the people whom Jesus taught us to love and take care of.   

Support for addiction services is under threat. Key concerns regarding addiction services include:

• Ending NARCAN Life Support
• Cuts to housing programs
• Stripping Medicaid access

Changes could severely weaken the safety net for individuals and families affected by addiction at a time when support is needed most.

NARCAN Life Support

The One Big Beautiful Bill proposal would eliminate a $56 million annual grant that funds training and distribution of Narcan to first responders. This is an essential tool in fighting opioid overdoses across the country.

Naloxone (Narcan) is a medicine that rapidly reverses an opioid overdose. Narcan attaches to opioid receptors and reverses and blocks the effects of other opioids.

The use of Narcan can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. Examples of opioids include heroin, fentanyl, oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine and morphine. It is not a treatment for opioid use disorder.

Provisional data from the CDC’s National Center for Health Statistics reports a substantial reduction in drug overdoses in 2024 by 26.9 percent. After years of increased overdoses, the federal government’s narcan program has resulted in a notable decrease in 2023.

In addition, deaths attributed to opioid use in 2023 were 83,140, and in 2024 they were down to 54,743. This short-term reduction in the number of opioid deaths can be interpreted as success, but the use of Narcan certainly saved many of those lives. Some parents and loved ones carry Narcan with them to be able to administer the life-saving drug to their loved ones. 

The College of Medicine and Psychiatry in Tucson and public health experts widely recognize Narcan as a key factor in reducing opioid-related deaths.

Also at risk are several vital addiction-related programs, including:

• Treatment programs for pregnant and postpartum women
• Peer support initiatives led by individuals in recovery
• The Youth Prevention and Recovery Initiative
• Programs helping emergency departments develop non-opioid pain management protocols

In a further blow, the Substance Abuse and Mental Health Services Administration (SAMHSA), headed by Robert F. Kennedy Jr., is reportedly in the process of being dissolved.

The agency has already lost a third of its workforce due to federal government staffing cuts, and the proposed budget will slash $1 billion from its operations.

The remaining staff may be absorbed into a new agency called the Administration for a Healthy America. Analysts warn of additional workforce reductions that could significantly weaken the nation’s substance abuse and mental health support systems.

What does $1 billion in budget cuts look like in an opioid addiction?

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Opioids are a class of drugs that include pain relievers available legally by prescription, the illegal drug heroin, and synthetic opioids such as fentanyl. Opioid pain relievers can be effective in the treatment for relieving pain.

These drugs activate opioid receptors on nerve cells in the body and brain.  Regular use can easily lead to dependence and addiction. Misuse of opioid pain relievers can lead to overdose incidents and death.

American Magazine’s Kevin Clark states that Catholic healthcare executives have warned that low-income urban and isolated rural communities would be hardest hit. The statistics in these areas from American Addiction Centers from 2020 show that

• Overdose rates in rural counties increased from 4.0 to 19.6 per 100,000 people between 1999 and 2019.  
• Per capita, the opioid overdose rate in rural communities is 45 percent higher than in cities. [5]
• Around 9.2 percent of people aged 12-20 living in rural areas binge-drink alcohol (5 or more drinks for males or 4 or more for females) in the past month, compared to 8 percent of those living in big cities.
• 3.5 percent of people aged 12 and older in rural areas misuse opioids, compared to 3.1 percent in big cities.
• Young adults aged 18-25 who live in remote rural areas misuse methamphetamine at almost twice the rate as those who live in urban areas.
• 9 percent of young adults living in rural communities misused prescription pain relievers in the past year, compared to 8 percent of those living in urban areas.
• Around 14 percent of behavioral health treatment facilities in the U.S. are in rural communities, and less than half of these specialize in addiction treatment.

Cuts to Housing Programs

The National Low Income Housing Coalition  reports that “the full budget request proposes a historic 44 percent cut to HUD’s vital affordable housing, homelessness, and community development programs, and would impose changes to rental and homelessness assistance that would leave more families struggling to afford rent and at increased risk of homelessness.”  These cuts will dramatically impact populations that struggle with addiction and low employment. 

Furthermore, by taking rental assistance away from struggling households for not meeting work requirements does nothing to help struggling households access better-paying jobs. It only increases their risk of homelessness and other hardships.

 Research shows that supportive housing, such as the Housing First programs:

• Effectively ends homelessness and reduces housing instability. A large body of research shows that the vast majority of people who live in supportive housing are able to stay stably housed in the community.
• Can reduce healthcare and other costs. Studies show that supportive housing can reduce the use of health care systems, corrections and other systems.
• Can lead to better treatment outcomes. Those in supportive housing reduce their use of substances over time. Available studies indicate that supportive housing works at least as well as – if not better than – other treatment programs available in the community that help people experiencing homelessness reduce their substance use.

