President Donald Trump called the tax bill passed Wednesday by Congress “an incredible Christmas gift for hardworking Americans.” But according to a trio of researchers who study the opioid crisis, it’s a gift that could end up killing thousands of people.

While Trump and Congressional Republicans were busy celebrating the passage of the tax bill, Leo Beletsky, Dan Ciccarone, and Nabarun Dasgupta were putting the finishing touches on a report that argues America’s opioid epidemic is “fundamentally fueled by economic and social upheaval,” which stand to get worse in 2018 following the passage of the tax bill.

“The opioid crisis, really broadly, is a symptom of these larger problems, these fissures in American society,” said Beletsky, an associate professor of law and health sciences at Northeastern University. The timing of his report’s publication Thursday in the American Journal of Public Health with the passage of tax bill was coincidental, but Beletsky called it “particularly tragic.”

The CDC reported Thursday that there were more than 42,200 overdose deaths in 2016 — up from 33,000 in 2015. The data shows that life expectancy in the U.S. fell for the second year in a row in 2016, the first two-year decline since the 1960s, and opioid overdoses were the primary cause. Trump administration officials and others have largely blamed the crisis on overprescription of painkillers, but the researchers argue it’s more complicated.

"I think we should be really alarmed,” Robert Anderson, chief of the mortality statistics branch at the National Center for Health Statistics, told NPR. “The drug overdose problem is a public health problem and it needs to be addressed. We need to get a handle on it."

The tax bill repeals the individual mandate penalties from the Affordable Care Act, which will result in up to 13 million fewer Americans having health insurance, according to the Congressional Budget Office. In the longer term, programs like Medicare and Medicaid, which together account for about $1.25 trillion in federal spending, will likely be targeted for cuts to offset increases in the budget deficit. Ultimately, that could translate to a workforce that is less healthy, less productive, and more likely to turn to opioids to numb the pain. It will also mean that fewer people will have access to addiction treatment.

“It won’t only affect people’s access to health insurance and healthcare, it will in fact increase inequality, decrease opportunity, and decrease the government’s ability to support people who are struggling,” Beletsky said. “As a result, we’ll see people be drawn to things that make them feel better. That may be opioids, that may be alcohol, it may be other drugs.”

“Inequality does not make this situation better”

“I don’t see many hopeful signs,” he said. “What will happen under this tax bill? I have no idea, it will definitely not get better.

Trump and GOP leaders in Congress have tried to sell the tax bill as something that will help average Americans, but it actually stands to exacerbate economic inequality in the long term. Nearly every income group will pay less taxes in 2019, but by 2027, according to an analysis by PolitiFact, everyone who earns less than $75,000 annually will have to pay more. A decade from now, nearly 76 percent of households in the top 1 percent — those earning over $912,000 per year — will see a tax cut. And almost 92 percent of the top 0.1 percent — those who make more than $5 million annually — will receive a break.

“Inequality does not make this situation better,” Ciccarone, a professor at the UCSF School of Medicine, said of the opioid crisis. “It will only feed it and will only make it worse.”

Many of the area’s hit hardest by the opioid epidemic are in Trump country — the Appalachian regions of West Virginia, Ohio, and Kentucky where poverty is endemic. And yet Trump administration officials rarely talk about the economic factors involved in the crisis. Attorney General Jeff Sessions has focused blame almost exclusively on painkillers.

“We’ve seen a surge in opioid prescribing,” Sessions said in September, announcing the creation of a new “Opioid Fraud and Abuse Detection Unit” within the Justice Department. “This was one of the major reasons that this drug epidemic began in the first place. Consider this: In the 20 years from 1991 to 2011, opioid prescriptions nearly tripled in the United States. That is too high. We have got to reduce prescription in the United States.”

Beletsky, Ciccarone, and Dasgupta, an epidemiologist at the University of North Carolina, make the case that curbing prescriptions won’t be the silver bullet that solves the opioid crisis. They note that opioid overdose deaths have not declined despite a crackdown on prescription painkillers — in fact, more people are dying as they turn to fentanyl and other powerful synthetic opioids.