The truth about the opioid wars

Trump talks tough about the danger of fentanyl—and then kills the successful Biden programs that brought opioid deaths down.

By Jeff Nesbit

Here’s the really good news: Drug overdose deaths in the United States from fentanyl and other synthetic opioids fell dramatically last year, the Centers for Disease Control and Prevention said on Wednesday. Opioid-related overdose deaths started to drop in 2023 and fell even more dramatically in 2024.

In fact, overdose deaths hit their lowest point in the past five years through a combination of sustained federal efforts at the Department of Health and Human Services to combat the opioid crisis during all four years of the Biden administration, local efforts to provide treatment and counseling, and sustained public education aimed at drug users about the risks of fentanyl overdose.

There were roughly 110,000 overdose deaths in 2023. A year later, there were roughly 80,000 overdose deaths -- a dramatic 27% drop in just one year. But the drop in overdose deaths from fentanyl was even more profound during the last year of the Biden administration. Overdose deaths from fentanyl dropped 37 percent from 2023 to 2024, the CDC said.

Synthetic opioids represent most overdose deaths (60 percent of all overdose deaths last year). But overdose deaths from methamphetamine and cocaine also fell dramatically last year: 28% compared with 2023 for meth and 28% from cocaine compared with 2023.

Again, that’s the really good news. Federal programs to combat the opioid crisis ramped up considerably at HHS during the Biden years. Local clinics, supported by federal and state resources, stepped up. A wide range of persistent federal, state and local efforts have clearly started to have an impact.

Yes, there are still way too many overdose deaths in America. There’s no question that we need to continue with every effort to interdict fentanyl shipments from overseas from sketchy sources, offer life-saving naloxone pretty much everywhere (an initiative from HHS begun during the Biden years), and find every conceivable way we know to educate drug users about the risks of synthetic opioids and fentanyl.

We made substantial progress in 2023 and 2024. The new CDC overdose death numbers prove it. Part of the drop is because HHS under President Joe Biden made naloxone much more widely available. HHS’s Food and Drug Administration under Biden made Narcan (the best-known version of naloxone) available over the counter in 2023. Narcan is now standard issue for first responders and available widely in a variety of public places, thanks to Biden’s HHS.

But here’s the really bad news. All the federal efforts to ramp up the war against fentanyl overdose deaths in the Biden years are at considerable risk now in the Trump years. The Trump White House might pretend and posture that it’s serious about dealing with the opioid crisis. But actions speak louder than words.

And here are the actions.

In March, in what can only be called the bare minimum, HHS renewed its declaration of a public health emergency on the opioid crisis. Because the United States does not have a national health care delivery system – it’s a federation of state-regulated networks – such a declaration of a health emergency is needed to dedicate federal resources and ease regulatory roadblocks to deal with the opioid crisis. (Covid-19 pandemic efforts at the federal level were allowed under just such a public health emergency declaration.)

And the Trump White House claimed that it is committed to critical prevention and treatment measures (along with law enforcement and interdiction efforts) when it laid out its drug policy priorities earlier this year.

In other words, President Donald Trump says he’s committed to reducing overdose deaths. But then, as so often is the case with Trump, you need to look closely at what he and his administration actually do.

And the truth is that the Trump White House and HHS, led by his HHS secretary, Robert F. Kennedy Jr., have slashed the federal programs responding to the opioid crisis and fired thousands of workers responsible for overseeing and implementing these programs.

The first Trump budget submitted to Congress laid waste to core HHS programs dealing with the opioid crisis. Kennedy, meanwhile, fired hundreds of HHS career staff with the dedicated experience in dealing with the opioid crisis.

Here’s a very specific example. There are others just like this one.

Trump’s Office of National Drug Control Policy promised – as its very first objective laid out in its strategy for dealing with the opioid crisis – that it would “expand access to overdose prevention education and life-saving opioid overdose reversal medications like naloxone.”

But the naloxone vending machines across America and the funds to pay for local public health staff to track the opioid crisis were all funded by the Overdose Data to Action grants administered by CDC’s National Center for Injury Prevention and Control.

That CDC overdose center providing those grants that helped make so much progress in 2023 and 2024? Trump’s 2026 budget proposed to eliminate it entirely. Meanwhile, Trump’s HHS has already severely damaged the office with staff reductions.

What else did Trump’s 2026 budget propose? A recommendation to drastically reduce funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) – the HHS agency on the front lines of the drug overdose fight.

Which is why hundreds of researchers and health care providers sent a letter to Congress this week decrying Trump’s cuts to the HHS programs that have made considerable progress on the opioid crisis. The Trump budget cuts “certainly undermine the hard-fought progress we have made, especially in overdose prevention,” they wrote.

So, what are state and local health officials who relied on these federal HHS programs and funding out of CDC and SAMSHA supposed to think? Here’s what they’ll think: that Trump is all hat and no cattle. He promises and poses and talks about the big things he’s going to do – and then his administration does something else entirely.

In this case, Trump promised that his administration was going to make continued progress on fentanyl overdose deaths in America, which is an issue that millions of his GOP voters care about. But you know who made considerable progress on this crisis in 2023 and 2024, based on CDC’s new drug overdose report this week? Joe Biden did.

Jeff Nesbit was the assistant secretary of health for public affairs at HHS during the Biden administration.

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