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The US has recorded a historic drop in overdose deaths. The Trump administration’s campaign to slash spending and reduce the federal workforce could reverse this fragile progress, public health experts say
Published : 11 Apr 2025, 04:25 PM
Federal spending cuts instigated by the White House threaten to reverse a steep decline in American overdose deaths and are jeopardising other gains in the battle against synthetic opioids, people on the front lines of the anti-narcotics fight say.
Government drug researchers have been sacked. One of the nation’s premier narcotics testing labs has furloughed chemists who test the potency of illicit drugs. A Pennsylvania outreach centre that distributed thousands of doses of lifesaving overdose-reversal medication has closed its doors. An Illinois nonprofit that works to reduce overdose deaths in communities of colour is slated to lose grants worth 60 percent of its budget. The office of federal workers who conduct the nation’s only annual survey on drug use has been gutted.
To piece together how the Trump administration’s actions could affect the nation’s overdose crisis, Reuters spoke with more than three dozen current and former US health officials, public health experts, community-level harm reduction advocates and recently fired federal workers. Their warning was stark: Layoffs and funding cuts are dismantling the carefully constructed health infrastructure that drove the number of overdose deaths down by tens of thousands last year.
“We’re finally seeing smart investments bear fruit, and then suddenly eliminating what works is going to have very sinister consequences for progress on overdose prevention,” said Leo Beletsky, professor of law and health sciences at Northeastern University in Boston.
The damage is spreading fast. Robert Ashford, executive director of Unity Recovery, which runs drug outreach programs in Texas and Pennsylvania, got word last week that his Pennsylvania operation was due to lose $1.2 million – nearly 20 percent of its budget – almost immediately. The money was part of federal grants, funneled through Pennsylvania and other states, that have been targeted for elimination by the Trump administration.
Unity Recovery quickly shuttered its Philadelphia location, cut hours at its Pittsburgh office in half, and laid off 23 workers who offered healthcare, food, counseling and drug addiction services to about 8,000 people a month.
There’s a chance that funding could be restored, thanks to an April 3 federal court ruling that blocked the Trump cuts, at least temporarily. But Ashford isn’t budging until that money is firmly in hand. “If we open and don't get those dollars back, it puts us at risk of closing everything,” he said.
The cutbacks come alongside Trump’s high-profile moves to crack down on cartel drug smuggling and production, and to threaten Mexico with crushing tariffs unless it slows the flow of fentanyl into the United States. The Trump administration believes its efforts will “help build a safer, healthier future for America,” a White House spokesman said.
These efforts are part of a return to an enforcement-heavy approach to America’s narcotics addiction crisis, a strategy that focuses on stopping drugs from reaching US users, and de-prioritizes efforts to curtail demand, public health experts and former US officials say.
But so far, fentanyl prices in four cities across the country suggest the administration's efforts have done little to nothing to reduce supply, according to Reuters’ interviews with more than four dozen fentanyl users.
In a 2024 investigation, “Fentanyl Express,” Reuters showed how efforts by the Biden and first Trump administrations to disrupt the fentanyl supply chain had failed, but that a medication called naloxone was helping to keep thousands of users alive, driving down overdose deaths even as the synthetic opioid pipeline remained wide open.
For the first time since the dawn of the so-called war on drugs in the 1970s, the US has been experiencing a sustained and sharp reduction in overdose deaths. The drop is widely attributed to expanded investment in public health programs and the work of local harm reduction groups armed with naloxone, a potent overdose antidote.
Overdose fatalities for all drugs in the 12 months ending Oct 31, 2024, fell 25 percent to 84,000 compared to the same period a year earlier, according to the most recent data compiled by the US Centers for Disease Control and Prevention.
The drop in deaths was even sharper for synthetic opioids, the vast majority due to fentanyl overdoses. Over the same period, synthetic opioid fatalities fell by 33 percent to 52,400.
The White House has listed reducing overdose deaths, including through expanded access to naloxone, at the top of its 2025 drug control priorities. But some public health experts and street-level outreach groups say the administration’s targeted funding cuts have, as in the case of Unity Recovery, accomplished just the opposite.
