President Trump has been running against drug traffickers for a long time. He said they should be given the death penalty “for their heinous conduct.” On the first day of his second term, he signed an executive order listing the cartel as a “terrorist organization.”
However, many public health and addiction experts fear that his budget proposals and other actions will effectively punish those who use drugs and suffer from addiction.
The Trump administration has vowed to reduce deaths from overdose, one of the nation's most deadly public health crises, by highlighting law enforcement, border patrols and tariffs on China and Mexico to eliminate fentanyl and other dangerous drugs. But it also calls for massive cuts in programs that reduce drug demand.
The budget submitted to Congress this month is seeking to eliminate more than $1 billion for domestic and local treatment and preventive services. The Office of Substance Abuse and Mental Health Services, a leading federal agency committed to drug use, is set to collapse into a new administration due to a healthy America that has lost about half of its workers due to layoffs under the Trump administration, and is well beyond mental illness and drug use.
And if Medicaid cuts are recognized as being discussed by Republicans in Congress, millions of Americans will not be able to continue and start treatment much less.
The White House did not respond to requests for comment. The budget itself states that ending drug trafficking “starting with a commitment to safe boundaries and law and order,” reducing addictive services that are overlapping or “too small for a national impact.”
According to public health experts, these cuts are painful. Because they come just as the country is making sustained progress in reducing fentanyl deaths. Many interventions may have contributed to their progress, including the availability of overdose inverted spray naloxone. More treatment beds, plain housing, peer counseling. And the strength and volume of illegal drug supply, they say. However, so far, it has not been convincingly demonstrated which of these factors deserves a greater focus and investment.
“If we refund these programs without fully understanding what is working, and then our overdose rates start to rise again, it's going to be a tragedy,” said Dr. Matthew Christiansen, addiction medicine physician in the city W.VA, labeled ground zero for the opioid crisis.
A letter signed by more than 320 behavioral medicine scholars sent to Congressional leaders on Monday condemned cuts that include “community-based naloxone distribution, peer outreach programs, drug use-related infectious disease prevention programs and drug testing strip programs.”
The president's budget calls for an end to the “harm reduction” grant, a strategy to prevent disease transmission, which has been largely accepted by mainstream addiction treatment providers and keep drug users alive.
The budget rides federal financial support for “dangerous activities” called “harm reduction,” including “safe smoking kits and consumables” and “syringes” for drug users.
That language is a callback to false reports in 2022, and you can use a $30 million federal harm reduction grant to buy smoking cracks and meth pipes. In fact, a small portion of the grants designated as “Safer Smoking Kits” were supplies such as alcohol swabs and lip balms. The grant also supported the state's programs that allow for sterile syringe replacement, effective in reducing hepatitis C and HIV infection rates.
“We've seen a lot of people who have had a lot of trouble with their health,” said Dr. Christiansen, former director of West Virginia's drug management policy. “These are tools that help reduce the harm of opioids while also helping you succeed in the long term.”
According to the annual federal agency survey on substance use, in 2023, 27.2 million Americans age 12 and older had substance use disorders, 28.9 million had alcohol use disorders, and 7.5 million had both.
The budget leaves behind its unharmed block grants to the nation to combat addiction and mental illness. But in addition to the potential for Medicaid reductions, without additional grants, practical training and surveillance from agencies, the state cannot afford the many medical and social services it needs to prevent and treat addiction, Dr. Christiansen said.
David Hertzberg, a professor of drug policy and history at the University of Buffalo, said Trump would connect a nearly single-minded link between border issues and border issues when the government associates opium burrows with Chinese immigrants. Fearing invasion by Chinese workers, Congress has severely restricted immigration in China, caused by reports of Chinese men using opium to seduce young white women into prostitution.
And then, as he has now, as Herzberg said, political conservatives have discovered that targeting foreign drug suppliers is a muscular tool to advance the broader agenda.
In contrast to highly publicized drug attacks, people who use drugs chronically become an afterthought, usually appearing only as street stimuli, and their addiction is perceived as a result of their choices, he said. Elected leaders defending welfare risks are tormented as being soft to crime.
“If politicians are going to stick their necks out for them, I'd be shocked,” Hertzberg said.
