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opioid crisis
We Need to Double Down on Harm Reduction, Not Walk Away From It
We have come too far to turn our backs on what works when it comes to sound, life-saving drug policies. Now is the wrong time to politicize practical, proven responses to this medical emergency.
Sep 04, 2025
We lost more than 80,000 Americans to overdose last year, making it the leading cause of death for adults aged 18 to 44. But, for the first time in years, we have some reason for hope: in 2024, overdose deaths dropped by 27 percent. That progress, however, didn’t happen on its own. It came from investments in harm reduction: an ecosystem of strategies including naloxone distribution, syringe service programs, medications for opioid use disorder, and housing-first programs that secured shelter for people before connecting them to care.
Unfortunately, much of that progress is in danger. In recent weeks, President Trump issued an executive order targeting the very programs that provide these services and helped bring down overdose deaths. In doing so, the administration is cutting federal funding for proven, evidence-based interventions. It is also carving out naloxone from the larger harm reduction ecosystem it belongs to, falsely suggesting that naloxone can succeed in isolation. The reality is that saving someone from an overdose requires more than just increasing naloxone’s availability. It requires a broader public health approach to reach those at risk. Without systemic support for trusted community-led networks, naloxone will not be able to reach the people who are most vulnerable.
I should know. I’ve spent the past 30 years working with people who use drugs—first addressing HIV in Central and Eastern Europe, and now as Director of Drug Policy at the Open Society Foundations, where we support harm reduction efforts globally. I’ve seen, time and again, that when we lead with evidence and compassion, we save lives.
The biggest barrier we consistently face isn’t science, but the stigma and misunderstandings associated with drug use.
Back in the 1990s, I worked on a program that supported harm reduction efforts in former Soviet countries, then the region with the highest rates of HIV among people who use drugs. The interventions were straightforward: provide sterile syringes, educate people about safe injections, and offer access to basic medical care. Whether in Tomsk, Russia, or my hometown in New Jersey, I never met a person who didn’t want to protect themselves. We were fortunate to have tools that people actually wanted. And they work. Syringe service programs cut HIV and hepatitis C infections in half. Other interventions, like methadone and buprenorphine, can lower HIV incidence by as much as 60 percent by helping people reduce or stop injecting altogether.
The biggest barrier we consistently face isn’t science, but the stigma and misunderstandings associated with drug use.
People mistakenly believe that providing sterile syringes encourages drug use or that drug treatment medications simply “replace one drug with another.” But by supporting and translating scientific research, educating medical professionals, and, perhaps most importantly, supporting people who use drugs, we’ve made great progress. These efforts have not only produced strong results but have also helped chip away at longstanding stigma.
Take, for example, the OnPoint NYC—the first overdose prevention center in the country. Since 2021, the center has reversed nearly 2,000 overdoses. Syringe exchange programs are now authorized in 37 states, the District of Columbia, and Puerto Rico. With bipartisan support, red states from Kentucky to Indiana to South Carolina are using opioid settlement funds to support critical harm reduction work. The reality that many have recognized is that harm reduction programs provide an important on-ramp to broader care. They engage people who often don’t go to traditional medical providers out of fear. People who visit syringe service programs are five times more likely to enter treatment than those who don’t. Harm reduction programs are an optimal venue for naloxone distribution since they directly reach people at risk of overdose. That’s why the Trump administration’s recent actions are so concerning. They reflect a shift away from science that has been working.
We have come too far to turn our backs on what works. We must not politicize practical, proven responses to this medical emergency. We live in a time where evidence-based public health interventions that had once been taken as givens have become political flashpoints. But we can’t let politics come in the way of saving very real lives. Too much is at stake now.
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Trump-GOP Cuts Could Reverse Last Year's Historic Drop in Drug Overdose Deaths, Warn Experts
Cuts to Medicaid and prevention, harm reduction, and treatment programs "will equal more people dying," said one public health expert.
May 15, 2025
Federal public health officials on Thursday announced an unprecedented drop last year in drug overdose deaths, which have plagued the United States for decades and had been rising steadily over the past several years.
But experts warned that now is exactly the wrong time to "take our foot off the gas pedal," as the Republican Party and President Donald Trump are threatening to do with steep cuts to Medicaid and other federal programs.
