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As the new year begins, Oregon, like much of the country, is facing a public health crisis with opiates (pain pills and heroin). Oregon currently leads the nation in abuse of prescription pain pills, and from 2001-2011 admission rates to drug treatment facilities for opiate addiction quadrupled. Although action is being taken, both at the state and local level, to curb the prescription of opiates, we are still seeing devastating local effects. From 2015 to 2016 alone, the number of opiate addicted infants born requiring neonatal intensive care (NICU) treatment doubled in Jackson County. What are the tools we have to fight this epidemic? In spite of efforts to limit the availability of prescription opiates, there is still, unfortunately, a large supply of illegal opiates in this community. As the supply of legal opiates has gone down, many people have turned to illegal opiates such as “street pills” and heroin. One of the most important tools we have to combat this is substance abuse treatment. Access to treatment, for most people, requires health care coverage, and for many this coverage is under direct threat if the Affordable Care Act (ACA or “Obamacare”) is repealed. As physicians providing addiction treatment in our community, we are deeply concerned that the rush to repeal the ACA will seriously hurt local efforts to end the opiate crisis. From 2011 to 2014, with the passage of the ACA, Jackson County saw a surge in insurance coverage for its residents. In 2011, 27% of adults 18-64 were uninsured, a rate that dropped to 4% in 2014. In looking at potential impact on access to opiate treatment this number is striking: nearly one-third of adults in Jackson County would have limited or no access to treatment were we to revert to pre-ACA insurance coverage levels. In our practices, we have seen the success of health coverage provided by the ACA in bringing people, particularly young adults, into drug treatment. We have seen young mothers in the throes of heroin addiction turn their lives around and become caring and responsible parents. With treatment and monitoring, opiate addiction can be kept in remission for many people: they can hold jobs, take care of their families, and lead meaningful lives. Without treatment, however, addiction devastates entire families, with children suffering the most as they are deprived of their parents and often placed in foster care. While the ACA is by no means perfect legislation, and there is much that needs to be fixed, its hasty repeal has potentially very serious consequences for our community. We urge our legislators, particularly Rep. Greg Walden, chairman of the House Energy and Commerce Committee, to carefully weigh whether repealing the ACA without a viable alternative to address the opiate crisis is truly in the best interest of Oregon. — Kerri Hecox, M.D., is a family physician in Medford with expertise in treating addiction disorders. Jim Shames, M.D., is a family physician board-certified in addiction medicine. Both authors provide medication-assisted treatment of opiate disorders as part of their clinical practice.