“War on Cartels” and Harm Reduction in Peril

President-elect Donald Trump wants drug traffickers to be executed, and could soon have the authority to make that happen.

The death penalty for drug smugglers and increased military action against transnational drug trafficking organizations are part of Trump’s plan to address the United States’ overdose crisis—a topic that was largely ignored in the run-up to the election, along with drug policy writ large.

“When I am back in the White House, the drug kingpins and vicious traffickers will never sleep soundly again,” Trump said in his drug policy agenda released in December.

His aggressive stances deeply concern drug policy experts and advocates, who told Filter they expect a second Trump presidency to escalate the drug war, deal a devastating blow to harm reduction efforts and make the drug supply even more hazardous.

Silver linings in the new political reality are scarce. Trump recently indicated some support for cannabis reform and his attorney general pick, Matt Gaetz, has voted to decriminalize it. Meanwhile Robert F. Kennedy Jr., the frontman of Trump’s “Make America Healthy Again” (MAHA) approach, has been critical of the drug war and has expressed support for legalizing cannabis and psychedelics.

Kennedy, who has perpetuated conspiracy theories about vaccines and threatened to make sweeping cuts to the Food and Drug Administration and National Institutes of Health, was confirmed on November 14 as Trump’s pick to head the Department of Health and Human Services.

Here are some of the major drug-policy themes we can expect from the second Trump administration, and advocates’ related fears.

“War on the Cartels”

Trump’s incoming “border czar” Tom Homan has said the new government will designate transnational drug trafficking groups as foreign terrorist organizations.

“These cartels are animals. And that’s why President Trump’s gonna take them off the face of earth,” Homan, the former acting head of Immigration and Customs Enforcement (ICE), told Fox News on November 11.

He echoed Trump’s drug policy agenda, which promised to “wage war on the cartels.” Trump also pledged to fully secure the border, deploy the Navy to disrupt fentanyl being trafficked by ship, and direct the military to launch “covert and overt actions to inflict maximum damage on cartel leadership.”

Claire Zagorski, a harm reduction expert and PhD student in translational science at the University of Texas at Austin, said drug trafficking groups are so successful in part because they’re nimble and can operate from many different countries.

“It’s not like they have headquarters on Google Maps that you can bomb,” she told Filter.

But David Bier, director of immigration studies at the Cato Institute think tank, said Trump’s border policy pertaining to fentanyl isn’t so different to President Joe Biden’s.

“The Biden administration has been aggressive in trying to stop fentanyl from entering the United States,” he told Filter. “They’ve been deploying lots of non-invasive scanners and making lots of seizures, and I think it’ll be more the same.”

While drug seizures may increase, Bier said this is unlikely to reduce the availability of fentanyl in the US, because the cost of production is so low that any seized amount can be replaced “tenfold.” If anything, Bier said, seizures will increase the potency of the drugs being smuggled as producers adapt to new restrictions, per the Iron Law of Prohibition.

“There’s really not … a clear limit to how potent synthetic opioids can get,” he said. “And so every time they crack down at the border, it just provokes more innovation.”

Trump has consistently scapegoated undocumented immigration for the arrival of fentanyl and fentanyl-involved overdose, but this has little basis in reality.

In a 2023 Cato Institute report, Bier analyzed federal data to show that 89 percent of convicted fentanyl traffickers in 2022 were US citizens, and that most drugs are seized at legal border crossings.

Trump’s plan to “destroy the drug cartels,” includes asking Congress to allow for drug smugglers and traffickers to receive the death penalty.

“You’ll never really solve the drug problem unless you do what other countries do, and that’s the death penalty for drug dealers,” he told Fox News in June.

Maritza Perez Medina, director of federal affairs for the Drug Policy Alliance (DPA), finds it plausible that Trump could change federal law to execute people convicted on federal trafficking charges.

“He could do that relatively easily through congressional legislation. And that’s the concerning part,” she told Filter.

