Inside the Collapse of the America's Overdose Prevention Program

Scientific American

05-06-2025

At an addiction conference in Nashville, Tenn., in late April, U.S. Secretary of Health and Human Services Robert F. Kennedy, Jr., spoke about his own experience with drug use. 'Addiction is a source of misery. It's also a symptom of misery,' he said. Kennedy's very personal speech, however, ignored recent federal budget cuts and staffing reductions that could undo national drug programs' recent progress in reversing overdoses and treating substance use.
Several experts in the crowd, including Caleb Banta-Green, a research professor at the University of Washington, who studies addiction, furiously spoke up during Kennedy's speech. Banta-Green interrupted, shouting 'Believe science!' before being removed from the venue. (The Department of Health and Human Services did not respond to a request for comment for this article.)
'I had to stand up and say something,' says Banta-Green, who has spent his career working with people who use drugs and was a senior science adviser at the Office of National Drug Control Policy during the Obama administration. 'The general public needs to understand what is being dismantled and the very real impact it's going to have on them and their loved ones.'
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The Trump administration has defunded public health programs and made plans to consolidate or eliminate the systems that track their outcomes, making it difficult to monitor the deadly consequences of substance use, Banta-Green says. For instance, staff cuts to the Overdose Data to Action program and the Opioid Overdose Prevention and Surveillance program will hamper former tracking efforts at the Centers for Disease Control and Prevention and at local and state health departments' prevention programs. A recently fired policy analyst at the overdose prevention division at the CDC's National Center for Injury Prevention and Control— who wishes to remain anonymous, citing fear of retaliation—tells Scientific American that she used to provide policy support to teams at health departments in 49 states and shared public overdose data and information to Congress.
She is a veteran who should have had protected employment status, but she lost her job during federal cuts in February. 'No one else is doing surveillance and data collection and prevention like the CDC was,' she says. 'There's so much that's been cut.' (When approached for an interview by Scientific American, a CDC spokesperson said, 'Honestly, the new administration has changed how things normally work' and did not make anyone available for questions.)
What Gets Measured Gets Managed
Provisional data suggest that deaths from drug use declined by almost 25 percent in 2024, though overdoses remain the leading cause of death for Americans aged 18 to 44. Cuts to the National Survey on Drug Use and Health will make it difficult to measure similar statistics in the future.
Because substance use is highly stigmatized, Banta-Green says it's important to have diverse, localized and timely data from multiple agencies to accurately capture the need for services—and the ways they're actually used. 'You can't design public health or policy responses if you don't know the scale of the need,' he says.
Overdose trends vary by region—for example, usage of the synthetic opioid fentanyl appeared earlier on the East Coast than the West—so national averages can obscure critical local patterns. These regional differences can offer important insights into which interventions might be working, Banta-Green says. For instance, important medications such as naloxone rapidly reverse opioid overdoses in emergency situations. But getting people onto long-term medications, including methadone and buprenorphine, which reduce cravings and withdrawal symptoms, can more effectively prevent mortality in both the short and long term.
Declining deaths may also mask tragic underlying dynamics. Successful interventions may not be the only cause of a drop in overdoses; it could also be that the people who are most vulnerable to overdose have recently perished and that there are simply fewer remaining at risk. 'It's like a forest fire burning itself out,' Banta-Green says.
This underscores the need for the large-scale data collection threatened by the proposed budget and staff cuts at the CDC and National Institutes of Health, says Regina LaBelle, an addiction policy expert at Georgetown University. 'What [the administration is] doing is shortsighted' and doesn't appear to be based 'on the effectiveness or the outcomes of the programs that [it's] cutting,' she says. For example, despite promising to expand naloxone access, the Trump administration's latest budget proposal cuts funding for a critical program that distributes the lifesaving medication to first aid responders.
'A Chance at Redemption'
When LaBelle was acting director of the White House Office of National Drug Control Policy during the Biden administration, she led efforts to expand evidence-based programs that provided clean syringes and tested users' drugs for harmful substances. These strategies are often referred to as 'harm reduction,' which LaBelle describes as 'a way you can meet people where they are and give them the services they need to keep them from dying.'
