Every day, 20 to 30 trucks roll into a factory in Minnesota. They’re filled with quartz — some of it like a powder, and some of it like sparkling little pebbles, in big white sacks.

“It’s about 30 million pounds of quartz a month,” says Marty Davis, the CEO of Cambria, a company that manufactures material for kitchen and bathroom countertops. “About a million pounds a day.”

All of this quartz gets transformed into a kind of engineered stone that looks like granite and marble, but with more durability and stain resistance. Quartz countertops have really taken off over the past decade, and factories around the world are churning out slabs of the stuff under different brand names.

However, if countertop-making businesses don’t follow worker protection rules, cutting these slabs to fit customers’ kitchens can release lung-damaging silica dust.

Natural granite contains silica too, but all of the quartz that goes into engineered stone means that it contains about twice as much.

So far, 19 countertop workers in the U.S. are known to have developed severe lung disease after cutting engineered stone along with other stone; two of them died of their illness, and others have been told they will eventually require lung transplants.

Manufacturers such as Cambria say that their slabs of composite stone are completely safe when cut and polished with the proper precautions.

“There’s clear regulation and clear guidance and governance on how to process materials safely to control dust and respiratory inhalation of dust,” Davis says.

He invited NPR to tour his factory. Above the entrance is a sign that says: “Through these doors walk the finest countertop makers in the world.”

Cambria produces around 30,000 slabs of quartz countertop material every month, says Davis, who adds that the company has also spent millions of dollars on air-handling systems to control dust.

“There’s no good dust. Zero,” says Davis, who gained an appreciation of safe manufacturing practices while working in his family’s dairy business.

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Cambria receives raw quartz that is then combined with a binder and pigments to produce engineered quartz slabs, which are then sent out to workshops around the country.

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Cambria

A sign warns of silica at the door to a huge room filled with mechanical mixers. There, workers wear respirators as they combine quartz, pigments and a binder. The mixture gets spread out onto what looks like a giant baking sheet, then goes through a machine that vibrates the material in a vacuum to remove any voids.

This produces a soft, compressed slab that feels almost like cookie dough. It hardens when it gets heated, then cooled and polished. The factory is filled with rows of finished slabs in different colors, ready to be sent out to countertop-makers.

Davis says these slabs go out to thousands of workshops, and he can’t follow his product to each one.

“How do you police your customers?” he says, noting that the dangers of silica have been known for decades. “There are many products that we make in our world that, if processed or consumed improperly, are dangerous.”

He says the Occupational Safety and Health Administration has clear rules on controlling worker exposure to silica. “If you follow and adhere, your employees will be safe,” Davis says.

His company’s own countertop fabrication shops prove this, he says. In addition to manufacturing slabs, Cambria runs a network of five shops that cut slabs to order.

“They’re clean as a whistle,” says Davis, adding that one of his own sons works in the shops.

In these workshops, and at the main factory, Cambria uses devices to do real-time monitoring of silica dust — something that Davis says goes above and beyond what is currently typical for the industry.

But some workers in countertop shops run by other companies say they weren’t protected from silica.

Juan (who didn’t want to use his last name because of medical privacy) says he had a job making countertops in Washington state, and a lot of what he cut was quartz.

For the first couple of years, his workplace practiced dry cutting — that means no spray of water to keep the dust down. There was so much dust, he says, he couldn’t see someone working 20 feet away.

Juan, who is now 38, says he wore a simple face mask that didn’t provide enough protection and that no one told him about silica, or the danger.

“At first you don’t feel the changes a lot,” Juan said in Spanish, speaking through an interpreter. “Then later, with time passing, your body starts telling you that you’re missing air, that you’re suffocating and you’re tired.”

In 2016, after four years at the shop, he developed a cough that wouldn’t go away, no matter what medicine he took. About a year later, a friend who was a chiropractor advised him to get his lungs tested.

At first, his doctor told him it wasn’t necessary. “Then when he did the tests, the doctor almost cried. He said, ‘I’m sorry, you’re right, your lungs are very damaged,’ ” says Juan, who has a wife and three children.

He says he can’t carry groceries and gets exhausted just walking from his house to his car. He’s being evaluated for a lung transplant.

“After this happened, they made lots of changes in the company,” Juan says. “Now they don’t cut like they used to. They bought a lot of machines and the machines do most of the work.”

