In the name of reducing fentanyl overdoses, the Trump administration has gone to the extreme—levying tariffs against Canada, Mexico, and China; listing cartels as terrorist organizations; calling for the death penalty against drug dealers; and weighing drone strikes in Mexico. “When voters overwhelmingly elected Donald J. Trump as President, they gave him a mandate to seal the border and stop the influx of deadly drugs,” reads a recently posted White House fact sheet. “That is exactly what he is doing.”
But the dramatic proclamations gloss over a glaring reality: The administration is slashing funding for state and federal agencies that provide addiction treatment and overdose prevention programs. And these cuts are likely just the beginning. The budget House Republicans passed last week sets the stage for cuts to Medicaid, which paid for opioid addiction treatment for 2 million people in 2021—more than a third of everyone treated. Experts worry that the cuts will undermine progress in the fight against overdoses, which decreased dramatically last year, but still claimed the lives of 87,000 Americans.
“There’s an agenda being played out here that has very little to do with Americans overdosing.”
“There’s an agenda being played out here that has very little to do with Americans overdosing,” says Richard Frank, director of the Brookings Center on Health Policy. “If they were that serious about the opioids, they would take a much more nuanced approach to making cuts.”
It remains to be seen how much the administration will embrace evidence-based opioid addiction treatments, such as the medications suboxone and methadone, and harm reduction methods, like syringe exchange programs. Health secretary Robert F. Kennedy Jr., who was addicted to heroin as a young adult, has called for a network of “healing farms” for those struggling with addiction, as well as a “tough love” approach that would incarcerate drug users who repeatedly refuse treatment. Asked whether he supported medication-assisted treatments during his Senate confirmation hearings, he said he did—but that 12-step programs, like Alcoholics Anonymous or Narcotics Anonymous, were the “gold standard.” (To support his assertion, he cited research by the Cochrane Collaboration—which studied people addicted to alcohol, not opioids.)
Here are three ways the administration might affect the opioid crisis:
The tariff cudgel
Trump’s flip-flopping on tariffs has wreaked havoc on the global economy. But consistently, he has justified tariffs against Canada, Mexico, and China by harping on their alleged failure to stop the flow of illicit fentanyl into the country. Canada and Mexico “have allowed fentanyl to come into our country at levels never seen before, killing hundreds of thousands of our citizens and many very young, beautiful people,” he said in an address to Congress last month.
In fact, virtually no fentanyl comes from Canada. Roughly 1/500th of the fentanyl seized by law enforcement last year came from the northern border, according to Customs and Border Patrol statistics. This hasn’t stopped Trump from declaring that Canada has failed to “effectively stem the tide of illicit drugs” and calling out the Senate Republicans who opposed the tariffs, writing on Truth Social, “They are playing with the lives of the American people, and right into the hands of the Radical Left Democrats and Drug Cartels.”
Last year, the amount of fentanyl seized at the southern border plummeted by roughly 20 percent, and the potency of fentanyl pills also declined
Here’s how fentanyl typically makes its way into the United States: Chinese companies usually make the precursors for fentanyl, often for medical reasons. But some of these precursors are bought by transnational criminal organizations in Mexico, which synthesize them into fentanyl and hire American citizens to smuggle the drugs across the border. Fentanyl smuggling is particularly challenging to combat because the drug is so cheap to produce and so potent. “It’s not like heroin, where there would be big packages taken across,” Frank says. “Fentanyl is much easier: If you produce a small amount of it and bring it into the country, you can still supply a medium-sized city.”
Last year brought progress with both China and Mexico: China, which has consistently denied its role in the fentanyl crisis, pointing to its own prohibition of the drug, came to an agreement with the Biden administration to tighten its regulation of fentanyl precursors and boost measures to stem drug trafficking. The amount of fentanyl seized at the southern border plummeted by roughly 20 percent, and the potency of fentanyl pills also declined—changes that Anne Milgram, the former head of the Drug Enforcement Administration, attributed to pressure the Biden administration put on cartels.
The two countries have had differing reactions to Trump. In February, faced with the looming threat of tariffs, Mexican President Claudia Sheinbaum extradited 29 alleged drug traffickers to the United States and said at a press conference in early April that there are more names set for extradition. In China, meanwhile, tariffs threaten to undermine the fragile collaboration. The United States “is using the fentanyl issue to spread all kinds of lies and has been smearing China, shifting the blame, regardless of the progress of the cooperation,” a senior Chinese foreign ministry official said in a briefing last month, according to Reuters. “It will seriously undermine dialogue and cooperation between the two countries on drug control.”
Cuts to state and federal agencies
In late March, the White House abruptly canceled more than $11 billion in Covid-era state funding that was aimed toward treating addiction, mental health disorders, and other health programs. After a coalition of states sued, a federal judge temporarily blocked the administration from terminating the grants.