The Centers for Disease Control and Prevention (CDC) reported that an estimated 80,391 people in the U.S. died of drug overdoses in 2024—a 27% drop, with about 30,000 fewer deaths than in 2023 and "more than 81 lives saved every day."
Synthetic opioids like fentanyl were still involved in most overdose deaths last year, but those deaths were down 37% between 2023-24.
"I would characterize this as a historically significant decrease in overdose deaths," Brandon Marshall, a Brown University School of Public Health epidemiologist, told The Washington Post. "We're really seeing decreases almost across the entire nation at this point."
Experts noted that numerous factors are likely behind the plunging fatal overdose numbers. The CDC said it has been able to strengthen overdose prevention capacities across the U.S. since Trump declared the opioid crisis a public health emergency in 2017 during his first term, making congressional support available.
As CNN reported, with new federal support, local policymakers in places like Mecklenburg County, North Carolina have been able to secure vending machines with naloxone, a medication that can rapidly reverse an opioid overdose; employ epidemiologists who focus on opioid trends to prevent deaths; and infrastructure that has helped public workers determine where to target their overdose prevention work.
But the CDC's National Center for Injury Prevention and Control, which funded those programs, was targeted by the so-called Department of Government Efficiency earlier this year as its Trump-appointed leader, billionaire tech CEO Elon Musk, sought to cut federal jobs. The center is also identified as a "duplicative, DEI, or simply unnecessary" program that should be cut in the White House's proposed budget.
"Any changes or impacts to those funding streams would mean that we either have to find other funding to support the team that works in that department, or we would have to lay them off. That would, of course, impact the work," Dr. Raynard Washington, director of the county health department, told CNN. "Experts work hand-in-hand with us on the strategies that we choose to implement on the ground, and then how we're evaluating what's working, and then how we share those best practices. That technical assistance is also just as invaluable as the actual grant dollars that we receive."
Medicaid cuts in the proposed budget, which would slash $880 billion in federal spending to secure tax cuts for the wealthiest Americans and corporations, could also reverse the historic progress made in 2024, as the healthcare program covers 47% of people with opioid use disorder and 64% of people who receive outpatient treatment.
Chad Sabora, a drug policy expert who helped spearhead the letter, told The Washington Post that cuts to Medicaid will leave people without medications they use to diminish the effects of opioid use disorder, like buprenorphine.
"It will equal more people dying," he told the Post.
On Monday, more than 320 faculty members from universities and other institutions wrote to Republican and Democratic Senate leaders to warn them that "dismantling the lifesaving work" of the CDC and other health agencies in the budget would have "dire consequences."
"At a time when the federal government should be boosting investments in behavioral health systems, service delivery, and public health surveillance programs, we are seeing drastic cuts to key agencies, including the Substance Abuse and Mental Health Services Administration (SAMHSA), the CDC, and the Health Resources and Services Administration (HRSA)," they said.
The 2026 fiscal year budget proposes over $1 billion in cuts to SAMHSA—a reduction of 16% of its funding—and $3.6 billion in cuts to the CDC, or nearly half if its funding.
The faculty members listed a number of programs that will be impacted those cuts, including:
- State and local health departments and behavioral health agencies;
- Evidence-based prevention programs like community-based naloxone distribution, peer outreach programs, drug-use related infectious disease prevention programs, and drug test strip programs, which help people determine whether a drug is laced with fentanyl;
- The National Survey on Drug Use and Health (SAMHSA), which is used extensively by policymakers, researchers, and health professionals and gives accurate population estimates of trends in alcohol, tobacco, and other drug use; and
- The Addiction Medicine Fellowship Program and Substance Use Disorder Treatment and Recovery Loan Repayment Program (HRSA), which will train the next generation of substance use care specialists across the country, with special programs dedicated to rural areas.
"Members of Congress, we urge you to protect these vital substance use and mental health services. Millions of Americans are depending on you," wrote the experts.
The White House signaled in the proposed budget that it doesn't support evidence-based harm reduction programs funded through SAMHSA grants, calling them "dangerous activities."