Dry-cutting methods generally are cheaper because they do not require specialized equipment or water recycling systems. One survey of countertop shops in 2012 found that the majority reported using dry methods all or most of the time in at least one fabrication step.

Margaret Phillips, an occupational health expert at the University of Oklahoma Hudson College of Public Health in Oklahoma City, has done silica sampling in shops to assess worker exposures.

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Water applied to cutting equipment, like this computer-operated saw, is one method to control silica dust exposure when cutting quartz slabs.

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Michael Conroy/AP

“If workers were doing mostly dry fabrication, so they were grinding, polishing, cutting, without any use of water on their tool to suppress the dust, then exposures tended to be very high,” Phillips says. “Like 20 times over the current OSHA limit, maybe even 40 times, or more. Dry fabrication is exposing workers to very, very high levels of silica dust.”

Her research has found that even just a few minutes of dry fabrication was enough to put a worker’s exposure over the permissible limit. “Any amount of dry fabrication could really be a problem,” she says.

Some shops don’t do dry cutting, like Capitol Granite near Richmond, Va. There, big computer-controlled machines cut through slabs while dumping up to 35 gallons of water a minute on the blade to keep down the silica dust.

“We do not do any dry work whatsoever. That’s the only way that you can eliminate any risk affiliated with silicosis in the shop,” says owner Paul Menninger.

He says if it were up to him, dry cutting would be illegal.

In his workplace, machine operators and workers doing touch-ups with handheld tools don’t have to wear respirators, because silica is well-controlled. Menninger knows this because he recently invited in an inspector from OSHA, who tested the air.

But he says there are a lot of shops, especially smaller operations, that government inspectors never get to. And the stone cutting industry is unlicensed.

“It’s not like plumbing or electrical or HVAC or any of the other trades,” he says, “whereby there seems to be a standard or an international code.”

Yet consumers rely on the industry and regulators to ensure that products are made safely, says Carolyn Levine, a Washington, D.C., resident who recently replaced her natural granite countertops with engineered quartz.

The lung illnesses found in the countertop industry are alarming, she says.

“Having regulations and precautions is important, and this is a good example of why,” Levine says.

She had never heard of engineered quartz before deciding to replace her old granite countertops, which she had for more than 12 years.

“I just wanted something lighter and brighter,” Levine says. “I had two guys give me estimates.”

They both were emphatic, she says, that compared to granite, the superior product was quartz.

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On a good day in the emergency room where we work, patients who need to be admitted to the hospital might expect to wait four or five hours, including evaluation and treatment, before they are sent upstairs to a ready bed.

On a bad day, ER patients might wait two or three times as long, and sometimes much longer.

Recently, one of us cared for a bedridden patient with chest pain who spent 47 hours in an ER hallway before a spot became available in the cardiac unit.

Keeping patients in the ER while waiting for an inpatient bed — a practice known as boarding — isn’t unique to the busy teaching hospitals where we work. According to the Centers for Disease Control and Prevention, most American hospitals have boarded patients in the ER for more than two hours while waiting for an inpatient bed.

It’s a stubborn problem. A 2001 study suggested that as many as 1 in 5 ER patients is boarded. In 2006 the Institute of Medicine identified boarding as part of a “national crisis” affecting emergency care. In 2016, two-thirds of hospitals reported boarding patients in the ER or an observation unit for more than two hours, compared with 57% in 2009.

Waiting hours for a hospital bed can be maddening for patients and their families. Sometimes literally. Researchers recently found that long waits in ER hallway beds are associated with delirium, a medical condition defined by confusion and disorientation.

But boarding in the ER affects much more than patients’ state of mind. The American College of Emergency Physicians has identified boarding as one of the most important factors in ER overcrowding. And overcrowding, in turn, has been associated with everything from delays in administration of pain medication and antibiotics to longer inpatient stays, greater exposure to medical error, delayed treatment for heart attack and even increased mortality.

To understand why boarding can have so many negative consequences, think of a busy school cafeteria at lunch. No matter how efficient the cafeteria workers are at making and serving the food, processing payment and getting people through the line, no one can sit down to eat if all the tables are occupied with other students.

In our case, the emergency department can be remarkably effective at diagnosis and treatment. But if there’s nowhere for admitted patients to go, the whole operation gets bogged down and everyone’s care suffers.

If boarding is such a problem, why do hospitals allow it to continue?

The answer, as with so many things in our health care system, is complicated. But it has a lot to do with money.

