Something extraordinary is happening in the American overdose crisis.
Recent federal data show that annual drug overdose deaths fell by 27 percent in 2024. This marks an unprecedented reversal after two decades of almost uninterrupted increases in overdose deaths.
Overdose deaths were initially driven by prescription opioids in the 1990s, began to shift toward heroin in the early 2010s and, since 2015, have been driven mostly by illicit fentanyl.
There’s still a long way to go in the overdose crisis. More than 80,000 people are still dying annually of overdose, roughly the number heading into the COVID-19 pandemic when the fentanyl crisis was already raging.
But the Trump administration now has an extraordinary opportunity to achieve a lasting public health victory.
To its credit, the administration has been vocal about the threat posed by fentanyl. Within hours of reentering the White House, Trump pushed fentanyl to the center of his trade disputes with China and Mexico. The administration was correct to press China to clamp down on trafficking in fentanyl precursors and pressuring Mexico to eradicate cartel-run clandestine labs.
Meanwhile, Attorney General Pam Bondi has prominently touted the success of Drug Enforcement Administration law enforcement operations, publicizing major drug busts and tying these actions to border control. The Biden White House had also been engaging in diplomatic efforts to reduce the fentanyl supply and to disrupt cartels.
Research suggests that focused law enforcement operations can disrupt drug markets, at least over the short term. The problem is that these gains can be hard to sustain.
Clandestine labs can be shut down, only to reopen the next day. Fentanyl is potent, compact and easy to manufacture with simple kitchen tools. Intercepting shipments at the southern border has proven incredibly challenging — a single kilogram brick concealed in a car can supply the ingredients for 500,000 pressed pills.
Supply reductions won’t work without a focus on decreasing demand for fentanyl. Almost six million Americans have an opioid addiction, often sustained by using multiple times a day.
Somewhat paradoxically, squeezing supply can increase the risk of fatal overdose. If the Trump administration could squash the flow of fentanyl today, there would be millions of Americans who would be sick with opioid withdrawal tomorrow.
For a fortunate few who are able to give up opioids “cold turkey,” a rapid decrease in supply would be just what they need to stop using. But this strategy won’t work for most people who are seriously dependent on fentanyl. If and when they return to using fentanyl, they will have lower tolerance and be at much higher risk of death.
The good news is that there is a public health toolbox to help people with opioid addiction — tools that have undeniably contributed to the recent drop in overdose deaths.
Medications like methadone and buprenorphine treat the core symptoms of opioid addiction, such as craving and withdrawal. Medications cut overdose risk by more than half compared to treatment without medication. Naloxone paired with overdose education has been incredibly effective not only as a tool for first responders but for people who use drugs and their social networks.
For people who are still actively using drugs, fentanyl test strips and safer use supplies can guide more informed choices about whether and how to use drugs. Test strips are particularly useful for people who, for example, recreationally use cocaine and are seeking to avoid potent opioids.
The administration has endorsed these tools. The White House Office of National Drug Control gave medication treatment, naloxone and test strips a prominent place next to law enforcement in their first priorities. Health and Human Services Secretary Robert F. Kennedy Jr. has also supported methadone and buprenorphine.
But rhetoric won’t work without resources. DOGE has already downsized the Substance Abuse and Mental Health Services Administration, reducing the scope of its operations through staff reductions and cuts to grants. The White House now proposes to eliminate the agency altogether and absorb it into a new Administration for a Healthy America.
The SUPPORT Act, a bipartisan law that funds state and local government responses to the overdose crisis, just passed a renewal vote on the House floor. Congress, at the same time, is debating the most consequential cuts to Medicaid spending in decades in Trump’s “big beautiful bill,” putting in jeopardy the primary source of coverage that has expanded access to addiction treatment for millions of low-income Americans.
There’s still time for an “Aha” moment. Cracking down on international drug cartels was a good start, but maintaining resources to treat Americans with active addiction is needed to sustain the drop in overdose deaths.
Doing so would not only be smart politics — it would also live up to the promise of making America healthier.
Brendan Saloner, Ph.D., is a Bloomberg Professor of American Health in Addiction and Overdose in the Department of Health Policy and Management in the Johns Hopkins University School of Public Health.