We've finally slowed the surge in overdose deaths. The Trump admin may undo all of it
On May 14, 2025, the Division of Overdose Prevention at the Centers for Disease Control and Prevention announced that the number of overdose deaths in 2024 had dropped 27%. This was an extraordinary, even historic announcement, given overdoses had risen relentlessly for more than 33 years, resulting in the deaths of more than a million Americans, with another 1 million projected to die before this decade is over. Now, for more than a year, overdose deaths have decreased every single month, most dramatically for deaths caused by illicit fentanyl — considered the toughest problem, given the opioid's high potency, simplicity of manufacture, and ease of smuggling.
That very same day, the new Secretary of Health and Human Services, Robert F. Kennedy Jr., in testimony before Congress, made no reference to overdoses, the number one killer of Americans 18 to 44 years of age, nor to the recent success. A week later, in his agency's 72-page 'Making America Healthy Again' manifesto, the word 'opioid' was never mentioned. Instead, he went on to propose that CDC should be disassembled, along with the other principal agencies responsible for addressing the overdose crisis. Those proposals, as part of the administration's 2026 fiscal year budget, passed the House and await action by the Senate.
For nearly thirty years I was a CDC scientist. I have been outspokenly critical of how CDC and those other agencies have handled the opioid crisis, but the solution is not to take a wrecking ball to the institutions that protect us, particularly when we seem to be making progress. What will be the consequences? A health secretary who systematically ignores mention of the major killer of adult Americans is clearly not interested in research on what could account for a decrease in deaths.
But among recent national initiatives, the push to increase availability of the opioid overdose antidote, naloxone (brand name Narcan), has clearly played a role. Between 2021 and 2023, the number of naloxone doses dispensed from retail pharmacies doubled, and millions of additional doses were distributed by harm reduction organizations. Then in March 2023, the Food and Drug Administration approved over-the-counter distribution of a nasal spray version.
By the end of the year, 20 million doses had been dispensed. The decline in overdose death rates started the month after the nasal spray became widely available. Temporal sequence is not causation, but in a public health crisis, a plausible step is mass distribution of an antidote easily administered by lay persons. Few interventions in medicine are more cost-effective than saving a life in ten seconds for $25.
Shortly after being put in charge of the U.S. health care system in February 2025, Kennedy, called for immediate decreased funding for naloxone. And he didn't stop there. Slated for abolition is the National Institute for Drug Abuse, the research group at the National Institutes of Health that helped develop the nasal version of naloxone. NIDA is currently researching opioid analgesics with lower addiction risk and developing wastewater detection systems to provide early warning of new illicit drugs. What is left of NIDA will be absorbed, with other decimated institutes, into a single entity focused on 'behavioral health.'Also on the chopping block is the Substance Abuse and Mental Health Services Administration, which provides the major funding for state and local naloxone distribution and drug treatment programs. CDC's Division of Overdose Prevention, which is responsible for monitoring the drug epidemic, is marked for demolition too, despite having just reported the unprecedented reduction in overdose deaths. Adding to the threat of a renewed overdose explosion, the CDC issued the stark warning of a seven-fold rise in overdoses from illicit carfentanil, an opioid 100 times more potent than fentanyl — so potent that the drug is used to sedate elephants and minuscule amounts can easily kill a person. Remnants of SAMHSA and the CDC's Division of Overdose Prevention will be folded into the new 'Agency for Healthy America." Even if we assume that every cent of the budgets of the three cancelled drug control groups is eliminated, the total reduction in the federal budget would be one-tenth of one percent, or considerably less than the cost of one aircraft carrier.
According to the new director of the Office of Management and Budget, Russell Vought, these transformations should be done in a way to assure that the federal workforce will 'be traumatically affected,' and 'viewed as the villains.' What should the few remaining traumatically affected villains do about the drug crisis? Kennedy, who attributes his heroin recovery to 12-step abstinence, made that clear in his 2024 documentary: 'We're going to build hundreds of healing farms' — places where people with addiction 'learn the discipline of hard work' and 'get re-parented,' all the while bringing 'a new industry to these forgotten corners of America.' Antidotes, treatment, prevention? These are at best irrelevant — more likely, a moral hazard.
The first thing you learn in public health is that all victories are temporary. Back in 2000, the CDC group where I worked demonstrated that ongoing transmission of measles — the most infectious pathogen known to humankind — had been eliminated from the U.S., thanks to nationwide hard work to raise immunization levels. A quarter-century later, because of lowered immunization levels consequent to a torrent of vaccine misinformation by Kennedy and others, there have been more than 1,000 measles cases in 30 states over the first five months of this year.
The question is now before Congress: If the agencies battling the drug epidemic are disabled, will a renewed explosion of deaths result? The last time the current president was in office, overdose rates rose more than 44% over the course of his tenure — the largest overdose increase in American history, with more than 300,000 lives lost. This time, we may never know if history is repeating itself since the systems that monitor overdose deaths are themselves subject to elimination. However, families of future overdose victims may still wonder if 2025 was the year we helped make Americans die again.
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