Since 1975 the number of hospitals in America has declined by 30%. That’s more than 1,500 hospitals shuttered, with half a million beds lost.

Market forces have been largely responsible, as technology became more expensive, reimbursement rates were curtailed and hospitals either merged or went bankrupt. Meanwhile, annual ER visits have increased by nearly 50 million since 1995.

It looks like a basic supply and demand problem.

But here’s a curveball: Most hospitals operate, on average, at only about 65% of their total inpatient capacity — and this number has actually dropped since 1975.

How can that be?

Reimbursement is a key part of the puzzle.

Medicare, which provides insurance for about 60 million Americans, sets the bar for how much hospitals are paid, from treating pneumonia to neurosurgery. And those reimbursement rates have strongly favored invasive procedures like surgery, colonoscopy and cardiac catheterization.

Simply managing medical conditions in the hospital is much less lucrative.

Hospitals have a strong financial incentive to prioritize these procedures and to give latitude to the specialists performing them in setting their schedules. As a result, dozens of surgeries might be scheduled for a Monday morning, just a handful the following day and almost none over the weekend.

This approach creates wide variation in the number of postoperative patients needing admission to the hospital on any given day. But one thing’s for sure, a surge in post-op patients needing hospital beds means fewer beds for ER patients, which creates a bottleneck and leads to boarding. The variation in demand causes hospitals to swing between overcrowding and underutilization.

So even though we’re seeing more patients in fewer hospitals, limited capacity may not be the primary issue. It’s that we’re using existing capacity inefficiently.

A 2012 review identified inefficiency rather than insufficient beds as the root cause of boarding. Other sources of inefficiency include restricting certain beds to certain specialties, skeleton staffing during nights and weekends and poor discharge planning.

The silver lining is that efforts to improve efficiency are much less expensive than building a new hospital wing. Smoothing out surgical scheduling, for one, has been shown to yield major improvements. Cincinnati Children’s Hospital increased occupancy to 91% from 76%, made $137 million in extra revenue and avoided a $100 million expansion by rejiggering the surgical schedule and streamlining discharges.

Many hospitals are working on the problem. In the two teaching hospitals where we work in Boston, policies are in place to use observation units, affiliated community hospitals and even “home hospital,” where patients receive care from teams that visit them at home, to spare inpatient beds.

Even so, other hospitals may be falling short. Researchers found in 2012 that a majority of the most crowded hospitals had been slow to adopt the most effective measures to alleviate the bed crunch.

Could legislation be the answer? Perhaps.

In 2005, Britain instituted a maximum length of stay of four hours for all ER patients. It worked — 94% of patients were meeting that goal by 2014, although hospitals there have slipped more recently. Australia, New Zealand and Canada have had similar successes.

A legislative mandate seems far-fetched in the U.S., given the current state of Congress. Medicare has begun offering financial incentives for hospitals to address boarding, and the major accreditation organization for hospitals introduced guidelines on how to improve boarding in 2014. Neither of these measures requires action, though.

Ultimately, we suspect that what is really needed is an overhaul of the current system of financial incentives and reimbursement, coupled with penalties for hospitals that fail to act on the problem.

Until then, we’re sorry if you’re still waiting for that bed.

Clayton Dalton and Daniel Tonellato are resident physicians at Massachusetts General and Brigham & Women’s hospitals, both in Boston.

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When Lorraine Griggs’ 86-year-old father was diagnosed with prostate cancer, he was treated with 35 rounds of radiation, though he had a long list of other serious medical issues, including diabetes, kidney disease and high blood pressure. The treatment left him frailer, Griggs recalls.

A few years later, when his prostate cancer reoccurred, Griggs’ father received a different kind of cancer care. Before his doctor devised a treatment plan, she ordered what’s known as a geriatric assessment. It included a complete physical and medical history, an evaluation by a physical therapist, a psychological assessment and a cognitive exam. The doctor also asked her father about his social activities, which included driving to lunch with friends and grocery shopping with some assistance.

“When the doctor saw how physically active and mentally sharp my father was at 89 years of age, but that he had several chronic, serious medical problems, including end stage kidney disease, she didn’t advise him to have aggressive treatment like the first time around,” says Griggs, who lives in Rochester, N.Y.

Instead, his oncologist placed her dad on one pill a day that just slowed down his cancer. Griggs’ father was able to enjoy his activities for another three years until he died at the age of 92.