Adams Sibley, a researcher at the University of North Carolina, told CNN that "now is the time to double down on efforts to educate and recruit folks into harm reduction and treatment, whatever their version of safer use looks like."
With fellow researcher Nabarun Dasgupta, Sibley tracked gradual declines in overdose deaths in cities and states over the past three years, before the national shift was seen in 2024.
They identified shifts in the population of drug users, with a growing number of people in the at-risk population taking advantage of newly funded treatment options—or having already died of overdoses—as one contributing factor to the plunging overdose death numbers last year, as well as a change in the supply of drugs available.
"The general dissatisfaction with the illicit opioid supply right now is surprisingly high," Dasgupta told CNN, pointing to the animal sedative xylazine, also known as "tranq."
Many users have reached an "inflection point" with their substance use disorders, said Sibley and Dasgupta, and policymakers must ensure the treatment and prevention programs funded by the CDC, SAMHSA, and other agencies are still there for them.
"The one thing that substance use treatment providers and people who use drugs alike will tell you is that people are ready when they're ready, and there are a lot of people ready right now," Sibley said.
Daniel Ciccarone, a researcher at the University of California, San Francisco, cautioned that even with last year's significant decrease, "we're still at very high levels of overdose."
"We need steady pressure," he told CNN. "To the degree that we stop paying attention... we will see a reversal."
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How Trump Promotes Grotesque Corporate Lawlessness
Dropping corporate cases en masse, as the Trump administration is doing, portends a return to recklessness and greed that fueled corporate catastrophes like Wall Street’s 2008 financial crisis.
May 08, 2025
“Corporations First.” That’s the slogan that would truthfully describe the Trump administration’s approach to law enforcement, not “America First.”
A new investigation by my organization shows that the Trump administration is dropping investigations and enforcement actions against corporations that showered money on Trump’s inauguration earlier this year.
Seventy-one big businesses, which were facing at least 102 ongoing federal enforcement actions at the time of Trump’s inauguration, collectively gave a whopping $57 million to the Trump-Vance inaugural fund, we found. And many may now be collecting special favors.
Time will tell whether the payments by other big corporate inauguration donors—like Amazon, Apple, Boeing, FedEx, Goldman Sachs, Google, Johnson & Johnson, Nvidia, and Pilgrim’s Pride—will see enforcement go away, too.
Trump’s inaugural haul from corporations facing investigations and lawsuits alone is comparable to the total amount raised for the inaugurations of former Presidents Barack Obama in 2009 ($53 million) and Joe Biden in 2021 ($62 million). And it’s just a third of the record-breaking $239 million Trump collected overall, $153 million of which came from corporate donors.
Regardless of president or party, private funding for the presidential inauguration poses a serious threat of corrupt influence buying by corporations and the wealthy. Unlike the vast majority of Americans, they can ingratiate themselves to an incoming administration with six- and seven-figure checks.
Donations by for-profit corporations are particularly suspect—corporations’ purpose, after all, is to amass wealth for private investors, an agenda that frequently pits them against laws and regulations that protect consumers, workers, and the broader public interest.
We may not know exactly what favors corporations might seek. But it’s reasonable to assume that getting rid of penalties or investigations for ripping off consumers, exploiting workers, polluting our environment, and engaging in illegal and unfair business practices would be high on the list.
Public Citizen has compiled a list of more than 500 enforcement actions against corporations that the Trump administration inherited from the Biden administration. During President Trump’s first 100 days alone, federal agencies halted or dropped at least 126 of these enforcement actions.
These include actions against 15 corporate inauguration donors whose cases were dismissed or withdrawn, plus six whose cases were halted. These 21 corporations collectively donated $18 million to the inaugural fund.
These include companies accused of violating consumer financial protections, such Bank of America, Capital One, JPMorgan, and Walmart; some crypto businesses accused of violating securities laws, such as Coinbase, Crypto.com, Kraken, and Ripple; private prison corporations that allegedly mistreated inmates, like CoreCivic and GEO Group; and businesses accused of engaging in illegal bribery schemes in foreign countries, including Cognizant, Pfizer, and Toyota.
