When Robert F. Kennedy Jr. assumed the role of health secretary in February 2025, he made history as the first in the position openly recovering from addiction to drugs and alcohol.
Soon after taking office, Kennedy addressed a public audience with a message that many substance use experts were eager to hear: evidence-based medications for opioid addiction treatment would continue to be a vital part of the nation’s strategy against the drug overdose crisis.
“We must undertake all the fundamental tasks you are involved with, the practical, pragmatic efforts,” Kennedy stated to enthusiastic 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.”
Over the past year, however, the Trump administration has shifted towards a more skeptical approach to medications for opioid use disorder, raising concerns among public health experts, addiction physicians, and patient advocacy groups.
In April, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a “Dear Colleague” letter warning against the prolonged use of methadone or buprenorphine, commonly known 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 stated.
A year before this, the Trump administration appointed Michael Stuart, a former West Virginia state lawmaker known for proposing legislation to ban methadone treatment, as the top lawyer for Health and Human Services (HHS).
In September, Rep. Erin Houchin (R-Ind.) introduced a bill in Congress aimed at reversing significant new flexibilities introduced by SAMHSA to make methadone treatment more accessible.
These actions collectively signal a revival of Republican resistance to medication-assisted treatment, a topic that had largely reached a consensus in recent years.
The U.S. has historically been wary of these medications, unlike other wealthy countries. The medical, public health, and drug policy sectors have been slow to fully adopt methadone and buprenorphine, despite substantial evidence indicating that their use lowers the likelihood of drug overdose death by more than 50%.
Many conservatives have criticized methadone and buprenorphine as merely replacing one drug with another, a sentiment echoed by former Trump health secretary Tom Price in 2017. However, the consensus seemed to shift over the past decade, notably as opioid overdose deaths peaked during the Covid-19 pandemic.
“Turning clinical care into policy is really fraught,” commented Yngvild Olsen, an addiction physician and former director of SAMHSA’s Center for Substance Abuse Treatment. She managed the revision of regulations to make methadone treatment more user-friendly. “The focus has shifted from evidence-based approaches for engaging people with substance use disorders, proven to integrate them into care, to more punitive and public safety measures.”
While the administration hasn’t directly opposed methadone or buprenorphine, the SAMHSA letters surfaced amid a broader move by Kennedy and other Trump-aligned health policy figures to reduce reliance on psychiatric medications.
This comes against the backdrop of major changes in the nation’s drug crisis. Overdose fatalities have declined since 2022, falling below 70,000 annually for the first time since 2019. Separately, the Trump administration has shown interest in exploring psychedelics like ibogaine as potential addiction treatments. Meanwhile, the addiction medicine community is abuzz about the potential of GLP-1s, like Ozempic or Wegovy — drugs typically used for diabetes or obesity — as treatments for addiction that could curb cravings.
Despite new alternatives, methadone, buprenorphine, and a third medication, naltrexone, remain the only three drugs approved by the FDA to treat opioid addiction.
Public health experts acknowledge these medications are underutilized, especially methadone, which is only available at specialized clinics requiring frequent early morning visits, drug testing, and counseling.
The medications themselves are opioids and can be challenging to discontinue. A sudden reduction in methadone doses can lead to severe withdrawal symptoms and increased relapse risk.
Following the Trump administration’s letter, there are concerns that inexperienced addiction medicine providers may hastily discontinue buprenorphine for patients or dissuade them from seeking methadone. Although data on discontinuation and long-term use is not definitive, researchers agree that extended treatment generally leads to better outcomes.
“Over time, multiple observational and experimental studies have shown that patients fare better the longer they continue medication,” stated David Fiellin, director of the Yale Program in Addiction Medicine. He mentioned, however, that many studies focus on periods as short as six months to a year. “We lack solid evidence beyond two years, but the consistent finding is that outcomes are best during the treatment period.”
Fiellin and other addiction medicine experts maintain a straightforward approach with patients: medication is continued as long as it is deemed beneficial by both the patient and provider. Some patients may choose to taper off due to side effects or inconvenience, eventually weaning off the medication entirely.
The Trump administration’s letters and Republican opposition to methadone raise questions about whether these are isolated incidents or indicative of a broader trend.
Michael Stuart, the West Virginia lawmaker confirmed in October 2025 as HHS general counsel, had previously co-authored legislation to ban methadone clinics in his state. The bill, introduced in early 2024, did not advance. Stuart has since been reassigned within HHS after a report from NOTUS revealed his investment in a major federal contractor’s stock.
Houchin’s proposed bill specifically targets new SAMHSA flexibilities established in 2024. Her legislation mandates daily in-person visits to a methadone clinic during initial treatment months, reinstates a requirement for patients to have been addicted for over a year before seeking treatment, and prohibits doctors from remotely evaluating patients for methadone or buprenorphine.
The bill faces strong opposition from major addiction advocacy groups and has not secured any co-sponsors or a hearing in the House Energy and Commerce Committee.
“If passed as currently drafted, the bill would result in more opioid overdoses,” wrote a coalition of organizations, including the American Society of Addiction Medicine and the American Academy of Family Physicians, in a March 2026 letter.
Healthcare providers who treat addiction aim to understand their patients’ goals and prescribe medication only when beneficial, Olsen noted. Some patients may require long-term methadone or buprenorphine treatment, similar to how individuals with diabetes need insulin or those with high cholesterol need statins.
“The confusing piece has been: What was the purpose of that letter?” Olsen questioned. “If it’s reinforcing current practice, that’s great. If it implies that everyone on these medications should eventually stop, that contradicts best practice, clinical guidelines, and evidence.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
