Defining the Need

In response to the opioid crisis, a newly organized group of funders emerged, committed to investing in a set of public health-oriented responses designed to proactively reframe the way we as a society address substance use (SU) and addiction.

Comprised of funders with a long history of investing in SU related issues and those that are newer, the coalition is a collective effort to chart a new course in SU policy and practice led by the philanthropic sector.

Individual and structural racism have been significant drivers in how the United States has responded to substance use throughout history, particularly since the formal launch of the War on Drugs. The aggressive pursuit of policies and practices that criminalize drug use and addiction and dehumanize people who use drugs has extensive and expansive roots in scapegoating non-white communities and has simultaneously failed to examine or address social determinants of public health and public safety. The most recent opioid crisis shifted the tone of national discourse on drug use and addiction as it appeared to affect greater numbers of white communities. Simultaneously, it reinforces punitive paradigms in which the application of hostile policies that are disparately applied across race lines.

In aggregate, the opioid crisis has illuminated the neglect and racism that has plagued the field for years and demonstrated the failure of primarily punitive and criminal justice-based responses to SU that implicitly and explicitly created disproportionately negative outcomes for BIPOC and low-income populations.

Examples include, but are not limited to:

  • Aggressive and disparate application of the criminal legal system and its longer term, hostile, and snowballing effects (sentencing, parole, probation)
  • Termination of parental rights
  • Disenfranchisement from housing, employment, education, and social safety net eligibility.
  • Funding streams earmarked for a single substance.

Fortunately, momentum is growing for a new direction in SU policy and practice. Foundations, federal, state, and local government agencies and other payers have taken a new look at issues of substance use, misuse, and addiction, have examined more closely the environmental contexts in which people use substances, and have slowly begun to shift away from primarily punitive impulses. A refined health-based, non-punitive paradigm must be the universal standard, and not reserved primarily for white people, those with privilege or access to resources as we saw with the early opioid response.

Funders have a unique role to play in broadening the conversation to ensure this public health frame which should recognize the role of social determinants is equitably applied to all types of drugs, and for all types of people. Funders efforts can help push the country beyond limited crisis-oriented responses to a longer-term dialogue about how to develop and sustain policies, programs and practices that equitably address SU as a health issue.

To this end, a diverse group of philanthropic entities, some who are newer and others who have been in the SU field for decades, whose strategies span health promotion and prevention, harm reduction, treatment, and recovery support, have come together to develop a funders collaborative to organize their efforts and provide a platform for shared learning. Founded on the belief that working together will maximize impact, the group seeks to decrease duplicative efforts, identify, and fund innovation in areas where there are gaps, work in areas where there is little funding, and improve visibility about issues that are typically left out such as prevention and harm reduction.