Time will tell whether the payments by other big corporate inauguration donors—like Amazon, Apple, Boeing, FedEx, Goldman Sachs, Google, Johnson & Johnson, Nvidia, and Pilgrim’s Pride—will see enforcement go away, too.
To be fair, some cases against corporate inauguration donors do appear to be proceeding unhindered. The antitrust cases against Google and Meta are proceeding, the FTC’s case against Uber for deceptive billing practices has been filed, and Gilead Pharmaceuticals is being required to pay $202 million to settle allegations of paying illegal kickbacks to doctors.
These signs of ongoing enforcement are a good thing. But among the more than 100 cases being dropped and halted, they’re exceptional. Because of the mass firings of federal workers at enforcement agencies, they likely represent the conclusion of past enforcement efforts, not the continuation of an ongoing trend.
Dropping corporate cases en masse, as the Trump administration is doing, is a greenlight for corporate lawlessness. It portends a return to recklessness and greed that fueled corporate catastrophes like Wall Street’s 2008 financial crisis, the Oxycontin-fueled opioid crisis, BP’s oil spill disaster, and Boeing’s deadly 737 Max crashes.
It is the definition of “corporations first.”
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We Don’t Throw People Away: Why I Support a Harm Reduction Approach in LA
We have a moral responsibility to set an example for the rest of the nation: one that’s rooted in compassion, humanity, and data-driven approaches.
May 07, 2025
If you were drowning, I wouldn’t ask how you got there before throwing you a lifeline.
I wouldn’t tell you to swim harder.
I wouldn’t tell you to make better choices, I wouldn’t hope you sink, and I wouldn’t put you in a cage.
If you were drowning, I would reach for you, pull you up, and do everything in my power to keep you alive.
That’s what harm reduction is: keeping people alive.
We don’t criminalize someone for losing a limb to the effects of diabetes. We don’t arrest them for not taking their insulin or for struggling to manage their blood sugar. We surround them with medical care, support systems, and resources to help them live healthier lives.
The first step isn’t forcing someone into a system they aren’t ready for. The first step is keeping them alive long enough to say yes.
Problematic substance use—a chronic, relapsing disease—is no different. And harm reduction is one of the many courses of medical action we’re taking to address this in MacArthur Park, Los Angeles, where the opioid crisis and homelessness collide in painful, visible ways.
I understand the frustration. I hear the anger. Lock them up, people say—oblivious to the harrowing truth that this crisis is made profoundly worse in our jails.
I want a healthy, accessible, thriving MacArthur Park just as much as my neighbors; a MacArthur Park where hardworking families aren’t forced to live amid trauma and visible substance use. But let me be clear: I don’t throw people away—and I don’t invest in failed solutions.
People don’t wake up one day and decide to become homeless or addicted. They end up there because they’ve been failed by an economic system that keeps people in poverty, by a housing system that makes rent impossible to afford, by a criminal justice system that treats problematic substance use like a crime instead of a disease, by a political system that chronically underfunds mental health, and by a for-profit healthcare system that allowed big pharmaceutical companies to manufacture the opioid epidemic and knowingly steal thousands of lives in exchange for billions of dollars.
We’ve spent over a trillion dollars on the failed War on Drugs, and the availability and potency of illicit drugs have only increased—along with our prison population.
It’s time for a different approach.
Decades of research have shown that harm reduction strategies provide significant public health benefits, including preventing deaths from overdoses and preventing transmission of infectious diseases. That’s why our office partnered with the LA County Department of Health Services and Homeless Healthcare Los Angeles (HHCLA) to deploy an overdose response team in the park seven days a week. Every day, they provide wound care, hygiene kits, naloxone, methadone, and harm reduction tools to people experiencing problematic substance use. They clean up biohazardous waste, picking up and safely disposing of left-behind needles and pipes that put our families in danger. They do the work that Recreation and Parks and LAPD can’t while reducing call volume to emergency responders, and we are all safer for it.
Since launching in late 2024, this team has collected over 14,000 hazardous items and distributed more than 3,600 naloxone kits—totaling over 11,000 doses of life-saving medication—and saved 52 lives. Those 52 people have names and faces and stories and hopes and dreams. They are someone’s child, someone’s friend, someone who now has a shot at accepting treatment, because we know that recovery isn’t a straight path—it takes multiple touchpoints. The first step isn’t forcing someone into a system they aren’t ready for. The first step is keeping them alive long enough to say yes.