Geriatric assessment is an approach that clinicians use to evaluate their elderly patients’ overall health status and to help them choose treatment appropriate to their age and condition. The assessment includes questionnaires and tests to gauge the patients’ physical, mental and functional capacity, taking into account their social lives, daily activities and goals.

The tool can play an important role in cancer care, according to clinicians who work with the elderly. It can be tricky to predict who will be cured, who will relapse and who will die from cancer treatment. Geriatric assessments can help physicians better estimate who will likely develop chemotherapy toxicities and other serious potential complications of cancer treatment, including death.

Geriatric assessment includes an evaluation by a physical therapist, a psychological assessment, a cognitive exam and a complete physical and medical history. The doctor takes all these factors into account and tallies a score for their patient to help guide their decision-making about the patient’s treatment.

Although the geriatric assessment is not 100% accurate, “it’s better than the clinician eyeball test,” says Supriya Gupta Mohile, a geriatric oncologist and professor of medicine at the University of Rochester. “If I didn’t do a geriatric assessment and just looked at a patient I wouldn’t have the same information,” she says.

A vulnerable population

More than 60% of cancers in the U.S. occur in people older than 65. As the population grows older, so will the rate of cancer among seniors. The cancer incidence in the elderly is expected to rise 67% from 2010 to 2030, according to a 2017 study in the Journal of Clinical Oncology. Yet many oncologists don’t have geriatric training.

Mohile, who treated Griggs’ father during his cancer relapse, explains that geriatric oncologists take a different approach than many other oncologists.

“We want to help older adults successfully undergo cancer treatment without significant toxicities, so it leads to a survival benefit,” she says. “What we don’t want to do is treat patients who will be harmed.”

Mohile says when she saw that Griggs’ dad was frail because of his other health issues, she explained that the standard treatment of care would be difficult for him.

“We went through the decision-making together and I was able to explain how it could cause harm and it would have no risk benefit. He wanted to live and not suffer toxicities,” she says.

A growing body of evidence supports the notion that cancer care for older adults can be improved with geriatric assessments.

A study published in the Journal of Geriatric Oncology in November found that in 197 cancer patients 70 years and older, 27% of the treatment recommendations patients received from the tumor board were different from those received after completing a geriatric assessment. Patients who received a geriatric assessment were recommended to have less intensive treatment or palliative care.

Overall, geriatric assessments have been found valuable for helping older adults with health conditions achieve higher quality of life. A 2017 Cochrane review of 29 studies of geriatric assessments on patients who’d been hospitalized found that patients were more likely to be alive and at home a year later compared to those who had standard care.

One of the reasons geriatric assessments can be so useful to clinicians treating cancer is that doctors don’t have enough information at their fingertips about how older patients respond to the drugs commonly used for chemotherapy. This is partly because there’s less research on this age group.

“You’re playing a guessing game most of the time. Older patients on chemo can get in more trouble than younger patients. The real issue is the patient’s capacity to tolerate care. I think geriatric assessments can improve how we tailor therapy,” says Efrat Dotan, associate professor of hematology/oncology at Fox Chase Cancer Center in Philadelphia and chair of the National Comprehensive Cancer Network, NCCN.

But other experts caution that geriatric assessments can backfire because of a dominant culture in medicine that tends to try to cure patients at all costs, even when treatments may be dangerous.

“Sometimes you don’t want to ask questions because you’re afraid you may have to deal with the answers,” says Otis Brawley, Bloomberg distinguished professor of oncology and epidemiology at Johns Hopkins University in Baltimore.

“The test tends to give us answers that scare us from treatment, and we are supposed to treat patients,” he says.

Often, if a cancer patient is turned away from treatment, they try to find a doctor that will offer it anyway.

“This happens all the time. The irony is that by going away from a doctor really doing the appropriate thing and then going to another doctor who doesn’t do the appropriate thing, sometimes that second doctor is actually hastening death,” says Brawley, former chief medical and scientific officer at the American Cancer Society.

An underutilized tool

Though geriatric assessments were developed about two decades ago and hailed as one of the clinical cancer advances of 2012 by the American Society of Clinical Oncology, they are still not widely used by oncologists.

The Surgical Task Force at the International Society of Geriatric Oncology found that only 6.4% of surgeons use comprehensive geriatric assessments in daily practice, and only 36.3% collaborate with geriatricians, according to a 2016 study in the European Journal of Surgical Oncology.

