In his first year back in office, President Trump reshaped U.S. drug policy and the response to fentanyl deaths in sweeping, often chaotic fashion, rapidly dismantling efforts launched by the Biden administration aimed at expanding drug treatment.
Many experts credit Biden-era public health policies with saving tens of thousands of lives. But with new laws, executive orders, budget cuts, and military redeployments, Trump pivoted the nation from those strategies to a militarized drug war.
"From day one of the Trump administration we declared an all-out war on the dealers, smugglers, traffickers and cartels," Trump said in July, during a signing ceremony for the Halt Fentanyl Act.
Trump has launched U.S. Naval strikes against alleged drug boats; designated drug cartels as terrorist organizations; classified fentanyl as a weapon of mass destruction; and deployed National Guard troops in American cities and along the U.S.-Mexico border.
Meanwhile, his administration threw into question support for even basic federally funded addiction treatment programs, at one point temporarily freezing $140 million in federal grants as front-line care providers scrambled to maintain services.
Scrapping the public health approach
Trump's rapid realignment of U.S. drug policy stems in part from his assertion that Biden's effort to reduce fentanyl deaths was a wholesale failure. Speaking this month, Trump made the false claim that "three hundred million people died last year from drugs."
Fentanyl deaths did surge in the first two years of the Biden administration, during the COVID pandemic. But fatal overdoses declined sharply in 2023 and 2024, as the Biden team raced to expand access to opioid-treatment medications, including buprenorphine and naloxone.
The Biden administration also boosted federal spending by tens of billions of dollars on addiction treatment, while embracing a "harm reduction" approach, providing Medicaid health insurance, housing and other services to people even if they weren't yet able or willing to stop using street drugs.
According to provisional data compiled by the Centers for Disease Control and Prevention, fatal overdoses in the U.S. plunged nearly 27 percent during Biden's last year in office.
"We've made gains. There are more people now being treated for substance use disorders and opioid use disorders," said Richard Frank, a drug policy researcher at the Brookings Institution. "That is largely due to the Medicaid (insurance) expansion."
But after returning to the White House, the Trump administration, working with GOP leaders in Congress, moved swiftly to strip roughly $1 trillion from Medicaid funding, including cuts to programs that support addiction care. In a July executive order, Trump also attacked harm reduction efforts, claiming without evidence that they "only facilitate illegal drug use."
The shift alarms many researchers, physicians, and drug policy analysts, who fear a resurgence of drug deaths.
"The biggest risk really of increasing overdose deaths is the Medicaid cutbacks," said Regina LaBelle, who briefly served as acting director of the White House Office of National Drug Control Policy under Biden and now teaches drug policy at Georgetown University. "It's not just about defunding harm reduction. They're also defunding prevention, treatment and recovery programs."
Fentanyl, a "weapon of mass destruction"
There's also growing evidence that Biden-era law enforcement and diplomatic efforts managed to disrupt the flow of fentanyl into the U.S., in part by convincing China to help reduce the sale of industrial "precursor" chemicals used to make street fentanyl.
"The important (Biden team) success was the cooperation with China that built up during 2024," said Vanda Felbab-Brown, who studies drug cartels and street drug trafficking at the Brookings Institution. "This included law enforcement cooperation and intelligence exchange and cooperation on anti-money laundering efforts."
Over the last 12 months, however, Trump and his team discounted the Biden team's efforts. Speaking in July, Trump suggested the deadly fentanyl crisis was "allowed to happen by people either that didn't care or were stupid people." He has also suggested that carnage from overdoses was so great it justified a militarized response.
"Two to three hundred thousand people die every year, that we know of, so we're formally classifying fentanyl as a weapon of mass destruction," Trump said in December, citing a statistic contradicted by federal data.
Research by the CDC, the U.S Drug Enforcement Administration, and other top U.S. drug researchers shows that drug deaths peaked in 2023 at roughly 115,000 deaths in a single 12-month period. The latest provisional CDC data shows roughly 76,500 fatal overdoses in the 12-month period ending in April 2025.
Indeed, many of Trump's new drug policy initiatives are based on claims that drug policy researchers describe as wildly inflated or wholly inaccurate. One of his first major fentanyl-related actions was an executive order signed in February imposing steep tariffs on Canadian products, because of what Trump described as Canada's "central role" in fentanyl smuggling.
But data from the U.S. Drug Enforcement Administration shows Canada plays almost no role in the U.S. fentanyl crisis. In 2024, roughly 43 pounds of fentanyl was seized at America's northern border. That compares with roughly 21,100 pounds seized at the southern border.
Top administration officials have also made exaggerated claims about progress made to reduce drug deaths during Trump's first year back in office.
During a cabinet meeting, Attorney General Pam Bondi said aggressive anti-drug policies had already saved 258 million American lives. In a separate post on social media, Bondi estimated the lives saved at a much lower figure, claiming roughly 119 million lives saved. Researchers who study the potential harm of fentanyl and other street drugs told NPR both claims are greatly inflated.
Today is Fentanyl Awareness day. In President Trump’s first 100 days we’ve seized over 22 million fentanyl laced pills, saving over 119 Million lives.
— Attorney General Pamela Bondi (@AGPamBondi) April 29, 2025
We are fighting relentlessly for the families of loved ones lost, for those whose lives are at risk, and for the soul of our… pic.twitter.com/nQLnN0nipn
Will blowing up boats stop fentanyl deaths in the U.S.?
Defense Secretary Pete Hegseth, meanwhile, has said Trump's military strikes near Venezuela are already having a deterrent effect on drug cartels.
"There aren't many people getting in boats right now running drugs, which is the whole point. We want to stop the poisoning of the American people," Hegseth said, during an appearance hosted by the Ronald Reagan Presidential Foundation.
The Trump administration has declined to offer evidence that boats targeted by the Navy are operated by cartel-linked smugglers. Researchers who study drug traffickers, including Felbab-Brown at Brookings, say even if some boats are carrying street drugs, they almost certainly aren't carrying fentanyl, the drug that accounts for most U.S. overdose deaths.
The latest U.S. National Drug Threat Assessment, published by the DEA in July 2025, says drug gangs in Mexico, not Venezuela, "remain the dominant threats" trafficking fentanyl into American communities.
Drug gangs, motivated by the lure of huge profits, have also developed flexible underground supply routes, which may be largely unaffected by military strikes that kill low-level gang members.
Critics of the Trump administration's approach told NPR the deterrent effect of a militarized U.S. drug war will also be hampered by Trump's decision over the last year to pardon or free a growing number of drug "kingpin" figures.
Since returning to office, Trump pardoned Ross Ulbricht, who was serving a life sentence after creating Silk Road, an internet site used to traffic fentanyl and other street drugs; pardoned Larry Hoover, former leader of the Chicago-based Gangster Disciples; and pardoned the former president of Honduras, Juan Orlando Hernandez, convicted on drug and weapons charges after governing his country as "a narco-state," according to a statement from the U.S. Justice Department.
"There's a lot of mixed messages and mixed signals [from the White House] which creates sort of chaos and uncertainty," said Jeffrey Singer, a drug policy analyst at the Cato Institute, in an interview with NPR in May. "On the one hand you're threatening even tougher penalties on people who deal in drugs, while on the other hand you're releasing drug dealers from prisons."
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