I also want to be clear about what our office can and cannot do. The City Council cannot make arrests. What we can do is invest in solutions. We can choose to fund the strategies that actually reduce harm, that save lives, that address the root causes of these crises. Or, we can choose to push people out of sight and throw them away.
The fight for humanity goes far beyond MacArthur Park. We see it happening across the country. We see it in how President Donald Trump treats immigrants like pawns, willing to let families suffer for cheap political points. We see it in how he attacks the LGBTQ+ community, stripping away protections and treatment, denying their very existence. We see marginalized communities degraded and vilified and sacrificed at the altar of power, and we see misinformation peddled at every turn to satiate a hungry, desperate base. It is easy to dehumanize. It is easy to discard people. It is easy to think of human lives as inconvenient. But we have to resist that urge. We are better than that in Los Angeles. We have a moral responsibility to set an example for the rest of the nation: one that’s rooted in compassion, humanity, and data-driven approaches. And since my very first day in office, that’s what I’ve always done, no matter how uphill the battle may be.
MacArthur Park is struggling. Yes, we are frustrated, scared, and sometimes, angry. But I refuse to abandon the people suffering in front of us.
We don’t throw people away. We fight for them.
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Families Rally for Opioid Accountability as Supreme Court Hears Purdue Case
"I don't want their money," one woman who lost a son to the opioid crisis said of the Sackler family. "I want them in prison."
Dec 04, 2023
At the U.S. Supreme Court on Monday, families whose loved ones are among the tens of thousands of Americans who have died of opioid use disorder each year over the past two decades rallied to push the nine justices to reject a proposed bankruptcy plan that would give the former owners of Purdue Pharma legal immunity—with many joining the U.S. Justice Department in arguing that the company should not be released from accountability for the opioid epidemic.
Purdue Pharma filed for bankruptcy in 2019, as the number of Americans killed by opioids hit 50,000 and the OxyContin manufacturer faced thousands of lawsuits alleging its aggressive marketing of the addictive painkiller had fueled the rising death toll.
The company agreed to settle the lawsuits for $10 billion, with the Sackler family—which oversaw Purdue when OxyContin was introduced and flooded communities across the U.S.—contributing $4 billion. In exchange, the Sacklers would be shielded from future lawsuits.
The bankruptcy plan—which now includes $6 billion from the Sacklers following a push from lawsuit plaintiffs—has been approved by state and local governments, tribes, and families and individuals who would be entitled to money.
But the U.S. Trustee Program, a watchdog at the Justice Department, has joined some families in arguing that the Sacklers should not be shielded from liability for the opioid crisis.
"No Sackler immunity at any $$," read one sign held by a woman outside the Supreme Court on Monday, while another said, "My dead son does not release Sacklers."
The issue at hand in the case, Harrington v. Purdue Pharma, is whether it is legal to give a third party—the Sackler family—legal immunity in a bankruptcy case even though they themselves have not declared bankruptcy, also known as nonconsensual third-party release.
A lawyer for groups and individuals told the court that families and governments are highly unlikely to get any more out of Purdue and the Sacklers than the money the company and family have offered as part of the deal.
The plan would include $161 million in a trust set aside for Native American tribes and $700 million to $750 million in a trust for families and individuals who were able to file claims, with payouts expected to range from about $3,500 to $48,000. Governments would use the money to set up addiction treatment centers and other programs to mitigate the opioid crisis.
"Forget a better deal—there is no other deal," lawyer Pratik Shah told the Supreme Court on Monday.
Curtis Gannon, representing the U.S. Trustee Program, noted that the Sackler family already showed that a "better deal" could be possible when it offered $6 billion for the plan instead of $4 billion. The Justice Department is advocating for a new settlement that would not include nonconsensual third-party releases, saying the current bankruptcy deal violates federal law.
"We do hope there is another deal at the end of this," said Gannon.
The justices appeared split on the case, in which a ruling is expected next summer. Justice Ketanji Brown Jackson noted that appeals courts do not allow bankruptcy plans that take away the rights of alleged victims to sue parties that have not declared bankruptcy.
