When Robert F. Kennedy Jr. became president in February 2025, he broke new ground as the first secretary of health to openly recover from drug and alcohol addiction.
In his public appearance shortly thereafter, he delivered exactly the message that many drug use experts were hoping for, particularly that evidence-based drug therapy for treating opioid addiction will remain an essential part of the nation’s response to the drug overdose crisis.
“We have to do all the basic, practical, real things that you’re involved in,” President Kennedy said at the Rx Summit in Nashville in April 2025, drawing applause from doctors, patients and drug policy experts. “We need Suboxone, we need methadone, we need naltrexone, we need Narcan.”
But the Trump administration has taken a decidedly more negative stance toward drugs to treat opioid use disorder over the past year, raising alarms among public health experts, addiction doctors, and patient groups.
In April, the Substance Abuse and Mental Health Services Administration issued a “Dear Colleague” letter warning against long-term use of methadone or buprenorphine (drugs commonly known as Suboxone).
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“SAMHSA remains committed to expanding access to comprehensive, evidence-based treatments, including the use of medication…but we are equally committed to ensuring that medication is part of a path to long-term recovery and sobriety, self-sufficiency, and prosperity, rather than a default sentence of lifelong medication,” the agency wrote.
A year earlier, the Trump administration appointed Michael Stewart, a former West Virginia congressman best known in drug policy circles for introducing legislation to ban methadone treatment, as the top lawyer at the Department of Health and Human Services.
And in September, Rep. Erin Houchin (R-Ind.) introduced a bill in Congress that would effectively roll back important new flexibilities enacted by SAMHSA aimed at making methadone treatment more accessible.
Taken together, these actions represent a rekindling of Republican hostility toward drug therapy, which had become a largely settled issue in recent years.
Unlike other wealthy countries, the United States has long treated the drug with suspicion. Despite extensive data showing that methadone and buprenorphine are more than 50% less likely to die from a drug overdose when used to treat opioid addiction, medical, public health, and drug policy sectors have been slow to adopt methadone and buprenorphine.
Many conservatives have historically derided methadone and buprenorphine as “just substituting one drug for another,” as former Trump Health Secretary Tom Price said in 2017. But over the past decade, these drugs appeared to be gaining consensus across the political spectrum, especially as opioid overdose deaths reached record highs during the COVID-19 pandemic.
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“Translating clinical treatment into policy is really hard,” said addiction physician Ingvild Olsen, who served as director of the SAMHSA Substance Abuse Treatment Center until early 2025 and oversaw regulatory changes aimed at making methadone treatment more accessible and patient-friendly. “The wind is clearly shifting away from thinking about evidence-based methods of engaging drug users and people who may have drug use disorders, methods that are proven to engage people in care, toward a focus on punitive public safety.”
Although the administration itself has not taken a position directly opposing the use of methadone or buprenorphine, SAMHSA’s letter comes amid widespread pressure from President Kennedy and other Trump administration health policy leaders to reduce the public’s reliance on psychiatric drugs.
It also comes at a time when the country’s drug crisis is undergoing major changes. The number of overdose deaths has plummeted since 2022, recently falling below 70,000 per year for the first time since 2019. Separately, the Trump administration has shown significant interest in focusing on certain psychedelic drugs, such as ibogaine, as potential addiction treatments. Meanwhile, the addiction medicine community is buzzing about the potential for GLP-1 drugs like Ozempic and Wigovy, typically used to treat diabetes and obesity, to shift paradigms as addiction drugs that can suppress cravings.
Still, methadone and buprenorphine, and a third drug, naltrexone, remain the only three drugs approved by the Food and Drug Administration specifically to treat opioid dependence.
Public health experts acknowledge that these drugs are not widely used. Methadone, in particular, is only available in specialized clinics that require early morning visits multiple times a week. Frequent drug testing. and counseling.
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Still, these drugs themselves are opioids, so they can be difficult for patients to stop. In particular, rapidly reducing methadone doses can cause severe withdrawal symptoms and increase the risk of relapse.
In response to the Trump administration’s letter, experts are concerned that inexperienced addiction health care providers may try to quickly take patients off buprenorphine or discourage patients from seeking methadone at all. Data on discontinuation and long-term use are also somewhat shaky, but researchers agree that longer treatment periods yield better results.
“Many observational and experimental studies over long periods of time have shown that patients do better the longer they stay on medication, but many of the studies have been conducted over periods of only six months or a year,” said physician and researcher David Fierin, director of Yale’s Addiction Medicine Program. “Beyond about two years, we don’t have strong evidence. Still, studies consistently show that outcomes are best during the period when patients remain on the medication.”
Fierin and other addiction medicine experts said their strategy for patients is simple: continue to provide the drug as long as they and the patient jointly decide that the drug continues to be beneficial. In some cases, patients who no longer want to take the drug due to inconveniences or side effects may gradually reduce the amount of the drug and eventually stop the drug altogether.
It is unclear whether the Trump administration’s letter and other prominent Republicans’ hostility toward methadone indicate some deviation or a broader trend.
Stewart, a former West Virginia state lawmaker who was confirmed as HHS general counsel in October 2025, previously co-authored a bill that would have outlawed methadone clinics in the state. His bill, originally introduced in early 2024, failed to advance, and Stewart was recently reassigned to an unknown role within HHS following a NOTUS report that he invested in the stock of a major federal contractor.
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A bill introduced by Rep. Houchin of Indiana is directly aimed at new flexibilities that will be codified by SAMHSA in 2024. Her bill would again require patients to visit a methadone clinic in person every day during the first few months of treatment. It would reimpose the requirement that patients can only receive methadone treatment if they have been addicted to opioids for more than a year. and prohibits doctors from evaluating patients seeking methadone or buprenorphine via telemedicine.
The bill has drawn significant opposition from major addiction groups, has no co-sponsor, and has not received a hearing in the House Energy and Commerce Committee.
“If the bill passes as currently drafted, we will see even more opioid overdoses,” a coalition of organizations including the American Society of Addiction Medicine and the American Academy of Family Physicians said in a March 2026 letter.
Olsen, a former SAMHSA employee, said health care providers who treat addiction already work to understand patients’ goals and prescribe drugs only when they are beneficial. But she stressed that some patients may need to continue taking methadone or buprenorphine for the rest of their lives, just as people with diabetes need insulin or people with high cholesterol need statins.
“What’s confusing is what the purpose of that letter was,” she said. “If it strengthens current practice, that’s great. If it somehow signals that everyone who starts taking one of these drugs should come off the drug at some point, that’s not consistent with best practice, that’s not consistent with clinical guidelines, and that’s not consistent with evidence.”
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