Many major academic centers have adopted the use of geriatric assessments. However, they’re still fairly scarce in community practices where staffing shortages, financial constraints, lack of institutional support and technology are major barriers to use. They are also time-consuming to complete — taking about two hours.

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Mohile, who uses geriatric assessments before treating patients, says “the geriatric assessment is a tool anyone can print out and use.”

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Mike Bradley for NPR

But these days, “the geriatric assessment is a tool anyone can print out and use,” Mohile says. It’s recently been streamlined and will soon be built into the online health record, Epic, she says.

Still, lack of training among oncologists is an issue, Mohile says.

“Geriatric assessments have been around for a long time, but they have not been traditionally used by oncologists because they haven’t been trained how to do it or use it,” she says.

Finding treatment options for frail patients

Matthew LoBiondo Sr. from Conesus, N.Y., was being treated with chemotherapy for a gastrointestinal tumor when Mohile first met him as an inpatient. The 89-year-old was hospitalized because he was weak, dehydrated and not eating. Mohile says the dose of the medication he was on was too toxic for him.

Once she took over his care, she weaned him off that treatment, did a geriatric assessment with him and tailored a less toxic treatment plan.

One of the tenets of geriatric assessments is to help physicians select treatments that are best suited for a patient by getting to the core of their physical and mental capacity, regardless of their chronological age.

That’s ultimately the best way to treat older cancer patients, says Armin Shahrokni, a geriatrician and medical oncologist at Memorial Sloan Kettering Cancer Center in New York.

“The data are clear that the fitness of an older cancer patient, rather than age per se, should be the factor considered” when it comes to cancer treatment, he wrote in an editorial in the Annals of Surgical Oncology.

“Age is a meaningless number. I can see a very active 85-year-old very healthy cancer patient who runs marathons. I can also see a 65-year-old with a lot of other comorbid illnesses who is not as functional. How I treat them for cancer would be different,” Shahrokni says.

When he assesses a patient to be too frail for cancer surgery, he says it doesn’t mean that a patient would automatically go on palliative care.

“You would be amazed at how many other options open,” he says.

A frail patient with lung cancer, for instance, can be redirected from surgery to radiation, which is less toxic than chemotherapy and less invasive than surgery.

Geriatric assessments are a way to guide better cancer decision-making, he says.

As more studies about the value of geriatric assessments come out, Shahrokni says he hopes more people will become aware of their importance and find a way to implement them in their practice.

Health problems are less obvious among older adults because of atypical presentations, or because of communication problems due to hearing loss or cognitive impairment. Problems such as psychosocial status, or the environment, increase in importance in older patients because they frequently coexist with health problems and can interfere with their management.

“I think things are moving forward very nicely. In the next 10 years my hope is that not only surgeons and oncologists will do these types of assessments, but patients and their families will demand the health care system to provide a more comprehensive assessment of their functional status before cancer treatment. I think this is going to lead to better outcomes for patients,” Shahrokni says.

Cheryl Platzman Weinstock is an award-winning health and science journalist. This article was written with the support of a fellowship from the Gerontological Society of America, Journalists Network on Generations and the Retirement Research Foundation.

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Babies born to mothers who used opioids during pregnancy represent one of the most distressing legacies of an opioid epidemic that has claimed almost 400,000 lives and ravaged communities.

In fact, many of the ongoing lawsuits filed against drug companies make reference to these babies, fighting through withdrawal in hospital nurseries.

The cluster of symptoms they experience, which include tremors, seizures and respiratory distress, is known as neonatal abstinence syndrome. Until recently, doctors rarely looked for the condition. Then case numbers quadrupled over a decade. Hospital care for newborns with NAS has cost Medicaid billions of dollars.

Studies indicate more than 30,000 babies with the condition are born every year in the U.S. — about one every 15 minutes. Although their plight is mentioned in opioid-related litigation, there are growing concerns that those same children will be left out of financial settlements being negotiated right now.

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Robbie Nicholson now works as a mentor with a company called 180 Health Partners that helps women with addiction go through pregnancy. Her own newborn went through drug withdrawals, related to the medications she took to control her opioid cravings. She says most women she works with need a stable place to live and reliable transportation.

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Blake Farmer

Robbie Nicholson, a mother in Eagleville, Tenn., tried to comfort her second child while the baby slowly underwent withdrawal from drugs Nicholson had taken during pregnancy.

