President Trump's First 100 Days: Addiction Policy

President Donald Trump marked 100 days in office on April 29th. His second term has in many ways been very different than the first, including the administration’s actions to address the addiction and overdose crisis. Below, ASAM breaks down the biggest developments impacting addiction treatment since January 20th, including what sets these actions apart from the first Trump administration. 

1. HHS Staffing + Grants Cuts

Secretary Kennedy finalized plans that reduced the workforce of the Department of Health and Human Services (HHS) by 20%, including plans to significantly consolidate agencies, including the Substance Abuse and Mental Health Services Administration (SAMHSA) into a new Administration for a Healthy America (AHA). See ASAM’s statement about that here. There are reportedly plans to go further, teeing up what is likely to be a spirited debate in Congress about the proposals.  

The Administration has also cut back on Congressionally appropriated SAMHSA grant funds that fund some treatment and wrap-around supports in states. 

2. New Focus on Chronic Disease

President Trump’s Health and Human Services (HHS) Secretary Robert Kennedy, Jr. has shifted HHS's focus to chronic disease, with a newly formed Make America Healthy Again (MAHA) Commission in tow. The administration has not clarified whether addiction is included in the focus on chronic disease, but ASAM has asked as much. The new commission’s focus is different than the commission employed during President Trump’s first term which was solely focused on addressing the addiction and overdose crisis. At this confirmation hearing, Kennedy agreed that medications for opioid use disorder (MOUD) were the standard for treatment. Stakeholders are still awaiting more information on how HHS and CMS under his leadership intend to navigate the addiction policy landscape. 

3. ONDCP Priorities

The White House Office of National Drug Control Policy (ONDCP)’s 2025 statement of drug policy priorities speaks of reducing overdoses, targeted actions on the supply-side, decreasing the domestic availability of illicit drugs, a promotional campaign focused on prevention, ensuring availability of medications for opioid use disorder, bolstering peer recovery support services, and using research to identify new tools. See ASAM’s response here.   

4. Medicare Advantage Cost Sharing

The outgoing Biden administration proposed limits on cost-sharing for behavioral health benefits under the Medicare Advantage program. ASAM applauded the proposal at the time. However, in a final rule released by the Trump administration, the Centers for Medicare and Medicaid Services (CMS) declined to finalize the proposal and instead said they would address it in future rulemaking. 

What’s different? 

The grant and staffing cuts at HHS are a departure from the first Trump administration, as well as the newfound focus on addressing the underlying contributors to chronic disease. The first Trump term was focused intently on healthcare, including a push for a major overhaul of the Affordable Care Act and Medicaid. So far, the second term has focused more on trade, immigration, and the federal bureaucracy, though Medicaid cuts are still on the table.  

Additionally, the first term was marked by a focus on addiction treatment, including the passage of the SUPPORT Act that made major changes to federal policy and expanded addiction treatment. So far, the new administration appears more focused on addressing addiction through actions such as tariffs levied at Mexico posed as holding the country accountable for fentanyl crossing the border into the United States. The administration has also designated some drug cartels as Foreign Terrorist Organizations, an official designation that allows a stronger law enforcement response. 

What’s next? 

1. Deregulation

The Administration has placed a big focus on eliminating/reducing regulations. Specifically, orders have tasked executive agencies with identifying 10 regulations for repeal for every regulation it promulgates. Other areas of focus have included addressing anti-competitive behavior, including in healthcare. ASAM recently teed up the area of methadone regulation for the Administration’s consideration, aimed at improving access to addiction treatment.  
 

2. Medicaid Policy Changes?

Congress is considering massive policy changes to Medicaid. While plans have not been finalized, experts have warned that certain changes could impact program eligibility, benefits, and enrollment. ASAM has joined efforts calling on Congress to protect Medicaid, especially for people with substance use disorder. The House Energy and Commerce Committee is expected to meet the week of May 12th to consider proposals to cut as much as $880 billion of Medicaid spending over a decade – a move that would force states to make very hard budget choices and could imperil access to addiction treatment. 
 

3. Renewal of Marketplace Subsidies?

Enhanced subsidies for people with health insurance plans on the marketplace are set to expire at the end of 2025. Unless Congress acts, almost everyone with a marketplace plan will see their insurance premiums rise in 2026. This could force some people to drop their health insurance all together, imperiling access to addiction treatment to those with these plans. It is unclear whether the administration will support renewing the enhanced subsidies or other measures to combat a rise in premiums. 

4. Pharmaceutical Tariffs?

The administration has suggested that it could levy tariffs on pharmaceuticals that are manufactured overseas. They have already begun an investigation into the national security implications of drug imports. There is the potential for this to weigh on medications for SUD that are manufactured overseas, which include some forms of buprenorphine and medications for alcohol use disorder – a condition that has already been impacted by shortages of acamprosate.  
 

5. Scheduling Review of Buprenorphine?

On Tuesday, April 29th, the House Energy and Commerce Committee passed the SUPPORT for Patients and Communities Reauthorization Act of 2025 (H.R. 2483), a section of which directs HHS/DEA to review data to consider the rescheduling of combo buprenorphine/naloxone products. Given the rescheduling of marijuana is currently still working its way through the regulatory process, it is unlikely that this process for combo buprenorphine/naloxone products would be completed by this year. 

ASAM intends to keep a close eye on all these developments. Be sure to subscribe to ASAM’s Advocacy updates (here) to stay in the know!