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The new year and the new presidential administration could mark a significant shift in America’s response to the opioid crisis.
While drug deaths rose steadily under President Donald Trump, they skyrocketed during Covid-19 and in the early years of the Biden administration, reaching an annual peak of about 110,000 in 2023. Although overdose deaths have since begun to decline, the poisonous fentanyl illicit drug supply is still killing Americans in astonishing numbers.
Trump’s return to power is likely to mark a new era in drug policy – and not just because of his threats to use trade tariffs against Mexico and Canada as punishment for failing to control illegal drug trafficking, or for imposing the death penalty on drug dealers . More broadly, many Americans appear to have become less tolerant in their views of people with addiction, especially in light of continued frustrations with drug use in traditionally Democratic cities like Portland, Oregon, San Francisco and Philadelphia.
In November, Californians voted overwhelmingly to impose harsher penalties for certain drug-related crimes, and in 2023, the Oregon Legislature voted to recriminalize drug possession, less than four years after a statewide ballot initiative overturned the charges of drug crime.
Much of the frustration seems to center on the philosophy of harm reduction: measures designed to improve the health and safety of drug users without requiring them to immediately stop using. Many such measures, such as changing syringes or using test strips to detect fentanyl, are effective and largely uncontroversial. But the term “harm reduction” has become shorthand for cities’ hands-off approach to public drug use and open-air drug markets, much to the dismay of experts who endorse a more coordinated approach.
The rightward shift in attitudes toward drug use is also evident in the philosophy of Robert F. Kennedy Jr., Trump’s choice to lead the Department of Health and Human Services. Kennedy, who is in long-term recovery from alcohol and heroin addiction, has advocated for a greater role for police in drug policy, arguing that drug users must hit rock bottom before their recovery can begin.
Overall, 2025 is likely to bring an important debate about the future of drug policy, addiction care and harm reduction. Below, STAT outlines three key questions that will shape America’s response to the addiction and overdose epidemic.
Will Trump and Pam Bondi crack down on controlled consumption?
The first Trump administration strongly opposed the practice of supervised consumption, a harm reduction strategy in which drug users are encouraged to consume in a facility that provides medical supervision, thus preventing fatal overdoses.
When a Philadelphia nonprofit announced plans to open a supervised consumption site, the Trump administration filed a lawsuit in federal court, successfully blocking the organization from moving forward. In an op-ed, Rod Rosenstein, the deputy attorney general, wrote that “injection sites are destroying the surrounding community” and baselessly suggested that “a bystander or medical provider who comes into contact with such drugs could suffer serious injury.”
Now, however, the facts on the ground are different. Supervised consumption in the US is no longer hypothetical: OnPoint NYC, a New York-based nonprofit, now operates two locations in Upper Manhattan, and a separate organization in Providence, RI, recently held a groundbreaking for its own location. The legislatures of Vermont and Minnesota have also passed laws allowing supervised consumption locations to open.
It was striking that Kennedy was open to controlled consumption during his campaign. In one instance, he directly said he would consider implementing the strategy if he knew it would be effective, and at numerous points during his independent bid for president, he endorsed the Netherlands’ response to its own drug crisis decades ago, including opening dozens of supervised consumption sites.
But the sites still violate a federal law commonly known as the “crackhouse statute,” which prohibits operating facilities for the purpose of consuming illegal drugs. With several sites already operating and others set to open soon, it’s not clear whether Trump and his nominee for attorney general, Pam Bondi, will actually send federal law enforcement officials to shut them down.
What does Kennedy think about methadone and buprenorphine?
Although better known for his opposition to fluoride in water, his vaccine skepticism and his advocacy on nutrition, Kennedy made the opioid crisis a central issue of his independent bid for president. While campaigning, he filmed “Recovering America,” a documentary focused on addiction that highlighted several approaches that Kennedy viewed as potential solutions worthy of government support.
His signature proposal is undoubtedly the creation of hundreds of “wellness farms” where people can pursue addiction recovery while spending time outdoors and participating in job training. Kennedy’s documentary also featured several drug court judges, an Amsterdam public health official and a trauma therapist.
Notably, however, the documentary – and Kennedy’s comments on addiction in general – have avoided any mention of the gold standard drugs used to treat opioid addiction: methadone and buprenorphine.
People who use both drugs are much less likely to die from an overdose, and in the fentanyl era, addiction medicine experts consider them the only realistic means of stopping the illicit use of opioids. But at least one doctor in Kennedy’s orbit, Drew Pinsky — a media personality known as “Dr. Drew” – has expressed skepticism about the drugs.
Kennedy is a strong supporter of Alcoholics Anonymous and the 12-step philosophy of addiction recovery. He has said he attends as many as nine rallies a week, and as a presidential candidate he has promised to hold one at the White House. Narcotics Anonymous, a 12-step offshoot that focuses on opioids, has historically opposed the use of these drugs.
Will the DEA allow buprenorphine to be prescribed via telehealth?
Under President Biden, the Drug Enforcement Administration repeatedly delayed a crucial drug policy decision for about two years: whether or not providers should continue freely dispensing buprenorphine via telehealth.
While doctors and other healthcare providers once had to conduct an in-person examination before writing a prescription for buprenorphine, during the Covid-19 pandemic they have been able to initiate the medication via telehealth. Many addiction treatment providers focused on telehealth have flourished since 2020, and many addiction medicine advocates have celebrated the change, arguing that it has improved access to treatment.
Buprenorphine is rarely used recreationally and overdoses involving buprenorphine are extremely uncommon. Still, the DEA appears intent on restoring many of the rules that existed before the pandemic. After the latest extension, the temporary rule that allows more flexibility will expire at the end of 2025. But the DEA must make a final decision at some point, and is now free to do so under an administration that likely favors greater flexibility. role of law enforcement in responding to the overdose crisis.
STAT’s coverage of chronic health conditions is supported by a grant from Bloomberg Philanthropies. Us financial supporters are not involved in decisions about our journalism.