The nonprofit’s Pennsylvania staffers hand out about 30,000 doses of naloxone annually, building trust in neighborhoods to get it into the hands of drug users who need it most. That medication helped slash total drug overdose deaths in Pennsylvania by 30 percent over the 12-month period ending in October 2024, compared to the same period a year earlier, CDC data shows.
“To cut the entire networks of care that resulted in the drop in overdoses?” said Unity Recovery’s Ashford. “It's so shortsighted. It lacks any strategy.”
‘DRAMATIC RESTRUCTURING’
In late March, nonprofits around the country received notices that their grants would be ending after the Trump administration tried to claw back around $11 billion in unspent federal grants to states and localities that were allocated by the Biden administration.
Originally granted as part of COVID-era stimulus packages, the funds were being used by states to prevent and control infectious diseases, track mental health services and fund addiction treatment.
On Apr 3, a federal judge temporarily halted the cancellation, saying the sudden termination had caused “direct and irreparable harm to public health.” The Trump administration has pushed back, asking for a stay of the order pending appeal.
Meanwhile, Trump’s Health and Human Services Secretary Robert F. Kennedy Jr. is slashing some 20,000 employees as part of a “dramatic restructuring” of the department.
Among the hardest hit by those layoffs has been a small federal agency called the Substance Abuse and Mental Health Services Administration, or SAMHSA, which helps states expand access to naloxone and other opioid treatments.
SAMHSA has been gutted by at least two rounds of layoffs in recent weeks. It has also paused a flagship overdose prevention initiative that provides technical assistance to help states most effectively expand access to naloxone, according to a top official at SAMHSA who spoke on the condition of anonymity.
The Department of Health and Human Services said in a statement that it is committed to “addressing the opioid overdose crisis” and that “critical programs within HHS will continue.”
The Biden administration made naloxone available over the counter and persuaded Congress to fund its distribution nationwide. Dr. Rahul Gupta, who oversaw Biden’s push as director of the White House Office of National Drug Control Policy, said Trump’s cuts are taking a “sledgehammer” to local programs he credits as the primary cause of the reduction in overdose deaths.
“People will die as a consequence,” he said. “There’s no doubt about it. Lives are dependent upon the availability of life-saving medications like naloxone.”
The CDC, the premier US public health organization and a major player in the fentanyl crisis response, is also in the Trump administration’s crosshairs. Some 2,400 CDC employees are due to be sacked. The targets also include 1,200 workers at the National Institutes of Health, which funds cutting-edge research into the synthetic opioid crisis, including how to use new medicines to help people manage addiction.
Senate Republicans also are debating large reductions in funding for Medicaid, the government insurance program for the poor, to help achieve $1.5 trillion to $2 trillion in spending cuts over the next decade laid out in Trump’s budget blueprint. That could cut off millions of Americans from access to treatment for their opioid addiction.
It’s too early to say whether these measures have led to an increase in overdose deaths, as researchers fear. The most recent CDC data on synthetic opioid deaths runs through October 2024, months before Trump took office.
For those on the front lines of the fentanyl crisis, the abrupt changes out of Washington are confusing and disorienting, said Alice Bell, director of overdose services at Prevention Point Pittsburgh, a Pennsylvania nonprofit that helps drug users. “It’s something like flash bangs,” Bell said, referring to stun grenades.
Her group so far has escaped cuts, but it’s hard to make long-term decisions now because she said she no longer views the federal government as a reliable partner.
In its statement, Health and Human Services said it was prioritizing funding projects that would “Make America Healthy Again.”
“The taxpayer dollars we saved were originally set to be wasted on a non-existent pandemic Americans moved on from years ago,” the statement said.
FENTANYL FLOWING ON THE STREETS
Trump favors a get-tough approach to fentanyl that has centered on law enforcement, tariffs and a crackdown on migrants. Since returning to office, he has designated Mexican drug cartels as terrorist organizations and threatened unilateral military action against them.
On Feb. 1, he issued an executive order targeting imported goods from Mexico and Canada with 25 percent duties, ostensibly to force these nations to stem the flow of drugs and fentanyl precursors into the United States, although he later exempted goods covered by a North American free trade deal. In that executive order, Trump directly linked the drug crisis to his efforts to harden the border and expel millions of immigrants living in the country illegally. US border officials have long said the vast majority of fentanyl smuggling is done by American citizens, however.
