Ale del Pinal of the West Oakland Punks With Lunch harm reduction program readies boxes of Naloxone for distribution in 2022. Gov. Gavin Newsom says the state’s CalRx-branded naloxone is lowering the cost of the overdose reversal drug and saving lives.

Almost every family in America, in one way or another, has suffered from the drug overdose epidemic that takes tens of thousands of lives each year. This epidemic has run rampant for decades, touching every community, every socioeconomic class, and destroying too many lives.

Overdose is the leading cause of death in Americans ages 18 to 44. Almost a third of all adults in the United States know someone who has died of a drug overdose. Nearly half of all adults have a family member or close friend who has been or is currently struggling with addiction.

Thanks to a strong commitment from the Biden administration, America finally saw some progress in reversing this catastrophe. The federal government began investing in treatment and overdose prevention, and from 2023 to 2024, overdose deaths in the U.S. fell by nearly 25%.

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But the Trump administration has abandoned American families just as the country was making headway in our fight against the overdose epidemic.

Last year, President Donald Trump slashed the Substance Abuse and Mental Health Services Administration in half and is making concerted efforts to shrink its budget even further. With little warning, earlier this year, Trump moved to terminate thousands of the agency’s grants, potentially $2 billion, that communities across the country use for addiction treatment, prevention and recovery services, and mental-health care. Within a day, he reversed that action. But addiction treatment providers around the country — many already operating on shoestring budgets — still are left wondering how they’ll keep doors open the next time the administration has a whim.

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A leader who understands the gravity of this crisis would not toy with the fate of thousands, if not tens of thousands, of lives.

Before Trump’s One Big Beautiful Bill was signed into law, researchers warned it would “cause approximately 156,000 people to lose access to treatment for opioid use disorder and that the overdose rate among that group will double, leading to approximately 1,000 additional fatal overdoses each year” in a letter to House Speaker Mike Johnson. The bill passed anyway. And estimates of the damage it will inflict are likely an undercount.

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The full scope of the Big Ugly Bill’s harm won’t be quantified for years, in part because Trump laid off the team that managed the Substance Abuse and Mental Health Services Administration’s National Survey of Drug Use and Health. That team produced one of the foremost reports on behavioral health data in the country and provided information that countless other researchers use to identify vulnerable populations, discern what treatments are proving effective and more. Without this team, we have lost critical insight into progress made in the fight against addiction — and the damage Trump is inflicting is that much more obscured.

Meanwhile, Trump’s recent Great American Recovery Initiative rolls back so-called “non-effective interventions” like harm reduction. This approach is not rooted in science, no matter what Trump or his secretary of health and human services, Robert F. Kennedy Jr., tells you. Decades of research and evidence make clear that harm reduction strategies reduce mortality rates, protect people from infectious diseases like HIV and Hepatitis C and increase the likelihood of people entering substance use treatment. RFK Jr. has historically advocated for abstinence-only recovery treatments, which reject the use of medication-assisted treatment like methadone, have concerningly high rates of relapse and may actually be deadlier than receiving no treatment at all. The few elements of Trump’s plan that may actually address the opioid crisis are undercut by the president’s decimation of funding for addiction treatment.

But where Washington retreats, California has stepped up.

We built the nation’s largest state-administered purchaser for prescription drugs — Medi-Cal Rx and CalRx — so Californians can bargain with Big Pharma from a position of strength.

That work has saved lives in the most direct way imaginable.

In the spring of 2024, CalRx-branded naloxone, the miracle drug that can revive overdose victims on the brink of death, hit the market at almost half the existing retail price. We saw quick results: Within a single quarter, overall generic naloxone prices declined by 22%. Before that, generic prices had decreased only 15% over two years.

Competition arrived, prices dropped and more people could get the medication that makes the difference between a funeral and a second chance.

With CalRx naloxone, California has saved more than $40 million in less than two years — and with those savings, we’re doubling down on our fight against the opioid crisis. Through the Naloxone Distribution Project, we are sending free naloxone to community organizations, first responders and local agencies statewide. So far, they have reported that more than 416,000 overdoses have been reversed. That’s 415,000 chances to reach out, get help and live a healthy life again.

We are also confronting the changing face of addiction.

California is getting ahead of a reemerging wave of deadly stimulant addiction — likely the result of cocaine and methamphetamines being cut with fentanyl. Over 12,000 new Medi-Cal members struggling with stimulant use have signed up for contingency management through a Recovery Incentives program, offering the most effective, evidence-based treatment in the absence of Food and Drug Administration-approved medication.

We’ve also been aggressive in targeting fentanyl trafficking and disrupting the supply of deadly illicit drugs, including partnering with local law enforcement and expanding the California National Guard’s role in drug interdiction across the state and at the border.

But victory in this fight is far from guaranteed; the progress we’ve made on America’s overdose crisis is in dire straits — because of President Trump.

This is a cruel slap in the face to the tens of millions of Americans who know firsthand the ravages of drug addiction.

In California, we believe in a “no wrong door” approach to care, that everyone should be able to access the services and resources they need to get back on their feet and live a healthy life. We have the largest emergency department-based opioid addiction treatment model in the country, through the CA Bridge Program, which works with hospitals across the state to provide immediate access to medications for addiction treatment. Whether someone seeks help through their primary care physician, emergency room, community organization or if they’re in jail or prison, we have created a system where stigma and silos don’t stand in the way of saving lives.

Guest opinions in Open Forum and Insight are produced by writers with expertise, personal experience or original insights on a subject of interest to our readers. Their views do not necessarily reflect the opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership.

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Substance use disorder is not a moral failing; it is a medical crisis. No one deserves to struggle through it alone, without support or second chances. Medications should be affordable, and those in need of support should be able to find it.

If the Trump administration truly cared about the health of the American people — or the overdose crisis it so often invokes — it would follow what works, fund what saves and stop pulling the ground out from under communities. Too many lives are at stake.

Gavin Newsom is the governor of California.

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