President Donald J. Trump's public health agenda, “Make America Healthy Again,” aims to address a broad range of public health challenges, ranging from chronic diseases like obesity, diabetes, and cardiovascular disease to systemic issues like poor diet, environmental toxins, and over-medication. However, overshadowed in this agenda is one of the nation's most urgent health epidemics—the overdose crisis, which has claimed over a million lives since the late 1990s.1
Trump's rhetoric on the overdose crisis emphasizes law enforcement-focused strategies, such as disrupting fentanyl trafficking, imposing tariffs on imports from Canada, Mexico, and China, and increasing funding for U.S. Customs and Border Protection. Yet, domestic production of illicit fentanyl and other synthetic adulterants remains a major driver of overdose deaths, undermining border-focused enforcement. More critically, these policies fail to address the fundamental issue: over 50 million Americans struggle with addiction, yet only 1 in 5 receive treatment.2
One of the administration's most controversial proposals, led by U.S. Secretary of Health and Human Services Robert F. Kennedy Jr., is the establishment of “healing farms”—rural communities promoting abstinence-based recovery through labor and a 12-step, faith-centered model. Yet history warns of the pitfalls of such an approach. The U.S. Narcotic Farm in Lexington, KY, implemented similar methods in the 1930s, combining detoxification, manual labor, and music therapy. However, its failure to incorporate medication-assisted treatment resulted in a staggering 90% relapse rate.3 Evidence overwhelmingly supports medications for opioid use disorder (MOUD) such as buprenorphine, methadone, and naltrexone as the gold standard for OUD treatment, yet they remain deprioritised in Trump's plan. Abstinence-based programs also overlook broader structural drivers of addiction, including economic and housing instability, perpetuating social disparities in access to treatment.
Additionally, broader threats to public health infrastructure—particularly the Trump administration's proposed rollbacks of the Affordable Care Act (ACA) and Medicaid coverage—could severely restrict access to lifesaving treatment for individuals with OUD. Medicaid currently covers nearly 40% of non-elderly adults with OUD,4 making it the largest payer for substance use disorder treatment in the country. Its expansion under the ACA significantly improved MOUD access.5 Weakening Medicaid coverage and eliminating ACA-mandated preventive services, therefore, could increase opioid-related morbidity and mortality.
The overdose epidemic remains one of the most pressing national public health crises, and as healthcare professionals, it is our ethical duty to advocate for policies that prioritise evidence-based treatments and protect vulnerable populations. In the face of policies that threaten population health, silence is not an option.
Contributors
SM and DZ conceptualized, revised, and drafted the manuscript.
Declaration of interests
The authors all declare no competing interests.
Acknowledgements
No funding was received for this work.
References
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