A few weeks ago I got into a pretty heated discussion with a woman whose son died of an overdose. She had been adamantly opposed to Kamala Harris and believed Donald Trump would make things better for people like her son.
Last week Trump cut a billion dollars in funding for substance use treatment.
The sudden reduction was part of a broader, $12 billion reduction in health services provided by the federal government through state programs. Coloradans will lose about $250 million due to those cuts. The programs affected will either be scaled back dramatically or shuttered altogether.
While state legislators scramble to backfill where possible, the truth is that the hole is simply too deep. Like medical professionals in the aftermath of a mass shooting, they must triage what is salvageable from what is already a lost cause. Communities across the state — particularly in poorer, more rural locales — will see their services disappear overnight.
That will lead to pain, suffering and death.
For mental health and substance misuse care, that means people already struggling to climb out of a dark pit will find the stairs beneath them crumbling and falling away. In turn, many will plummet back into the abyss.
What makes that more tragic is that overdose deaths had been curbed to a plateau over the past few years and began dropping significantly by January 2024.
While the opioid crisis has plagued America for decades, the COVID pandemic exacerbated the problem. Deaths jumped 32%, to 93,331, between 2019 and 2020, after the pandemic hit. The upward trend continued through February 2022 when the 12-month moving average leveled out at around 110,000 deaths. What started as a slow decline beginning in June 2023 became a steep drop by January 2024.
Cumulatively, the country saw a 26% reduction in overdose fatalities between June 2023 and October 2024 (the latest data available). The 82,020 deaths marked the lowest point since just after the COVID pandemic began.
Theories explaining the drop range from less potent drugs to better public health. But most experts agree that the increased availability of Narcan should be credited for saving many of those lives. When administered soon after a fentanyl overdose begins, the nasal spray is highly effective and rapid in reversing the effects.
The Biden Administration made that a priority during its four years in office. They made doses free and put funds behind education programs so that any member of the public could administer it. Companies, schools and other organizations began stocking doses. Individuals, particularly those who used drugs, carried them in purses and on their persons.
Here in Colorado, the campaign included well-known media personalities like Kyle Clark, who used his show, NEXT with Kyle Clark, to tell people he began carrying a dose with him and asked others to do the same.
Effectively, the Biden Administration helped to turn everyday citizens into the first line of defense. And first responders across the country, who previously arrived too late to aid an overdose victim, saw the results first hand. People saving people. That was a huge win.
The Biden Administration also backstopped that with funds, administered through the states, that helped aid people who misused substances to deal with their addiction. The resources provided helped reduce the number of people susceptible to an overdose in the first place.
Now the Trump Administration threatens to undermine those gains.
In the name of eliminating fraud and waste, they have cut the funds that saved those lives. The same programs may not be available to people in need in the future. Programs that helped buy and distribute Narcan may face budget cuts — or be eliminated entirely. The places where people sought help dealing with addiction and substance use disorders will be limited and available only to those who can afford them.
Public health programs that had targeted areas with higher rates of overdose deaths may fold. That is the reality created by this sudden, ill-conceived decision. And that is without considering cuts to Medicaid, which has become a prime target for Trump and Republicans in Congress.
The effects will not be immediate. There will not be a sudden jump back up to 110,000 deaths next month. But expect the steep decline to level out soon. Eventually, as more and more programs shutter, the rates could begin to rise again. Hopefully they will never see the same post-COVID peaks, but there will still be tens of thousands more lives lost than if Harris had been elected.
I do not know if the woman who so misunderstood the actual record of the Biden Administration will ever understand that Harris would have saved lives. But the families who lose loved ones over the next four years and beyond might. They are the ones who will have to look back and wonder if Trump’s policies put people in early graves.
Mario Nicolais is an attorney and columnist who writes on law enforcement, the legal system, health care and public policy. Follow him on BlueSky: @MarioNicolais.bsky.social.
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