Above photo: AP Photo/Matt Rourke.
Trump’s drug war policies weaponize the overdose crisis to wage class war.
And will ultimately only make the crisis worse.
Since his inauguration, Donald Trump has been on a relentless spree, pushing policy after policy and executive order after executive order. From rollbacks on environmental regulations to attacks on immigrants, many of these will inevitably affect public health and well being. No matter how random a decision or policy may seem, an underlying theme of Trump’s rhetoric is an effort to divide the working class, identifying already marginalized groups as “the enemy” or “the problem.” This is an effort to misdirect the righteous anger of the public away from crises caused by capitalism and toward groups that are negatively affected by the same capitalist system.
One of the areas we see this most starkly is around substance use and the overdose epidemic. Trump and his administration say they care about or want to address the overdose crisis, but in reality, beyond using public anger to divide the working class, the policies the administration puts forward to address substance use and the opioid epidemic will not curb drug use or overdose, instead make things worse.
The Opioid Epidemic And Trump’s Harmful Policies
Up until this point the Trump administration has put forward a variety of policy measures related to the opioid epidemic. Trump issued executive actions against cartels, designating them as foreign terrorist organizations and expanding surveillance efforts by drone. His administration has gone back and forth around threatening tariffs on Mexico, China, and Canada stating that their goal is to curb the flow of drugs like fentanyl. Trump himself has also floated the idea of the death penalty for those convicted of dealing illegal drugs. More recently, during a speech to the Department of Justice Trump even put forward the idea to appeal to “vanity” by launching a public health campaign around how drugs “ruin your look.”
Aspects of many of these policies were summarized in a document released by the administration entitled “Statement of Drug Policy Priorities.” The document, one of the first to outline on paper what policies the administration will actually pursue in regards to substance use and addiction, contains a mix of law enforcement based strategies and medical treatment proposals.
To date, Trump has been largely silent on policies supporting harm reduction measures, though this document does mention making naloxone and drug test strips available to communities. Harm reduction is an overall approach or philosophy that aims to minimize the negative consequences of drug use—such as overdose, disease or illness, and stigma—without requiring abstinence, but instead meeting people where they are at the moment based on their goals. Harm reduction measures can include offering a naloxone and drug test strips, along with various medications for substance use disorders—measures the administration at least mentions in its document—but it also can include giving access to clean syringes, supervised consumption sites or overdose prevention centers (OPCs), drug checking services, and even safe supply programs to name just a few modalities—measures not mentioned at all. Overall, the approach behind harm reduction is one that centers around humanizing and protecting the well-being of those using substances while acknowledging they may continue to consume substances. In this light there should be no surprise it went without mention in the administration’s policy document as the administration’s rhetoric around substances has always focused on othering and criminalizing populations—and regions—as the reason for the opioid epidemic.
While we have discussed the true causes of addiction and overdose in the past, even within the narrow confines of capitalist solutions, Trump’s analysis of the situation and proposed solutions remain nonsensical. As NPR has noted, prior to the introduction of tariffs, the opioid crisis was already showing signs of improvement. Fatal overdoses from fentanyl and other street drugs fell by more than 21% from June 2023 onward, dropping below 90,000 deaths for the first time in nearly five years. These drops are theorized to largely be due to the expansion of the same harm reduction measures Trump refuses to even mention in his policy documents—measures centered in a framework, antithetical to the divisive politics Trump centers in his overdose response. This framework is one that focuses on not stigmatizing substance use or human beings but instead meeting people where they are with love, compassion and respect.
The Political Use Of Drug Control
Trump wages his “war on drugs” as part of a different war, a war on the working class, one to divide, atomize, and attack sectors of the international working class, blaming them for the crises of capitalism. To be clear, this is not a new tactic as governments throughout history have utilized drugs to both criminalize populations and consolidate power. In David Musto’s Origins of Narcotic Control, he reveals how drug policy has been employed to target marginalized communities, from Chinese immigrants in the late 1800s to Black activists in the 1970s. Even seemingly innocuous substances like salt and tea were once considered “drugs” and regulated for political purposes.
As Susan Reiss notes in We Sell Drugs, the modern history of drug control, particularly around dividing and controlling sectors of the international working class, goes deep. Throughout the 20th century, “Drug control was institutionalized through market regulations to secure adequate supplies of drugs while limiting and delineating the legal boundaries of their circulation.” Various measures, culminating in the 1961 Single Convention on Narcotic Drugs, “selectively authorized participation in cultivating, manufacturing, and distributing drugs that effectively advanced US geopolitical and economic dominance.” As she notes, “drug control has always been about economic power” and drugs in general “constitute part of a powerful arsenal that the government flexibly deploys to wage war and to demonstrate its capacity to bring health, peace, and economic prosperity.”
Today Trump’s administration pursues a similar strategy to the past. The overdose epidemic is used as a guise to advance US imperialist policy toward countries like Mexico. His tariffs, for instance, are a smokescreen for xenophobic and imperialist goals, rather than being a genuine effort to address substance use. At the same time it is used to frame people coming to the US as the enemy, an enemy which, according to Trump, is at least connected to, if not responsible for, fueling the overdose epidemic in the US. Through this type of rhetoric Trump seeks to divide sectors of the poor and working class, pitting them against each other.