”When you just basically phone up one day and say, ‘We’re taking all the money back,’ you have people who are scheduled for appointments that day and their care is not going to be covered,” says Keith Humphreys, an addiction policy researcher at Stanford University. “Nurses, doctors, counselors don’t have a salary. To the extent that you’re investing in infrastructure and you’re building new clinics, that stops in the middle.”
In Colorado, the Covid funding was supporting crisis response teams and peer support counselors for those struggling with addiction. In New York, more than 200 organizations lost funding for their efforts to address food insecurity, mental health, and maternal health. In Pennsylvania, an outreach organization distributing the overdose reversal drug naloxone closed its doors.
But the proposed cuts go far beyond state funding. In late March, Kennedy announced plans to pare down the staff of the Department of Health and Human Services from 82,000 to 62,000. Staffers already let go from the Substance Abuse and Mental Health Administration (SAMHSA), part of HHS, include those working to raise awareness of 988, the national suicide prevention hotline, and all employees running the National Survey on Drug Use and Mental Health. The annual survey of roughly 70,000 Americans tracks critical trends—from what drugs teenagers are using to changes in levels of suicidality.
“Those are important things that policymakers need to inform the way forward,” says Regina Labelle, an addiction policy researcher at Georgetown University who served as the acting director of the White House Office of National Drug Control Policy under Biden. “I don’t know what the thinking is.”
“If you care about mental health and addiction, you wouldn’t grab the agency that does that and throw it into a blob with a bunch of other agencies that do really different things.”
The administration has also eliminated thousands of jobs from the Centers for Disease Control and Prevention, the federal agency tasked with tracking overdose deaths, and the National Institutes of Health, which funds research on novel opioid addiction treatments.
Meanwhile, in the name of government efficiency, HHS has consolidated several divisions, including SAMHSA, into the new Administration for a Healthy America. The new division will focus on primary care, maternal health, mental health, environmental health, and workforce development, according to an HHS announcement. That worries Humphreys, because there will no longer be an assistant secretary for mental health and substance use tasked with tackling the opioid epidemic. “If you care about mental health and addiction,” Humphreys says, “you wouldn’t grab the agency that does that and throw it into a blob with a bunch of other agencies that do really different things.”
For now, the administration has tapped Sara Carter, a Fox News contributor, as director of the Office of National Drug Control Policy, a position known as drug czar. Carter, who has no public health, law enforcement, or government experience, has focused in her recent work on the failures of the Biden administration to curb illegal immigration and stem the flow of illicit drugs. If confirmed by the Senate, her office will be tasked with advising the administration on drug policy and coordinating efforts across public health and law enforcement agencies.
Likely cuts to “the backbone of the drug addiction treatment system“
The recent House Republicans budget plan passed on Thursday instructs the Energy and Commerce Committee, which oversees Medicaid, to cut government spending over the next decade by $880 billion. The nonpartisan Congressional Budget Office has found that the majority of the cuts would need to come from Medicaid.
Such cuts would be devastating for efforts to solve the opioid crisis, as the program “is the backbone of the drug addiction treatment system,” says Humphreys. Medicaid pays for counselors, addiction treatment medication, and the overdose reversal drug naloxone. ”If you gut Medicaid, you are pulling out a lot of the tools that we have that help the most for people that are addicted to opioids. And that will cause suffering and death.”
More than half of Medicaid recipients treated for opioid addiction—including those in hard-hit states like West Virginia and Ohio—gained their coverage through Medicaid expansion.
While some Republicans have expressed concern about eliminating benefits, recent Republican proposals to impose work requirements on Medicaid expansion enrollees and cut the federal payment rate for expansion states would have an outsized impact on the opioid crisis. More than half of Medicaid recipients treated for opioid addiction—including those in hard-hit states like West Virginia and Ohio—gained their coverage through Medicaid expansion. Twelve states have trigger laws that would effectively eliminate Medicaid expansion if the federal government reduces its payment rate.
Cuts to addiction treatment—particularly medication-assisted treatment—could drive up the demand for illicit drugs. “If people are unable to obtain a legal medication,” Labelle says, “they will resort to an illegal means.” And cutting Medicaid coverage could also lead those who still have insurance to lose access to services, Humphreys says, since clinics need a certain number of patients in order to be viable.
Humphreys added that addiction rarely happens in a vacuum: Those struggling with drug use often also struggle with poverty, housing, spotty employment, and other health problems. “Anything you do to reduce the generosity of the American safety net has consequences for people who are addicted, particularly if they’re poor,” Humphreys says. “And they are disproportionately poor.”
This post has been syndicated from Mother Jones, where it was published under this address.