Trump Administration Extends Opioid Emergency as Overdoses Decline

The Trump administration announced on Wednesday that it would extend the emergency declaration linked to the opioid overdose crisis that was originally set to expire on March 21, indicating the administration’s continued approach to treating the opioid crisis as a national emergency.¹

The move comes as the Wall Street Journal reports that the number of drug overdoses has decreased in the past 12 months, equaling a 25% decline between October 2023 and October 2024.² Fatalities linked to synthetic opioids were the primary reason for the decline, as there were a smaller number of deaths related to this drug class.

However, even as these declines were reported, the number of deaths related to overdoses—totaling 82,000 in the 12-month period—were still higher than they were a decade ago. Unintentional drug overdose deaths increased from 6.3 per 100,000 in 2003 to 19.1 per 100,000 in 2019, with a further increase coming in 2023, increasing to a rate of 30.1 per 100,000.³ The decline in deaths related to drug overdose began in 2022, when it declined by 4% from 2022 to 2023 to 29.0 deaths per 100,000. The recent data show the continued trend of deaths declining, although the death rate still heavily outpaces that related to other unintentional deaths, such as motor vehicle accidents and falls.^2,3

The extension of the public health emergency comes as deaths due to overdose declined from 2023 to 2024 | Image credit: Kimberly Boyles - stock.adobe.com

A drop in the use of opioids could be among of the factors relating to the decrease in overdoses, with opioid use disorder declining each year since 2015. The availability of overdose-reversing drugs, such as buprenorphine, methadone, and naloxone, has likely also played a part in preventing overdoses. The FDA approved the use of naloxone nasal spray for OTC purchase,⁴ which improved the accessibility of life-saving drugs without the need for a prescription. The Biden administration had previously focused on making these treatments more readily available, including instructing employees on how to use overdose medications, distributing the medication for use by employees or customers, and keeping naloxone in an emergency kit.⁵

Addiction treatment and street drug recovery have also been helped by Medicaid coverage under the Affordable Care Act. Approximately 12% of beneficiaries using Medicaid have substance use disorder, and Medicaid accounted for 21% of spending for treating substance use disorder in 2009,⁶ which has likely increased since. The proposed cuts to Medicaid by the Trump administration⁷ may conflict with the extension of the opioid emergency, as cuts to Medicaid could hamper efforts to further decrease the rates of deaths related to drug overdose. Recent layoffs of federal workers who work on addiction at the Substance Abuse and Mental Health Services Administration, totaling 10% of their workforce,¹ could also complicate efforts to expand awareness and treatment for addiction.

The emergency declaration will last for approximately 90 days before it is set to expire again barring another extension. HHS Secretary Robert F. Kennedy Jr said in a statement that the public health emergency declaration will allow for flexibility when addressing the opioid crisis across the country.

References

1. Mann B. Trump administration extends opioid emergency as fentanyl deaths drop. NPR. March 19, 2025. Accessed March 20, 2025. https://www.npr.org/2025/03/19/nx-s1-5333651/opioid-trump-fentanyl-emergency-overdose
2. Wernau J, Abbott B. Drug overdoses are on the decline, in charts. Wall Street Journal. March 20, 2025. Accessed March 20, 2025. https://www.wsj.com/health/drug-overdoses-are-on-the-decline-in-charts-d55403bd
3. Curtin SC. Trends in death rates for leading methods of injury: United States, 2003-2023. CDC. March 2025. Accessed March 20, 2025. https://www.cdc.gov/nchs/products/databriefs/db526.htm
4. Bonavitacola J. Deaths due to opioid overdose fall for the 12th consecutive month. AJMC^®. November 14, 2024. Accessed March 20, 2025. https://www.ajmc.com/view/deaths-due-to-opioid-overdose-fall-for-the-12th-consecutive-month
5. HealthDay. Biden administration calls for greater access to overdose antidote. U.S. News & World Report. March 13, 2024. Accessed March 20, 2025. https://www.usnews.com/news/health-news/articles/2024-03-13/biden-administration-calls-for-greater-access-to-overdose-antidote
6. Substance use disorders. Medicaid.gov. Accessed March 20, 2025. https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/substance-use-disorders/index.html
7. Bonavitacola J. Trump endorses budget that would slash Medicaid funding. AJMC. February 20, 2025. Accessed March 20, 2025. https://www.ajmc.com/view/trump-endorses-budget-that-would-slash-medicaid-funding