José Martínez, a substance use counselor based in Buffalo, N.Y., says harm-reduction practices helped save his life. When Martínez got his first job as a peer advocate for people using drugs, he was still in a chaotic part of his own addiction and had been sleeping on the street and the subway—and regularly getting into fights—for a decade. The day after he was hired to help provide counseling on hepatitis C, he got into a New York City shelter. As his bruises healed, he learned life skills he was never taught at home. 'For a lot of people, drug use is a coping tool,' he says. 'The drug is rarely the problem. Drug use is really a symptom.'
Working with others who understood that many people need help minimizing risks gave Martínez a chance to make progress toward recovery in a way that he says abstinence-only treatment programs couldn't. 'I don't agree that somebody should be sober in order for them to do things different,' he says.
Over the past six years working for the National Harm Reduction Coalition, Martínez started a national support network for other peer program workers and community members—people who share their experiences and are a trusted source of education and support for others using drugs. 'There's never no time limit,' he says. 'Everybody works on their own pace.'
Though Martínez's program doesn't take federal funding, the Trump administration is cutting similar kinds of peer programs. Martínez says doing this peer work gives many users a sense of purpose and stability—and helps them avoid previous behaviors. The proposed 2026 federal budget will slash the CDC's opioid surveillance programs by $30 million. It also creates a new subdivision called the Administration for a Healthy America that will consolidate the agency's prevention work, along with existing programs at the Substance Abuse and Mental Health Services Agency (SAMHSA), which often coordinates grants for treatment programs. The programs formerly conducted through SAMHSA are also facing cuts of more than $1 billion. Advocates fear this will include a shift toward funding abstinence-only priorities, which, Martínez says, 'will definitely mean that we're going to have more overdoses.' (Some research suggests abstinence-based treatment actually puts people at a higher risk of fatal overdose than those who receive no treatment at all.)
'The general public needs to understand what is being dismantled and the very real impact it's going to have on them and their loved ones.' —Caleb Banta-Green, addiction research professor
These cuts could disproportionately affect communities already facing higher overdose rates: Martínez, who is Puerto Rican, notes that U.S. Black, Latino and Indigenous communities have experienced drug overdose death increases in recent years. In many states, overdose deaths in Black and brown communities remain high while white overdose death rates are declining. Looming cuts to Medicaid programs, LaBelle warns, are likely to worsen inequalities in health care access, which tends to make communities of color more vulnerable.
In Kentucky, where Governor Andy Beshear recently celebrated a 30 percent decline in overdose deaths, Shreeta Waldon, executive director of the Kentucky Harm Reduction Coalition, says the reality is more nuanced. While national overdose deaths declined in white populations from 2021 to 2023, for example, they continued to rise among people of color. Black and Latino communities often face barriers when accessing health services, many of which have been shaped by predominantly white institutions. Waldon says it's essential for people from diverse backgrounds to participate in policy decisions and necessary to ensure that opioid abatement funds —legal funds used toward treatment and prevention—are distributed fairly.
Without adequate federal funding, Waldon predicts treatment programs in Kentucky will become backlogged—potentially pushing more people into crisis situations that lead to emergency services or incarceration rather than to recovery. These financial and political pressures are not only making it harder to find support for people in crisis; they also reduce opportunities to discuss community needs. Waldon says she knows some social workers who now avoid terms such as 'Black woman' or 'marginalized' in grants and public talks out of fear of losing funding.
But people currently needing treatment for substance-use disorder are not necessarily aware of the federal funding news—or 'what's about to hit them when they try to go get treatment and they're hit with barriers,' Waldon says. 'That's way more important to me than trying to tailor the way I talk.'
Funding and staffing cuts don't just limit resources for the people most in need. They limit the ability to understand where someone is coming from, which undermines efforts to provide meaningful care, Martínez says. Harm reduction is more than the services and physical tools given to community members, he says. It's about the approach. 'When you look at a whole person, you plant the seed of health and dignity,' he says. 'If everybody deserves a chance at redemption, then we've got to rethink how we're approaching things.'