These cuts kill
On March 27, Trump’s billionaire-controlled administration announced the firing of another 10,000 full-time workers at the U.S. Department of Health and Human Services (HHS). That brings the total to 20,000 people forced out of HHS so far – almost 25% of the agency’s workforce.
Imagine eating at a restaurant that just fired 25% of its staff (or better yet, working at one). The experience would likely be unpleasant. But when cuts are made to medical care and research, people die. In recent years, hundreds of thousands have died from drug overdoses in the U.S. annually. The workers at HHS and affiliated programs have helped reduce those numbers with evidence-based treatment and prevention programs.
The HHS umbrella includes the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, the Food and Drug Administration (FDA), the Centers for Medicare and Medicaid Services, and more. Some 67.3 million people are enrolled in Medicare, and almost 90% are older than 65. More than 37.6 million U.S. children are enrolled in the Children’s Health Insurance Program (CHIP), which provides health coverage for children in families that earn too much to qualify for Medicaid but cannot afford private insurance. Trump’s policies show he doesn’t care about older people or kids.
In 2022, the NIH launched the Harm Reduction Research Network, a national initiative to lower opioid overdose deaths. Its research addresses the many disparities affecting communities due to class, race, and even geographic factors. A Dec. 16, 2022, news release said:
“Novel forms of harm reduction services may prove helpful in rural areas of the country, where people may need to travel long distances to receive care and services. According to 2020 CDC data, rural counties experienced 26.2 overdose deaths per 100,000 people, which was only slightly lower than the rates in urban counties (28.6 deaths per 100,000 people); overdose deaths involving psychostimulants were higher in rural counties than in urban counties from 2012 to 2020. Additionally, several projects will be aimed at populations disproportionately affected by the negative impacts of drug use, including Black and Latino/Latina communities, and women.”
This is the type of research that helped drive down opioid deaths by 24% between September 2023 and September 2024. The fate of such research – and medical care for those suffering with addiction – is now in jeopardy, while Trump promises more tax breaks for billionaires.
To shed light on the real lives of people struggling with opioid addiction, Struggle-La Lucha has begun a series on the epidemic. The following is an interview with Moon Soselo, a young woman who is currently taking naltrexone to treat opioid addiction.
‘Focus on harm-reduction based treatment’
Moon Soselo: I grew up in Seattle, Washington, and have moved around the country a lot, but always find myself back in Washington. I’ve mostly worked in the food service industry, though I have pipe dreams about finishing school and becoming a journalist. And I’m a big ‘ole lesbian.
Gregory E. Williams: God bless the lesbians who fight so we’re all free! So you were prescribed Suboxone? Are you still taking it?
MS: I’m not. I actually only took Suboxone for a few months. I’d moved and lost my Medicaid for a while, and of course, ended up relapsing in that period, but never fully fell back into addiction. Six months after I got my first Suboxone prescription, I used heroin for the last time.
Now I take naltrexone. It’s normally given as a monthly shot, but I take it orally once a day because no pharmacies here stock the shot. Anyway, it basically blocks opioids from sticking to your receptors. It’s really great for people who have gone through full detox and want to, like, “lock in” their sobriety. It’s not really right for people who are still in a chaotic use period, though, because it is theoretically possible to break through the block and get high, but you can die trying.
GEW: So you were getting Suboxone through Medicaid?
MS: Yup! I didn’t have to pay a cent, which was a relief. I went to the Seattle STEP Clinic. They actually helped me get on Medicaid, too. I didn’t have it before. I don’t think I would have been able to achieve sobriety without Medicaid!
GEW: Have you ever used Narcan to reverse an overdose?
MS: I’ve never had it used on me. I have used it on others twice, both times were very scary situations. It worked both times, though! I definitely encourage people to carry it, and take a quick training course if they can.
GEW: Absolutely. I think they should be giving it out in schools, along with condoms and Plan B (which would be illegal where I am in Louisiana).
How do you access naltrexone?
MS: I have Medicaid again, and I see a psychiatric nurse practitioner at the local clinic who prescribes it in addition to my other psych meds. We only have one addiction program out here, and they focus on folks who have court orders, and the program uses an AA model, so it’s not for me. I know the AA model has worked for people before, but both statistically and anecdotally, harm-reduction-focused treatment is more successful.
GEW: Do you have any thoughts on Trump’s rhetoric around the opioid epidemic?
MS: He’s basically been blaming it all on China and Mexico, right? My understanding is that curbing undocumented immigration won’t change anything because it’s mostly smuggled during legal crossings, and that India has also been a producer of precursor chemicals for fentanyl, so illicit drug manufacturers would probably just change suppliers.
I have major doubts that tariffs and border control will have any positive impact whatsoever. Further, it’s pretty likely these policies are going to raise the prices of regular goods people need, putting more people into poverty, and poverty is a major risk factor for addiction. I would not be surprised if these policies actually worsen the opioid epidemic. The best way to actually curb opiate addiction is to focus on harm-reduction-based treatment.
GEW: Do you feel like it’s dehumanizing when these politicians talk about the opioid epidemic in order to get support for the policies they’re pushing without actually talking to and meeting with people dealing with addiction? I mean, they could actually go to clinics and talk with people and learn what their actual needs and struggles are.
MS: Oh, absolutely. It feels like we’re just a rhetorical tool, an excuse to implement policies that won’t help us and don’t actually have anything to do with us.
They don’t really care if tariffs curb fentanyl manufacturing, but if it hurts China, great!
GEW: If anything, I would think that all this sensationalist talk about the opioid epidemic (as opposed to conversations about things that actually help) is further stigmatizing people affected by addiction. Is there anything we haven’t talked about that you wish people knew about opioid addiction?
MS: Unless you have a lot of money and resources, there is a kind of catch-22 issue with opiate addiction. It gets expensive quick, so when you’re deep in it you’re usually walking a tightrope just keeping up with rent and feeding yourself. I was, on average, $300 in debt to my dealers at any given time.
Opioid detox usually takes about one to two weeks to get out of the acute stage, depending on how much/long you were using and which opioid you were using. And working through it would be like trying to work through having the flu, food poisoning, a back injury, and Fight Club-level insomnia, all simultaneously.
But getting a full, straight week off can be tough to do even at decent jobs, let alone two weeks. And if you don’t have paid sick leave or vacation, then you probably can’t afford the paycheck hit. So, you try to maintain the balance of getting high to avoid withdrawal, so you can go to work, so you can eat and pay rent. It’s an awful trap that just keeps getting worse and worse.
This is honestly where medications like methadone and Suboxone really, really can make a huge difference because you can be in treatment while maintaining your day-to-day life. With Suboxone, you only have to go through roughly 24 hours of withdrawal before it’s safe to take, so it can be started on a weekend. And with methadone, you don’t have to wait any time at all to start taking it, though there are usually pretty strict rules for methadone prescriptions, so you do have to work around a clinic schedule. Both medications really are game changers.
Gregory E. Williams is a public health worker in New Orleans.
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