The Center on Budget and Policy Priorities reports that “Affordable housing is a basic human need, but many families’ incomes are not high enough to afford market-rate rents in their neighborhoods.  The One Big Beautiful Bill budget proposals could make this worse.

Many households already struggling to afford rent could have their housing assistance taken away under proposals that Congress could consider this year, putting them at risk of eviction and homelessness.”

Stripping Medicaid Access

The One Big Beautiful Bill proposal also includes steep cuts to Medicaid, along with new barriers that would limit access to care for millions. This includes those struggling with addictions.

Federal law requires States to provide certain mandatory Medicaid benefits, and the law also allows States the choice of covering other optional benefits. Mandatory Medicaid benefits include inpatient and outpatient hospital services, physician services, laboratory services, radiology services and home health services, among others.

Proposed changes to Medicaid based on the Congressional Budget Office include: 

• Increased Community Engagement and Work Requirements
• Increased Proof of Eligibility
• Moratorium on Provider Taxes
• Decrease in Enrollment Eligibility for Medicaid
• Increased and Enhanced Verification Standards
• Increased Cost-Sharing Charges

In total, 7.6 million people could lose Medicaid coverage, and 73 million people could have a significant decrease in benefits and services.

Lyndon B. Johnson signed the bill that led to Medicare and Medicaid on July 30, 1965. At first, Medicaid gave medical insurance to people getting cash assistance. Today, a much larger group of the marginalized and socio-economic poor population is included :

• low income,
• pregnant women,
• people of all ages with disabilities, and
• people who need long-term care.

So, what happens now?

There will be significant cuts to Medicare estimated at  $500 billion, and to Medicaid estimated at $793 billion.  The bill proposes Medicaid cuts over the next 10 years. It will strip low-income beneficiaries of financial assistance, making it more difficult to afford healthcare.

It could also undermine long-term care access and, by removing nursing home staff requirements which could potentially jeopardize care. Additional changes in the bill include rollback rules designed to streamline enrollment, impact eligibility of some immigrants for Medicare, and increase the cost of premiums and cost sharing for people with state marketplace plans.

Now that the bill has passed, it could negatively impact individuals struggling with addiction. By reducing funding for substance abuse treatment, mental health services, and other safety net programs, the bill could make it harder for people to access essential care, potentially exacerbating the opioid crisis and other addiction issues. States and communities would have to provide the funding for these services.  Resulting in negative health and social outcomes .

Love, Mercy and Justice

The Jesuit theologian James F. Keenan defines mercy as a “willingness to enter the chaos of another.” 

In his 2020 encyclical “Fratelli Tutti,” Pope Francis urged Christians to exhibit a “preferential love shown to those greatest in need; it undergirds everything we do on their behalf” (No. 187).

Reflection

Take some time to read the links attached to this newsletter. Then think about the following questions: 

1. What are my thoughts? Are my thoughts merciful? 
2. Are my thoughts full of love and compassion for my brothers and sisters?   
3. Justice is the equal and fair treatment of everyone without discrimination and bias. Are my thoughts just, equal, and fair to those whose circumstances are different than mine?
4. Matthew 25:40 states, “Amen, I say to you, whatever you did for one of these least brothers (sisters) of mine, you did for me.” What am I willing to do for the least of my brothers and sisters?   

Call to Action

1. Contact your Senators and oppose the bill
2. Identify and call non-profits in your community that rely on Medicaid to serve their clients, and see how you can help them out
3. Educate yourself and others on the contents of this bill and any modifications
4. Participate in local rallies, social media discourse, etc.
5. Align and get involved with organizations that are actively working to oppose the bill, such as Network.org, League of Conservation Voters, Catholic Religious Congregations, etc.

Mercy Now by Mary Gauthier

My father could use a little mercy now
The fruits of his labor                                                        
Fall and rot slowly on the ground
His work is almost over
It won’t be long and he won’t be around
I love my father, and he could use some mercy now

My brother could use a little mercy now
He’s a stranger to freedom
He’s shackled to his fears and doubts
The pain that he lives in is
Almost more than living will allow
I love my brother, and he could use some mercy now

My Church and my Country could use a little mercy now
As they sink into a poisoned pit
That’s going to take forever to climb out
They carry the weight of the faithful
Who follow ‘em down
I love my Church and Country and they could use some mercy now

Every living thing could use a little mercy now
Only the hand of grace can end the race
Towards another mushroom cloud
People in power, well
They’ll do anything to keep their crown
I love life, and life itself could use some mercy now

Yea, we all could use a little mercy now
I know we don’t deserve it
But we need it anyhow
We hang in the balance
Dangle ‘tween hell and hallowed ground
Every single one of us could use some mercy now
Every single one of us could use some mercy now
Every single one of us could use some mercy now