Shortly after President Donald Trump won the 2024 election, I predicted what his second administration might mean for drug and addiction policy.

I thought that a future Trump administration was likely to prioritize law enforcement and criminal justice–oriented drug policies over broad public health approaches, even while maintaining some support for treatment and overdose prevention.

Many of those predictions have become reality. But in the meantime, the hundreds of thousands of people who have lost their lives to overdose deaths involving fentanyl, and their families and communities left behind, are being used as a tool to achieve other goals.

In its quest to reshape U.S. relationships in the Western Hemisphere, the Trump administration is radically recasting the overdose crisis and the central role fentanyl plays. It has interwoven the fentanyl issue into international policy discussions, even with countries that have little to do with the U.S. overdose problem. 

The reframe underlies the nation’s federal drug policy and our current approach to global affairs.  Take, for example, the recently released National Security Strategy (NSS). Prior versions of the NSS cast the effort to disrupt transnational criminal organizations (TCOs) as part of a global effort reliant upon diplomatic efforts and coordinated with our foreign partners. The 2025 version puts an America First spin on stopping TCOs via the “Trump Corollary” to the 1823 Monroe Doctrine, which asserts U.S. primacy over the Americas. 

The result is a drug policy strategy heavy on symbolism and short on results. 

The Fentanyl Narrative

Today, a constant stream of public messaging inextricably links immigration enforcement and illicit fentanyl in the public’s mind. The central narrative driving the administration’s approach to immigration is simple: The fentanyl pouring across the border is brought by unauthorized migrants; therefore, the solution is tighter border control.

Unfortunately, this narrative not only suggests immigration enforcement is the single strategy to drive down overdose deaths and drug use in the U.S. It also has left investments in research and public health for the opioid epidemic weakened, stalled, or placed at risk. 

Fentanyl entering the U.S. is primarily smuggled into the country by U.S. citizens.

The link between immigration and fentanyl is nothing new; the belief that migrants are responsible for fentanyl deaths predates the second Trump administration. A 2022 NPR–Ipsos poll found that nearly half of the U.S. public believed migrants were bringing fentanyl into the country and driving up overdose deaths.

Yet the facts don’t support this belief. Fentanyl entering the U.S. is primarily smuggled into the country by U.S. citizens. Further, Customs and Border Protection data show that most illicit drugs are interdicted at ports of entry, not between ports where unauthorized migration typically occurs.  

In addition to its messaging about drugs and migrants, the second Trump administration is using fentanyl to transform international politics. It has found a way to use the very serious issue of overdose deaths to justify increased tariffs against Canada, traditionally one of our closest allies. 

The optics are powerful; the connection is not.

The tariffs imposed on Canada were done in the name of fentanyl control, even as the Drug Enforcement Administration’s own threat assessment states that fentanyl flow from Canada is minimal. Canada now has a “fentanyl czar,” not because of data or evidence, but solely to pressure Canada on other, unrelated issues.

Even actions taken against the failed state of Venezuela have been swept into the fentanyl narrative. The administration has framed highly publicized maritime interdictions and the capture of Nicolás Maduro as part of a fentanyl crackdown, despite the fact that Venezuela is not a source of illicit fentanyl. 

The optics are powerful; the connection is not. 

Funding Cuts Put the Nation’s Health at Risk

The good news is that overdose deaths are declining, and have been since 2023. But the crisis is far from over. Alaska Native, American Indian, and Black communities continue to experience disproportionately high overdose death rates. And in a ten year period, over 300,000 children lost a parent to overdose, creating a long-term bow wave with potential repercussions for generations.

The Trump administration’s One Big Beautiful Bill, or Reconciliation Act, signed into law in July 2025 represents the most significant change to addiction coverage in a decade. The Congressional Budget Office estimates that by 2034, 10 million people will become uninsured due to provisions in this act, placing people with substance use disorder at great risk.

Major cuts to Medicaid and the administration’s relentless efforts to cut congressionally appropriated grants that prevent, treat, and help people recover from substance use disorders put the nation’s health at risk. 

Just recently, the administration sent termination notices to grant recipients nationwide; a total of $2 billion in congressionally approved grants were ordered terminated immediately. The terminated programs included aid to pregnant and parenting women with substance use disorder, prevention of underage alcohol use, providing first responders with overdose prevention tools, and drug court funding. 

After a public outcry, the administration relented and reversed course, all within 24 hours. Fortunately, the administration’s budget proposal calling for further cuts to grant funding has, to date, been rejected by the U.S. House of Representatives and Senate.

We Can’t Go It Alone 

My service in both the Obama and Biden administrations in the Office of National Drug Control and Policy has provided me with a unique perspective on the flaws and promise of a robust, all- of-the-above strategy to address substance use disorder and overdose deaths in the nation. These strategies rely upon public health tactics that meet people where they are while providing access to services that improve their chances at long-term recovery. 

At the same time, we cannot mitigate drug problems without relying on  multilateral efforts to disrupt transnational organized crime. 

A global effort is necessary to prevent the proliferation of money laundering and other criminal activity that threatens and destabilizes democratic institutions. The U.S. cannot stop rogue actors by itself when transnational criminal organizations operate without regard to borders and across numerous criminal enterprises. TCOs traffic in drugs, people, fuel, and sometimes even avocados. Countering TCOs relies upon international cooperation. 

You can’t arrest your way out of the epidemic, but you can defund your way into a deadlier one.

Part of the disconnect in the current administration’s approach to TCOs is the critical role of money laundering, the fuel that keeps TCOs operating. Here again, the administration’s rhetoric doesn’t match the reality. 

In the past year, the president has pardoned numerous people previously convicted of financial crimes linked to drug trafficking. For example, the administration pardoned the founder of Silk Road, the dark web drug marketplace connected to six overdose deaths; he pardoned the former Honduran President who was successfully tried in U.S. courts on drug trafficking charges; and, finally, he pardoned the Binance co-founder who pled guilty to failing to prevent money laundering on his crypto platform. 

Tackling drug trafficking is a critical challenge that requires both transparency and global cooperation. Money laundering is part of a vast global network and intelligence sharing as well as international law enforcement efforts are necessary to address it. 

America First rhetoric may resonate politically. But it is not a substitute for public health efforts, and a go-it-alone strategy won’t stop transnational criminal organizations. It’s often been said that you can’t arrest your way out of the epidemic, but you can defund your way into a deadlier one.