The new year and new presidential administration could mark a significant shift in the U.S. response to the opioid crisis.
While drug deaths trended steadily upward under President Donald Trump, they skyrocketed during Covid-19 and in the early years of the Biden administration, reaching an annual peak of roughly 110,000 in 2023. Though overdose mortality has since begun to decline, the toxic, fentanyl-driven illicit drug supply is still killing Americans at astonishing rates.
Trump’s return to power likely marks 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 illicit drug smuggling, or to impose the death penalty on drug dealers. More broadly, many Americans appear to have become less tolerant in their view of people with addiction, especially in light of ongoing frustrations with drug use in traditionally Democratic cities like Portland, Ore., San Francisco, and Philadelphia.
In November, Californians voted overwhelmingly to impose tougher penalties on some drug-related crimes, and in 2023, Oregon’s legislature voted to recriminalize drug possession, less than four years after a statewide ballot initiative eliminated misdemeanor drug charges.
Much of the frustration appears to center on the philosophy of harm reduction: measures meant to improve drug users’ health and safety without demanding that they immediately stop using. Many such measures, like syringe exchange or the use of test strips used to detect fentanyl, are effective and largely uncontroversial. But the moniker “harm reduction” has come to serve as a shorthand for cities’ hands-off approach to public drug use and open-air drug markets, to the dismay of experts who endorse a more coordinated approach.
The rightward swing in attitudes toward drug use is also evident in the philosophy of Robert F. Kennedy Jr., Trump’s pick 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 police role in drug policy, arguing drug users must “hit bottom” before their recovery can begin.
Overall, 2025 is likely to feature significant discourse about the future of drug policy, addiction treatment, and harm reduction. Below, STAT lays out three key questions that will shape the U.S. response to the addiction and overdose epidemic.
Will Trump and Pam Bondi crack down on supervised consumption?
The first Trump administration was staunchly opposed to the practice of supervised consumption, a harm reduction strategy whereby 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 sued in federal court, successfully preventing the organization from moving forward. In an op-ed, Rod Rosenstein, the deputy attorney general, wrote that “injection sites destroy the surrounding community” and baselessly suggested that “a bystander or emergency medical worker who comes into contact with such drugs can be gravely harmed.”
Now, though, the facts on the ground are different. Supervised consumption in the U.S. is no longer hypothetical: OnPoint NYC, a New York nonprofit, now operates two sites in Upper Manhattan, and a separate organization in Providence, R.I., recently held a groundbreaking for its own site. The Vermont and Minnesota legislatures, too, have passed laws allowing for supervised consumption sites to open.
Notably, Kennedy expressed openness to supervised consumption while on the campaign trail. In one instance, he directly said he would consider employing the strategy if he knew it to be effective, and at numerous points throughout his independent bid for president, he endorsed the Netherlands’ response to its own drug crisis decades ago, which included opening dozens of supervised consumption sites.
But the sites do still violate a federal law commonly known as the “crack house statute,” which prohibits operating facilities for the purpose of consuming illegal drugs. With multiple 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.
How does Kennedy feel about methadone and buprenorphine?
Though he is better known for his opposition to fluoride in water, vaccine skepticism, and advocacy surrounding nutrition, Kennedy made the opioid crisis a focal point of his independent bid for president. While campaigning, he filmed “Recovering America,” a documentary focused on addiction, highlighting several approaches that Kennedy viewed as potential solutions worthy of government support.
Arguably his signature proposal is the establishment of hundreds of “wellness farms” where people could pursue addiction recovery while spending time outdoors and participating in vocational training. Kennedy’s documentary also featured multiple drug court judges, an Amsterdam public health official, and a trauma therapist.
Notably, however, the documentary — and Kennedy’s remarks about addiction more generally — have avoided any mention of the gold-standard medications used to treat opioid addiction: methadone and buprenorphine.
People taking either medication are vastly less likely to die of an overdose, and in the fentanyl era, addiction medicine experts view them as the only realistic means of stopping illicit opioid use. But at least one doctor in Kennedy’s orbit, Drew Pinsky — a media personality known as “Dr. Drew” — has expressed skepticism about the medications.
Kennedy is a major proponent of Alcoholics Anonymous and the 12-step philosophy of addiction recovery. He has said he attends as many as nine meetings per week, and as a presidential candidate, pledged to hold one in the White House. Narcotics Anonymous, a 12-step offshoot focused on opioids, has historically opposed the medications’ use.
Will the DEA allow buprenorphine to be prescribed via telehealth?
Under President Biden, the Drug Enforcement Administration spent roughly two years repeatedly delaying a critical drug policy decision: whether to let providers continue freely providing buprenorphine via telehealth.
While doctors and other health providers were once required to conduct an in-person examination before writing a buprenorphine prescription, emergency rules issued during the Covid-19 pandemic allowed them to initiate the medication via telehealth. Many addiction treatment providers whose business focuses on telehealth have flourished since 2020, and many addiction medicine advocates have celebrated the change, arguing it has improved access to treatment.
Buprenorphine is rarely used recreationally, and overdoses involving buprenorphine are exceedingly uncommon. Still, however, the DEA has appeared intent on restoring many of the rules that existed prior to the pandemic. Following the latest extension, the temporary rule allowing for greater flexibility now expires at the end of 2025. But the DEA needs to reach a final decision at some point, and now is free to do so under an administration that is likely to favor a greater law enforcement role in responding to the overdose crisis.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.