With the anticipation of another Trump Administration, a question before us is what this means for the future of addiction and drug policy.
I’ve taken some time to ponder a set of issues, ranging from public health approaches to supply side issues based on the last Trump administration and in light of the broader political climate. Below are a few items for consideration:
Public Health
1. Medications for Opioid Use Disorder (OUD)
Status Quo Continuity: Expanding access to medications like methadone and buprenorphine is likely to continue under a Trump administration, especially given the strong bipartisan support for addressing the overdose crisis. While there may not be dramatic changes to the new methadone rules, expanded access to buprenorphine (especially for prescribers and telemedicine models) could gain traction. A key issue for the future will be how to ensure adequate funding and workforce support for clinicians prescribing these medications.
Potential Areas of Tension: Tensions often arise between concerns over social disruption, whether perceived or actual, and the public health needs of people with substance use disorder. The administration will likely take a few high-profile actions, couching them as swift and decisive, without fully embracing a public health-centric approach.
2. Harm Reduction Strategies
Naloxone and Syringe Services: Efforts to expand harm reduction programs like naloxone distribution may persist, but other tactics are less likely to be expanded under a Trump administration. Some local or state-level programs might still see growth, but federal support may be more muted—especially for syringe services programs. There will likely be continued resistance among those who see harm reduction as enabling or condoning drug use.
Focus on Law and Order: The administration is more likely to focus on enforcement and drug courts. This could include continuing support for police-led diversion programs that help people with substance use disorders avoid incarceration and get treatment, but with a focus on public safety.
3. Medications Access in Jails and Prisons
Uncertainty with 1115 Waivers: The continued use of Medicaid 1115 demonstration project waivers to provide treatment for opioid use disorder, including buprenorphine and methadone in jails and prisons, will likely face increased scrutiny. A Trump administration may push to restrict federal funding for these programs, especially as part of a broader effort to limit Medicaid costs.
Medications in Jails and Prisons: Expect more questions about continued support for programs that provide medications for OUD in jails and prisons, a critical issue considering the high rates of overdose deaths in the reentry population. If the administration prioritizes prison reform, access to medications may be preserved, but this will depend on the broader political landscape and funding considerations.
4. Law Enforcement and Diversion Programs
Drug Courts and Law Enforcement-Centric Approaches: Drug courts, pre-arrest diversion, and pre-trial diversion programs will likely continue to receive support under a Trump administration, in line with its previous emphasis on law enforcement approaches to the overdose crisis. These programs are popular with elected officials and policymakers who want to demonstrate their support for both public safety and treatment.
Supply Reduction Efforts
5. The Supply Side: Cryptocurrency and Money Laundering
Drug Trafficking: While much of the rhetoric about drug trafficking will continue to focus on the US-Mexico border, and migration issues will continue to be conflated with drug trafficking, questions remain about how the broader issue of drug trafficking by transnational criminal organizations will be addressed. For instance, what regulations will be implemented regarding drug trafficking on cryptocurrency platforms given the crypto industry’s support for the Trump campaign?
Relationship with China and Mexico: On the supply side, expect continued tension and diplomatic pressure directed at China for precursor chemicals and the fentanyl trade, and against Mexico for its role in trafficking fentanyl into the U.S. However, will the pressure match the political rhetoric? The next administration will also have to decide whether to once again include China on the list of major illicit drug producing countries.
6. ONDCP and Project 2025
Potential Scaling Back: Project 2025, with its plans to reorganize or scale back certain federal agencies, could lead to a reduced role for ONDCP (Office of National Drug Control Policy). If this happens, we could expect decreased interagency coordination and a less strategic direction for drug policy.
Reorganizations: The broader trend toward decentralization of federal power and reorganization of agencies may lead to ONDCP’s influence being diminished, potentially in favor of other agencies such as the Department of Justice or DEA. We can also anticipate a renewed effort to move the HIDTA and DFC grant programs out of ONDCP and into other federal agencies.
Implications for the Future
Ultimately, the next Trump administration will likely continue to focus on law enforcement solutions to drug policy, particularly those that connect drug treatment with criminal justice approaches. Look for an emphasis on drug policy through a criminal justice lens, rather than on public health initiatives that include low barrier options for services in the community.
Politically, the Trump administration may seek to leverage drug policy to demonstrate that it is tackling the overdose crisis without abandoning its central political themes, which tends to favor policies that prioritize “tough on crime” strategies.
There are additional wild cards that may change any predictions, including the role Robert Kennedy Jr. will play in addiction and public health policy, as well as questions over the continued existence of the Affordable Care Act. Drug policy will be a complex terrain to navigate in the next few years, especially as political, public health, and law enforcement priorities continue to intersect and evolve.