One action by Trump could disrupt the illicit trade: He signed an executive order last week prohibiting Chinese goods from entering the US through a streamlined and duty-free entry system known as “de minimis.” Last year, Reuters revealed how chemical smugglers have exploited this US trade provision to sneak fentanyl precursors into the US before routing them to Mexico to be synthesized into street fentanyl. The Trump administration called the closing of this provision for Chinese goods a “critical step” in ending the US fentanyl epidemic.
But these moves have meant nothing for Steve Dzeguan, a 52-year-old fentanyl user in South Philadelphia.
On a recent morning, he stood near the corner of Kensington Avenue and East Orleans Street holding a frosted donut and a hot container of instant ramen noodles, still giddy from the fentanyl he said he’d injected an hour earlier. Nearby, two unconscious men lay sprawled on the curb. One was missing a shoe. Four Philadelphia police officers walked past chatting among themselves, never glancing at the men. Dzeguan said he’s paying $3 to $5 for a bag of fentanyl that lasts him a day, perhaps less. It has cost that much as long as he can remember.
“Nothing has changed here,” Dzeguan said, referring to the price of fentanyl. He and others scoffed at the idea that the Trump administration had cut down on the supply of fentanyl on US streets. “The fucking politicians are really bullshitters,” Dzeguan said.
Reuters asked more than 50 fentanyl users in Philadelphia, Boston, San Francisco, and Columbus, Ohio, about the prices they’re paying for fentanyl on the streets. Almost all said prices had been stable for months, and in some cases years.
Pricing data shared by law enforcement in Minnesota and Los Angeles showed that a gram of fentanyl was slightly cheaper today than in 2023. A former senior US official with knowledge of current price trends said that prices across the country were generally consistent over the last year and have dropped in some areas.
Illicit fentanyl is commonly sold either by the gram or by single-dose, tenth-of-a-gram bags sometimes called “points.” In Boston, in and around the intersection of Massachusetts Avenue and Melnea Cass Boulevard, called Methadone Mile by some locals, the price is between $30 and $40 a gram, virtually unchanged from last year.
In the Hilltop neighborhood of Columbus, Ohio, it is about $110 per gram, also unchanged. In the area around Kensington and Allegheny avenues of South Philadelphia, the price has dropped from about $50 a gram to as low as $30. The price is steady at around $60 a gram in the Tenderloin area of San Francisco.
In South Philly, Nicole Didomenico, 28, smoked a cigarette as she struggled to stand and talk. She recalled a few numbers: Seven years ago, when she started using fentanyl, a bag cost her $10. Last summer, she paid $5, and now sometimes pays $3 a bag, which equates to about $30 a gram.
Along Boston's Methadone Mile, Ron, 45, said he has been using drugs for 20 years, and that fentanyl remains cheap and ubiquitous. “There’s no drought,” he said.
Many fentanyl users described how naloxone had repeatedly saved their lives – and that they, in turn, always carry naloxone to be able to save others.
In San Francisco’s Tenderloin neighborhood, 21-year-old Rafael, with a heart-shaped tattoo on his cheek, credits naloxone with resuscitating him a half dozen times. “As many people as have saved me, I’ve saved others,” he said.
APPROVALS DELAYED
Caught up in the confusion about what the federal government will or won’t fund was a Pennsylvania testing lab that spots emerging drug threats, including new versions of fentanyl that are particularly lethal.
Alex Krotulski runs the Center for Forensic Science Research and Education, considered by health specialists to be one of the leading drug testing facilities nationwide. Reuters used it to test fentanyl precursor chemicals its reporters purchased from China as part of the Fentanyl Express investigation into the drug’s supply chain. The lab identified a previously unknown fentanyl precursor ingredient that Reuters brought in for analysis. Identifying such chemicals is crucial to law enforcement efforts to intercept shipments and stay on top of drug developments.
Earlier this year, the center had to furlough 11 people: two administrative workers and nine of the lab’s 30 chemists and assistants, after $4 million in federal grants were delayed for months, Krotulski said.
The center’s $2 million US State Department grant to test drugs seized at the border was held up as part of a global funding freeze that temporarily paralyzed the Department’s Bureau of International Narcotics and Law Enforcement Affairs’ programs, including counter-fentanyl efforts in Mexico. It was finally approved in mid-March.