“The whole experience is just traumatizing, really,” Nicholson says.

Nicholson’s ordeal actually began right after her first pregnancy. To help with postpartum recovery, her doctor prescribed her a pile of Percocets. That was the norm.

“Back then, it was like I was on them for a full month. And then he was like, ‘OK, you’re done.’ And I was like, ‘Oh my God, I’ve got a newborn, first-time mom, no energy, no sleep, like that was getting me through,’ ” she says. “It just built and built and built off that.”

After developing a full-blown addiction to painkillers, Nicholson eventually found her way into recovery. In accordance with evidence-based guidelines, she took buprenorphine, a medication that helps keep her opioid cravings at bay. And then came another pregnancy.

But buprenorphine — as well as methadone, another drug used in medication-assisted addiction treatment — is a special kind of opioid. Its use during pregnancy can still result in withdrawal symptoms for the newborn, although increasingly physicians have decided that the benefits of keeping a mother on the medication, to help her stay sober and stable during pregnancy, outweigh the risk of her giving birth to a baby with neonatal abstinence syndrome.

Treatment protocols for NAS vary from hospital to hospital, but over time doctors and neonatal nurses have become better at diagnosing the condition and weaning newborns safely. Sometimes the mom and her baby can even stay together if the infant doesn’t have to be sent to the neonatal intensive care unit.

But not much is known about the long-term effects of NAS, and parents and medical professionals both worry about the future of children exposed in utero to opioids.

“I wanted her to be perfect, and she is absolutely perfect,” Nicholson says. “But in the back of my mind, it’s always going to be there.”

There are thousands of children like Nicholson’s daughter entering the education system. Dr. Stephen Patrick, a neonatologist in Nashville, says schools and early childhood programs are on the front lines now.

“You hear teachers talking about infants with a development delay,” he says. “I just got an email this morning from somebody.”

Studies haven’t proven a direct link between in utero exposure to opioids and behavior problems in kids. And it’s challenging to untangle which problems might stem from the lingering effects of maternal drug use, as opposed to the impacts of growing up with a mother who struggles with addiction and perhaps unemployment and housing instability as well. But Patrick, who leads the Center for Child Health Policy at Vanderbilt University, says that is what his and others’ ongoing research wants to find out.

As states, cities, counties and even hospitals go after drug companies in court, Patrick fears these children will be left out. He points to public discussion of pending settlements and the settlement deals struck between pharmaceutical companies and the state of Oklahoma, which make little or no mention of children.

Settlement funds could be used to monitor the health of children who had NAS, to pay for treatment of any developmental problems, and to help schools serving those children, Patrick explains.

“We need to be in the mix right now, in schools, understanding how we can support teachers, how we can support students as they try to learn, even as we work out was there cause and effect of opioid use and developmental delays or issues in school,” he says.

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New mothers in recovery for opioid addiction meet with a support group in Oak Ridge, Tenn. Most had newborns who endured drug withdrawals at birth, known as neonatal abstinence syndrome.

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Blake Farmer

But it’s a nuanced problem with no consensus on where money is most needed, even among those who have been working on the problem for years.

Justin Lanning started Nashville-based 180 Health Partners, which works with mothers at risk of delivering a baby dependent on opioids. Most are covered by Medicaid. And those Medicaid departments in each state pay for most of the NAS births in the U.S.

“We have a few departments in our country that can operate at an epidemic scale, and I think that’s where we have to focus our funds,” he says.

Lanning sees a need to extend government-funded insurance for new mothers, since in states like Tennessee that never expanded Medicaid, these moms can lose health coverage just two months after giving birth. That often derails the mother’s own drug treatment funded by Medicaid, he says.

“This consistency of care is so key to their recovery, to their productivity, to their thriving,” Lanning says of new mothers in recovery.

Nicholson now has a job at 180 Health Partners, assisting and mentoring pregnant women struggling with addiction. Nicholson says their biggest need is a stable place to live and reliable transportation.

“I just feel kind of hopeless,” she says. “I don’t know what to tell these women.”

There are many needs, Nicholson says, but no simple fix. Those who work with mothers in recovery fear any opioid settlement money may be spread so thin that it doesn’t benefit their children — the next generation of the crisis.

This story comes from NPR’s reporting partnership with Nashville Public Radio and Kaiser Health News.

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