Making The Crisis Worse, While Escalating The War On The Working Class
We need to be clear, Trump’s drug war policies are not merely ineffective—they are actively destructive and will inevitably exacerbate the overdose crisis while intensifying state violence against the working class at home and abroad. Far from addressing the epidemic’s roots in the systemic violence of capitalism, his administration’s approach weaponizes public health failures to justify austerity, carceral expansion, and imperialist intervention.
As reported by the Wall Street Journal, almost immediately at the start of his term, the Trump administration directed federal judges to impose harsher sentences for drug crimes, effectively ensuring more substance users—disproportionately from poor, Black, and Latinx communities—are swept into the prison system. Beyond following a more punitive philosophy on drug use, Trump’s revival of 90s-style “tough-on-crime” policies also double as a spatial fix for capitalism’s failures, using mass incarceration to manage populations made surplus by deindustrialization and austerity. Meanwhile, on the front of incarceration, reports show federal prisons have implemented deadly cost-cutting measures, halting coverage of long-acting forms of medication assisted treatment (MAT) like injectable buprenorphine. These changes force incarcerated people to often endure dangerous medication transitions to sublingual forms of medication or go without treatment entirely, which will ultimately put folks at increased risk of overdose and death.
The administration is also making funding cuts and adjustments in government agencies that will put people’s health at risk. The administration has proposed a merger of the Substance Abuse and Mental Health Services Administration (SAMHSA), along with several other agencies, under a new agency called the Administration for a Healthy America (AHA). The merger signals coming cuts to essential addiction services at the hands of Elon Musk’s Department of Government Efficiency (DOGE). These cuts will come under the guise of greater “efficiency” and cost savings, but actually are a continuation of the neoliberal tradition of dismantling social safety nets. Restructurings like these occur at the same time there are layoffs at frontline harm reduction organizations because of the Trump administration cutting grant funding broadly. At OnPoint NYC for example, the overdose prevention center where I work, which is also the nation’s first overdose prevention center, staff have already been laid off because of budget cuts. Such reductions in staffing directly threaten lives. The administration’s active hostility toward harm reduction—an approach proven to reduce overdose deaths—reveals its true priority: maintaining the punitive approach to drug use rather than saving lives.
And the destructive measures extend beyond national borders. Trump’s designation of Mexican drug networks as “terrorist organizations” provides cover for military intervention south of the border including potentially drone surveillance. As we have noted, these moves are particularly cynical as “‘’organized crime’ prospered thanks to the encouragement and participation of high-level officials from various Mexican and Central American governments.” Further,
U.S. imperialism supplies weapons not only to the armed forces of the countries of the region, but also to these so-called organized crime organizations. The weapons are sold primarily out of Arizona, California, New Mexico, and Texas. These dealings have been well-known even as far back as the first Obama administration, which oversaw Operation Fast to Furious from 2009 to 2011.
Meanwhile, those largely responsible for helping create the opioid crisis such as large pharmaceutical companies go unpunished. As a Stanford-Lancet commission report found, it is clear that pharmaceutical companies like Johnson & Johnson, McKesson, Cardinal Health, and AmerisourceBergen helped create the opioid crisis in the 1990s as “poor regulation of the pharmaceutical and healthcare industry facilitated a quadrupling of opioid prescribing for profit.”
Furthermore, so many of the administration’s current policies literally manufacture the actual trauma that drives addiction. For example, the administration’s family separation policies and ICE raids are fuel for such trauma. As studies show, adults with adverse childhood experiences (ACEs) are 4.3 times more likely to develop substance use disorders and “emotional neglect, sexual abuse and physical abuse were the strongest individual ACE predictors for this association” all factors that are likely to increase as precarity deepens as capitalist crisis grows. Trump’s policies massively increase the risk of all of the risk factors and will only create a situation where more and more individuals are at risk of dangerous relationships with substances.
Finally, the administration’s rhetoric and policies compound the deadly stigma surrounding drug use, deterring people from seeking medical care and worsening outcomes for chronic conditions like wounds and HIV. As we have noted, criminalization ensures illicit drugs become increasingly dangerous—the rise of fentanyl/xylazine cocktails being a direct result of prohibitionist policies. This creates a contradiction: the state’s “solutions” actually expand the very underground markets they claim to target, while pharmaceutical companies continue profiting from both addiction medications and the opioids that started the crisis. The result is a self-sustaining system of trauma and profit, where each overdose death becomes an argument for further repression rather than an indictment of capitalism’s systemic failure.
The Real Solution: A Working-Class Approach
Trump’s policies are a clear example of how ruling-class governments use drug policy to further their interests at the expense of the working class. They are not new and instead are in line with a long history of using discussions around drugs to further policies that attack the poor and working class. Unfortunately, the Trump administration’s approach will only worsen the opioid epidemic, tearing families apart and pushing more people into precarious situations that make them more likely to self-medicate with dangerous substances. Criminalization, stigmatization, and insufficient access to care will lead to more overdose deaths, as people will be less likely to seek help due to fear of legal repercussions.
The real solution to the opioid crisis lies in a working-class approach—one that focuses on decriminalizing drugs, expanding harm reduction measures, along with addressing the systemic causes of addiction, such as the violence and alienation inherent in capitalism. These solutions will not come from Trump or any other capitalist politician. Their policies will continue to make things worse, while working-class people bear the brunt of the pain and suffering.
Ultimately, the overdose crisis is a product of capitalism and only a radical, working-class solution can address it.