By Poe Bertholon
For over a decade, the number of drug overdose deaths in the U.S. has escalated at a disturbing
pace, a trend that was exacerbated by the global COVID-19 pandemic. Now, our nation faces its
most alarming crisis of overdose occurrence and substance abuse.
Highly potent synthetic opioids (like fentanyl) and animal tranquilizers (like xylazine) are being
mixed into a variety of drugs. From Xanax to cocaine, to methamphetamine, to counterfeit pills,
buying drugs on the street has become a game of Russian roulette, contributing heavily to the
deadly surge in overdose deaths throughout the past decade.
Though access to substances is at an all-time high, there has been recent hope of a significant
shift. As of 2023, for the first time in a long time, the U.S. is experiencing a drop in overdose
deaths. Although the decline of 10.6 percent over the past year may seem minimal, it’s a massive
reversal from the more recent years of fatal overdoses regularly increasing by double-digit
percentages.
While data has yet to provide clear answers as to the factors contributing to the decline, it is
paramount to understand that this decline may be contingent on the continued attention and
support for addiction treatment, harm reduction services, and the Affordable Care Act.
Trump’s First Term
Trump’s presidential history is riddled with loss attacks and empty promises. During his first
term as President from 2017 to 2021, he declared a public health emergency as a response to the
opioid crisis in the U.S. and then proceeded to grant no leadership in the efforts he promised.
An internal memo acquired by NPR in 2017 found the White House was contemplating a 94%
cut in resources to the Office of National Drug Control Policy (ONDCP). According to NPR, he
later handed over the leadership of the opioid response to several selected politicians, including
former New Jersey Gov. Chris Christie.
The Government Accountability Office issued a report blasting the Trump administration during
his first term because the ONDCP did not issue a national drug control strategy for either 2017 or
2018, effectively reversing all the progress made up to that point.
Restoring Hell on Earth
Project 2025, an expansive text that lays out a conservative agenda for the next Republican
administration, states within its 900 pages that “The next President’s top drug policy priority
must be to address the current fentanyl crisis and reduce the number of overdoses and fatalities,”
According to the National Archives, the Trump Administration plans to adopt a comprehensive
approach that balances public safety and public health to combat the current drug crisis.
In a short video found on his campaign website titled “Agenda47: Ending the Nightmare of the
Homeless, Drug Addicts, and Dangerously Deranged”, Trump says, “Our once-great cities have
become unlivable, unsanitary nightmares surrendered to the homeless, the drug addicted, and the
violent and dangerously deranged.”
Trump’s plan for removing these threats to public safety includes banning urban camping and
returning people to mental institutions “where they belong,” as well as relocating people to
government-sanctioned tent cities.
Keith Humphreys, a psychology professor who studies addiction medicine at Stanford
University implies that these government interventions have proven to worsen problems with
homelessness and substance abuse, and while these measures may provide a sense of order and
control, for those relocated to these tent cities, it will be hell on earth.
The Criminal Justice Initiative
Trump has promised a law-and-order approach to policy of all kinds.
Under his administration, programs and practices that promote public safety, such as drug
courts, pre-arrest diversion, and pre-trial diversion programs, will likely continue to receive
support. Putting drug policy under a criminal justice lens rather than prioritizing public health
initiatives that would include low-barrier community service options.
A month into his second term, President-elect Donald Trump has already signed a cyclone of
executive orders. More recently, the Trump administration issued a memo pausing potentially
trillions of dollars in federal aid. This freeze would disrupt thousands of federal grant programs
that serve tens of millions of Americans and devastate programs ranging from health care to road
construction.
His intention to shift from a public health approach to a law-and-order approach is more likely to
increase incarceration rates, as opposed to funding initiatives like economic efficiency and harm
reduction.
Dismantling the Affordable Care Act
The future of addiction and drug policy in the next few years could be heavily dependent upon
the continued existence of the Affordable Care Act. Especially as political, public health, and law
enforcement priorities continue to converge and evolve.
Research from the ONDCP in a document found on the White House National Archives page
states that in 2018, only 11% of the estimated 21.3 million Americans who met the criteria for
substance use disorder received treatment at a specialized facility. This research shows that the
fatal “treatment gap” can be linked to a lack of access to effective treatment services as well as
the prevailing stigmas about addiction.
People with substance use disorder have been stigmatized and categorized as selfish or
undisciplined people unworthy of a life worth living due to their own choices. Upon entering the
world of recovery, one learns that addiction is a disease rather than a battle of willpower. “No
one chooses leukemia, heart disease, or depression. Abusing drugs, however, appears to many to
be a choice and a reckless and selfish one. It’s not,” says David Sheff in an excerpt from his
book Clean: Overcoming Addiction and Ending America’s Greatest Tragedy.
The drug and overdose crisis in the U.S. is likely to get worse if Trump is successful in
dismantling the Affordable Care Act [ACA], especially considering that it provides insurance
coverage for roughly 40% of Americans receiving opioid addiction treatment.
The ACA has contributed to a surge in the number of people attending treatment programs.
However, if the ACA is dismantled, as Trump has urged, those insurance coverage and care
would likely be reversed.
Efforts to expand harm reduction programs, such as naloxone distribution, may continue on a
local or state level, as federal support will be muted under a Trump administration.
There will likely be continued resistance among those who see harm reduction as enabling or
condoning drug use. If investment goes in that direction, addiction and drug-related deaths are bound to get worse.