A State Department official said the agency has been working “to review every dollar spent” to ensure that “taxpayer resources are being used to make America safer, stronger, and more prosperous.”
Another $2 million US Justice Department grant to monitor fentanyl sold on the streets for purity and adulterants – data the center shares with the US Drug Enforcement Administration and other agencies – was also held up for months.
Krotulski said a grant manager at DOJ told him the funding was held up because his center happens to reside in a so-called sanctuary jurisdiction. That would be Pennsylvania’s Montgomery County, which like scores of other places in the United States, limits its participation in federal immigration enforcement.
Trump issued an executive order on Jan. 20 that directed federal agencies to ensure that communities deemed insufficiently cooperative with US Immigration and Customs Enforcement would not have access to federal funds.
Shortly after Reuters contacted Montgomery County for comment, Krotulski said he received an email from his DOJ grant manager saying that final approvals were in the works. A day later, the grant was approved. He hopes the center will rehire laid-off staff but isn’t sure how long that might take.
The Justice Department said the grant went through the normal approval steps and that there were no instructions for its approval to be delayed. The official said “it is not factual” that the delay was related to the center’s location in Montgomery County or the jurisdiction’s policies.
Megan Alt, spokeswoman for Montgomery County, said she was not aware that funding for Krotulski’s lab was caught up in the dispute.
“If it is true that the federal government has paused funding for a nonprofit organization's program that saves lives by enabling the early identification of fentanyl, then the federal government’s actions will lead to more unsafe drugs in our streets and fewer resources to help,” Alt said.
A CHILLING EFFECT
The cuts to the US public health system come as Trump is also cracking down on so-called diversity, equity and inclusion (DEI) initiatives. That combination poses a particular risk for racial minority groups, who have not experienced a decrease in overdose deaths in the way that white communities have.
From 2021 to 2023, overdose deaths fell 9 percent for white Americans. Among minorities, however, they increased by 12 percent over the same period, according to CDC data. Despite the drop, whites still accounted for the majority of overdose deaths.
Health researchers are still studying why there’s been such a stark divergence in death trends, and why African Americans and Native Americans are dying at far higher rates than whites.
One reason, says Tracie Gardner, executive director of the National Black Harm Reduction Network, is that effective treatment and life-saving interventions such as naloxone haven’t reached communities of color as quickly or expansively as they have for white communities.
Public health specialists say such divergence in overdose trends means it’s important for treatment and harm reduction efforts to be tailored specifically to the most at-risk demographic groups.
There have been some examples of success. In Missouri, for example, officials ramped up naloxone distribution in Black neighborhoods to tackle the disproportionate overdose rates among Black men, who were dying at rates three times higher than white men. The results were dramatic: In the first half of 2024, overdose deaths among Black men plunged more than 50 percent, declining to 61 from 131 during the same period in 2023.
But programs that serve these communities and researchers who study these disparities are getting caught up in the administration’s DEI rollback and funding cuts.
They include the Northern Illinois Recovery Community Organization, a nonprofit that teaches people to administer naloxone and distributes drug testing strips, especially in communities of color. The organization estimates it will lose 60 percent of its $650,000 operating budget for the next fiscal year due to federal spending cuts, said the group's CEO, Dr Mary Roberson.
The National Institutes of Health has terminated grants to study drug use and treatment among specific racial and gender groups. SAMHSA, the substance-abuse agency, was forced to purge its website of some studies and fact sheets about drug prevention and treatment to comply with Trump’s executive orders around gender and DEI programs, said Scott Gagnon, the former New England regional director for the agency.
“There’s been a real chilling effect on being able to address vulnerable populations and marginalized populations,” said Gagnon, who was among those sacked at SAMHSA. He is now on administrative leave as some of the firings are challenged in court.
Last week, staff cuts at SAMHSA gutted the entire 17-person office responsible for the nation’s only annual national survey on drug use and mental health.
This survey, which is congressionally mandated, captures detailed demographic data on race and gender. That makes it a key tool that states and local aid groups rely on to tailor drug treatment and harm reduction programs to people most at risk, said Jennifer Hoenig, director of the office.
She lost her job last week.