Outside the court, Alexis Pleus, who lost her son to opioid use disorder, told Aneri Pattani of KFF Health News that many families, including hers, will not be entitled to money under the current deal because they are required to provide records such as the original opioid prescription.
Beth Macy, author of the book Dopesick, told CNN Monday morning that while some families "are divided" about whether the bankruptcy plan and payouts should move forward, as the U.S. Trustee Program "has pointed out, only 20% of the families who were eligible to vote on [the proposal], even voted."
"I don't want their money," Jen Trejo, whose son Christopher was prescribed OxyContin at age 15 and died of an overdose when he was 32, told Pattani. "I want them in prison."
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Critics Push Back Against Biden Revival of Failed 'War on Drugs' Approach to Fentanyl
"Over 100,000 of our loved ones being lost to avoidable overdoses a year is not because of a lack of enforcement, it's a direct result of it," the director of the Drug Policy Alliance argued.
Feb 07, 2023
U.S. drug policy reform advocates condemned President Joe Biden's commitment to "accelerating the crackdown on fentanyl trafficking" as part of his administration's strategy for tackling the opioid crisis, a policy the White House announced in a preview of Tuesday night's State of the Union address.
Although the SOTU preview says the administration will be "expanding access to evidence-based prevention, harm reduction, treatment, and recovery," the document says Biden will "work with Congress to make permanent tough penalties on suppliers of fentanyl," fentanyl analogs, and fentanyl-related substances (FRS).
The outline states that Biden "looks forward to working with Congress on its comprehensive proposal to permanently schedule all illicitly produced FRS into Schedule I," the most severe Drug Enforcement Administration classification.
"The push to place all fentanyl-related substances in Schedule I is unfortunate and misguided. Schedule I is supposed to be for substances that we know to be harmful and not helpful."
"Traffickers of these deadly substances must face the penalties they deserve, no matter how they adjust their drugs," the preview asserts.
In response to the SOTU preview, Maritza Perez Medina, director of the office of federal affairs at the Drug Policy Alliance, said in a statement that "we are glad to see President Biden continue to call for increased access to evidence-based treatment, harm reduction, and recovery services."
"But, his support for harsher penalties for fentanyl-related substances—which will result in broader application of mandatory minimum sentencing and disproportionately harm Black, Latinx, and Indigenous communities—in the same breath is incredibly counterproductive and fails to recognize how we got to this place to begin with," she asserted. "Over 100,000 of our loved ones being lost to avoidable overdoses a year is not because of a lack of enforcement, it's a direct result of it."
Gregory Dudley, who chairs the chemistry department at West Virginia University, argued that "the push to place all fentanyl-related substances in Schedule I is unfortunate and misguided. Schedule I is supposed to be for substances that we know to be harmful and not helpful."
"We don't know which of these substances would be harmful or helpful, and how could we without testing them?" Dudley asked. "Some of these substances could be lifesaving opioid antagonists like naloxone, or better. This proposal prioritizes criminalization over healthcare."
Susan Ousterman, who lost her son Tyler to an accidental overdose in 2020 and subsequently founded the Vilomah Memorial Foundation, said that "it's incredibly disheartening to see the president co-opting the grief of mothers like me in an attempt to increase penalties, rather than prioritizing the health measures that are desperately needed to save lives."
"Increased penalties for people who use or sell drugs, including fentanyl-related substances, would not have kept my son alive or the countless children of other mothers I have met," Ousterman stressed. "In fact, it's policies such as these that created the increased stigma and fear that kept our children from accessing help, and it's what has led to the increasingly dangerous drug supply that resulted in their deaths."
"It's time for the president and other policymakers to prioritize the lives of all humans by embracing a health approach rather than engaging in politics that only perpetuate this disastrous war on drugs," she added. "As a person who understands the profound impact both substance use and child loss have on families, I expected more."
Biden was one of the architects of the 1980s escalation of the War on Drugs. He coined the term "drug czar" while advocating the establishment of the cabinet-level position and was a key supporter of the 1994 Violent Crime Control and Law Enforcement Act, legislation that accelerated U.S. mass incarceration.
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