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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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