When Robert F. Kennedy Jr. took office in February 2025, he broke new ground as the first health secretary openly in recovery from addiction to drugs and alcohol.
At a public appearance soon after, he delivered precisely the message that many substance use experts had hoped to hear: that evidence-based medications for treating opioid addiction, in particular, would remain essential components of the country’s response to its drug overdose crisis.
“We have to do all of the nuts-and-bolts things that you are all involved with, the practical, pragmatic things,” Kennedy said to applause from doctors, patients, and drug policy professionals in April 2025 at the Rx Summit in Nashville. “We need Suboxone, we need methadone, we need naltrexone, we need Narcan.”
In the past year, however, the Trump administration has taken a decidedly more negative tack on medications for opioid use disorder, setting off alarm bells among public health experts, addiction physicians, and patient groups.
In April, the Substance Abuse and Mental Health Services Administration issued a “Dear Colleague” letter cautioning against the long-term use of methadone or buprenorphine, the drug commonly referred to as Suboxone.
“SAMHSA remains committed to expanding access to comprehensive, evidence-based treatment, including the use of medications … but we are equally committed to ensuring that medications are part of the pathway to long-term recovery and sobriety, self-sufficiency, and thriving, not as a default sentence to life-long medication use,” the agency wrote.
A year prior, the Trump administration appointed Michael Stuart, a former West Virginia state lawmaker best known in the drug policy community for introducing legislation to ban methadone treatment, as the top Health and Human Services lawyer.
And in September, Rep. Erin Houchin (R-Ind.) introduced legislation in Congress that would effectively roll back significant new flexibilities enacted by SAMHSA that aimed to make methadone treatment far more accessible.
Taken together, the actions represent a resurgence of Republican hostility toward medication-assisted treatment, which in recent years had become a largely settled issue.
The U.S., unlike other wealthy countries, has long treated the medications with suspicion. The medical, public health, and drug policy communities have been slow to embrace methadone and buprenorphine despite vast data showing people who use them to treat opioid addiction are more than 50% less likely to die of a drug overdose.
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 in the past decade, and especially as opioid overdose deaths reached record highs during the Covid-19 pandemic, they had appeared to gain consensus across the political spectrum.
“Turning clinical care into policy is really fraught,” said Yngvild Olsen, an addiction physician who served as director of SAMHSA’s Center for Substance Abuse Treatment until early 2025 and oversaw the rewrite of regulations that aimed to make methadone treatment more accessible and patient-friendly. “The winds clearly have shifted away from thinking about evidence-based ways of engaging people who use drugs, who may have substance use disorders, ways that have proven to engage people into care, and more toward focusing on the punitive and public safety.”
Though the administration itself has not taken stances directly opposing the use of methadone or buprenorphine, the SAMHSA letters came amid a broader push from Kennedy and other Trump-orbit health policy leaders to reduce the nation’s reliance on psychiatric medications.
It also comes amid significant shifts in the country’s drug crisis. Overdose deaths have plummeted since 2022, recently dipping below 70,000 annually for the first time since 2019. Separately, the Trump administration has expressed significant interest in turning to certain psychedelics, like ibogaine, as potential addiction medications. The addiction medicine community, meanwhile, is abuzz about the potential paradigm shift of GLP-1s like Ozempic or Wegovy, typically used to treat diabetes or obesity, as addiction medications capable of diminishing cravings.
Still, methadone and buprenorphine — and a third medication, naltrexone — remain the only three drugs approved by the Food and Drug Administration specifically to treat opioid addiction.
Public health experts acknowledge that the medications are widely underutilized — especially methadone, which remains available exclusively at specialized clinics that often require multiple early morning visits per week; frequent drug testing; and counseling.
Still, the medications are themselves opioids and can be difficult for patients to discontinue. A sharp reduction in methadone dose, in particular, can cause severe withdrawal and heighten risk of relapse.
In the wake of the Trump administration’s letter, experts have worried that less experienced addiction medicine providers could attempt to quickly discontinue buprenorphine patients, or discourage them from seeking methadone at all. And while data about discontinuation and long-term use is somewhat unsettled, researchers are uniform in their view that longer treatment duration yields better outcomes.
“Over a long period of time, a number of observational, experimental studies have demonstrated that patients do better … the longer medications are continued,” said David Fiellin, a physician and researcher who is the director of the Yale Program in Addiction Medicine, though he noted that many of the studies are conducted over a span of just six months or a year. “We do not have robust evidence once you get beyond two years or so. But nonetheless, the finding remains consistent that outcomes are best during the period of time that patients remain on medication.”
Fiellin and other addiction medicine experts said their strategy with patients is simple: They continue providing medication as long as they, and their patient, decide together that it remains beneficial. In some cases, patients who no longer wish to take the medication because of inconvenience or side effects can slowly taper off, eventually discontinuing medication altogether.
It is unclear whether the Trump administration’s letters, and other prominent Republicans’ hostility toward methadone, represents a few aberrations or a broader trend.
Stuart, the former West Virginia lawmaker who was confirmed in October 2025 as HHS general counsel, had previously co-authored a bill to outlaw methadone clinics in his state. His legislation, originally introduced in early 2024, did not advance, and Stuart was recently reassigned to an unknown role within HHS following reporting from NOTUS that he invested in the stock of a major federal contractor.
The bill introduced by Houchin, the Indiana congresswoman, takes direct aim at new flexibilities codified by SAMHSA in 2024. Her legislation would once again require patients to visit their methadone clinic in person, every day, during their first months of treatment; would re-impose a requirement that patients can only seek methadone treatment if they’ve been addicted to opioids for over a year; and bar doctors from evaluating patients seeking methadone or buprenorphine via telehealth.
The bill has generated significant opposition from major addiction groups, and has not gained any co-sponsors or a hearing in the House Energy and Commerce Committee.
“If enacted as currently drafted, the bill would result in more opioid overdoses,” a coalition of organizations, including the American Society of Addiction Medicine and the American Academy of Family Physicians, wrote in a March 2026 letter.
Health care providers who treat addiction already strive to understand their patients’ goals and prescribe medication only as is beneficial, said Olsen, the former SAMHSA official. But some patients, she stressed, might need to stay on methadone or buprenorphine for the rest of their lives, much as someone with diabetes would require insulin or someone with high cholesterol might require a statin.
“The confusing piece has been: What was the purpose of that letter?” she said. “If it’s reinforcing current practice, that’s great. If it means, somehow, there’s an indication that everyone who starts on one of these medications should at some point come off, that is not consistent with best practice, it’s not consistent with clinical guidelines, it’s not consistent with the evidence.”
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