President Donald Trump’s nominee for health secretary, Robert F. Kennedy Jr., said during his Senate confirmation hearing yesterday that substance use services were a "priority” to him should he be elected to lead the Department of Health and Human Services (HHS). Kennedy has been outspoken about his own experience using heroin and seeking help through Alcoholics Anonymous.
“I go to twelve-step meetings everyday,” Kennedy said at the confirmation hearing. “I hear many stories about the barriers to access to [addiction] care, and we need to improve that.”
Kennedy, a noted conspiracy theorist, has a reputation for ignoring or even opposing science when it comes to public health, and many are concerned that his “tough love” approach to the overdose crisis could make the disaster even worse. Especially when paired with the Trump administration’s drug policy, which experts say tends to focus more on criminalization than public health.
“We know that people who are engaged in abstinence-based treatment are actually more likely to die of an overdose,” said Maritza Perez Medina, the director of Federal Affairs at the Drug Policy Alliance. “What we need is a number of evidence-based treatment options for people, and I am concerned that [Kennedy] doesn’t follow the evidence or the science.”
Between 2023 and 2024, overdose deaths declined for the first time since the 1990s — by an astounding 14%, according to data from the Centers for Disease Control and Prevention (CDC). Many factors likely contributed to the decline, including the increase in availability of life-saving overdose reversal medications like naloxone and medication-assisted treatment like buprenorphine, along with decades of harm reduction efforts that ramped up the availability of things like syringe access programs.
Former President Joe Biden was the first president in U.S. history to endorse a harm reduction strategy at the federal level, making naloxone available over the counter and investing $82 billion in treatment facilities. Biden was also instrumental in passing the Affordable Care Act (ACA) in 2010, which along with its Medicaid expansions, funds treatment for some 40% of adults with opioid use disorder. (An error page now occurs when trying to access the White House official website describing the Biden Administration’s response to the overdose crisis, though a backup still exists on Archive.org.)
"They are using fentanyl and the overdose crisis as a reason to criminalize immigrant communities."
In the first administration, Trump did acknowledge the overdose crisis as a public health emergency and also ramped up naloxone distribution. He also signed the SUPPORT Act, which increased research flexibility for agencies studying substance use and made medicines like buprenorphine more accessible.
But in spite of this, Trump also tried to repeal elements of the ACA and cut funding for the Office of National Drug Control Policy, although these initiatives were blocked by Congress. Fentanyl analogs were also reclassified as controlled substances carrying the highest penalty in 2018 under the Trump Administration — but as repeatedly demonstrated throughout the last century of prohibition, banning more drugs isn't going to stop overdoses. Ultimately, the Government Accountability Office issued a report that concluded the prior Trump Administration failed to come up with a national strategy to combat the overdose crisis in 2017 and 2018.
“The playbook that he and this administration and the party are going with is that they are very much anti-harm reduction,” said Dr. Ryan Marino, an emergency medicine physician at Case Western Reserve University School of Medicine.
The first Trump Administration prohibited federal funding to go toward purchasing fentanyl test strips, said Regina LaBelle, the founder and director of the Addiction and Public Policy Initiative at the O'Neill Institute at Georgetown University.
Supervised consumption sites that recently or are in the process of opening in the Northeast also face an uncertain future under the new Trump Administration, which filed a lawsuit against one of these sites in Philadelphia that blocked them from opening.
As HHS Secretary, Kennedy would have the power to control many budgets that influence addiction treatment and prevention, heading agencies like the Substance Abuse and Mental Health Services Administration, the CDC, and the National Institute on Drug Abuse.
Kennedy has said he was open to using safe consumption sites, and has also endorsed the idea of creating a national network of “healing farms,” that use twelve-step programs like AA. However, addiction treatment specialists have said this approach would likely be inaccessible and ineffective for many with substance use disorder.
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“His proposal that people should be put on farms is something that the government actually did try, and it was incredibly problematic,” Marino told Salon in a phone interview, citing treatment farms created in the 1930s that have been criticized for unethically performing human experiments on people using drugs.
The Trump Administration could put prohibitions on federal funding that goes toward specific programs, like syringe access programs, LaBelle, who also served as the acting director of the White House Office of National Drug Control Policy under Biden.
“A lot of what will affect people who have a substance use disorder or are in need of health care are the budget decisions that are going to be made in the coming months,” LaBelle told Salon in a phone interview. “The majority of people who receive treatment receive [publicly funded] treatment, so the question remains: If the funding goes away, how does that affect the average person with a substance use disorder?”
In his first week in office this go-round, Trump has already issued a flurry of executive orders that seem to favor a criminalization approach over a public health-centered one. In one, he promised to crack down on immigration to reduce the illicit drug supply.
“From the get-go, they are using fentanyl and the overdose crisis as a reason to criminalize immigrant communities, militarize the border, and pursue high-level criminal charges,” Medina told Salon in a phone interview. “That is really concerning.”
Trump issued another executive order pardoning Ross Ulbricht, the founder of the underground Silk Road marketplace fueled by cryptocurrency. According to the BBC, Ulbricht was "convicted in 2015 in New York in a narcotics and money-laundering conspiracy and sentenced to life in prison." However, some have said the pardon was a means of fulfilling a promise Trump made during his campaign to crypto donors.
“While many of the actions of the Trump Administration will be focused on the criminal justice side and law enforcement approach, the fact that the president, when he was campaigning, supported marijuana legalization in Florida and freed the founder of the Silk Road is a bit of a cognitive dissonance,” LaBelle said.
This confounding strategy has been called a “flood the system” approach that often knocks the political system off-balance. Harm reduction and initiatives designed to fight the overdose crisis will likely soon be cut in the crosshairs of it.
“He's just very inconsistent,” Marino said. “It seems like the most consistent thing that you get from Trump is that everything he stands for is opposing harm reduction.”
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