Thousands of Americans could lose access to opioid addiction treatment following the passage of President Donald Trump’s latest tax and spending bill, prompting warnings from public health experts that the legislation may lead to a sharp rise in overdose deaths.
Signed into law earlier this month, the sweeping package—dubbed by Trump as the “Big Beautiful Bill”—includes major changes to Medicaid that researchers say will significantly cut coverage for low-income individuals. According to estimates from the Congressional Budget Office, the changes are expected to leave 7.8 million people without Medicaid by 2034.
Dr. Benjamin Linas, a professor of medicine and epidemiology at Boston University, led a team of researchers who projected that about 156,000 of those losing coverage would no longer be able to access medication-assisted treatment (MAT) for opioid use disorder. In a memo sent to congressional leaders before the bill passed, the team warned the change could result in approximately 1,000 additional overdose deaths annually.
“I’m angry,” Linas said. “This is a terrible policy that makes Americans sicker and increases suffering.”
While the U.S. has seen a marked decline in fatal overdoses—down nearly 27% from 2023 to 2024, according to the Centers for Disease Control and Prevention (CDC)—experts largely credit that drop to increased public investment in treatment access, stigma reduction, and medication-based therapies. Linas and others worry the new law could reverse that progress.
Their modeling focuses only on the impact of lost access to opioid treatments and does not include other potential health consequences of losing insurance, such as untreated chronic illnesses or mental health issues. The true toll, they say, could be far greater.
The American Society of Addiction Medicine (ASAM) has also expressed concern. While the bill includes exemptions for individuals with substance use disorders from new Medicaid work requirements, ASAM president Dr. Stephen Taylor warned those provisions must be implemented broadly to be effective.
“Our focus now is on trying to minimize the harm,” Taylor said. “If people lose the coverage they need, those exemptions become meaningless.”
Trump’s administration has shifted focus in tackling the opioid crisis toward stricter immigration and anti-trafficking policies, a pivot many public health experts criticize as misdirected.
“To say we’ve reduced overdose deaths because of tougher border policies is completely false,” Linas said. “It’s public health efforts that saved lives—and now we’re actively dismantling them.”
The legislation, Linas argues, reflects a broader problem in how the administration is handling health policy: “We were finally seeing results after years of investment—and now we’re turning our backs on that progress.”