Republicans won control of the Senate on November 5, and on November 13 were projected to retain a majority in the House, giving them a trifecta.  

Harm Reduction “in Peril”

While overdose deaths remain extremely high, preliminary data released by the Centers for Disease Control and Prevention in October showed they dipped by 12.7 percent in the 12-month period ending in May.

Though many factors could have played a part, there’s strong evidence that increased harm reduction resources, including from Biden’s push to make naloxone more accessible, have helped curb deaths. Like many, Medina fears Trump will undo that progress.

“I think harm reduction is really in peril,” she said.

While the Biden administration has at least paid lip-service to harm reduction, taking certain steps toward it while backing off others, Trump has never pretended to support it.

His win comes at a time when harm reduction efforts are regularly being thwarted at state and local levels. Oregon has reversed its drug decriminalization policy, California has legalized forced treatment for drug users, and San Francisco just elected Daniel Lurie as mayor, who plans to crack down (even more than his predecessor) on the city’s public drug use. The same tactic has been employed in Philadelphia.

A federal judge recently dismissed a case by Safehouse, a nonprofit in Philadelphia that has been fighting to open an overdose prevention center. Safehouse was sued by the previous Trump administration in 2019, which stopped it from opening the facility.

New York’s two overdose prevention centers, which have averted over 1,500 overdoses since opening in November 2021, might also be at risk, Medina said.

“Harm reductionists keep getting wins. We keep producing really great evidence that what we’re doing works,” Zagorski said. But, “it is not aligned with this … ‘pray the sin away, hard work will liberate you’ kind of mindset that you should just stop using drugs.” 

Uncertainties Over Cannabis, Psychedelics

Trump’s opponent in the presidential election, Vice President Kamala Harris, made history as the first major presidential nominee to support federal cannabis legalization.

Trump hasn’t gone as far. But in September, he expressed support for cannabis reform on his social media site Truth Social, saying he was voting in support of a Florida ballot measure to legalize it for adult use.

“As President, we will continue to focus on research to unlock the medical uses of marijuana to a Schedule 3 drug, and work with Congress to pass common sense laws, including safe banking for state authorized companies,” he said.

Florida’s Amendment 3 won 56 percent support on November 5, but failed to reach the 60 percent threshold required to change the state constitution.

Biden’s Department of Justice started a process of requesting cannabis be moved from Schedule I to the less-restricted Schedule III of the Controlled Substances Act, but the DEA has pushed back a hearing on the issue until next January or February.

According to the Drug Policy Alliance, rescheduling cannabis—as opposed to descheduling it—could still result in penalties for people using and selling it without a license, or deportations for non-citizens working in the industry.

“There’s been a lot of hype around the rhetoric itself,” Cat Packer, DPA’s director of drug markets and legal regulation, told Filter of Trump’s approach, “without a lot of follow-through and thought around what it would actually take to implement policy that works and serves veterans, consumers, patients, and all of the other stakeholders that continue to be impacted by federal cannabis criminalization.”

Regarding psychedelics, Trump has been largely silent. But Kennedy recently tweeted that the FDA’s “war on public health is about to end. This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”

Kennedy has also expressed disappointment that the FDA didn’t approve MDMA as a treatment for PTSD earlier in 2024.

Meanwhile billionaire Elon Musk, who currently wields significant influence over Trump and will co-lead a newly-created “Department of Government Efficiency,” says he uses prescription ketamine and has used other psychedelics, according to the Wall Street Journal.

However, Packer noted that the extent to which Trump supports reform around these substances is unclear, while the nature of any reforms is also critical.

“My concern in particular is that we could be creating a space of capitalism where certain folks have access to psychedelics,” she said, “and it may be at extremely high cost here, and other folks continue to be criminalized.”

Recovery Farms?

It became somewhat easier to get methadone and buprenorphine under the first Trump administration, partially due to restrictions easing in the pandemic. In 2018, Trump also signed into law the SUPPORT Act, funding “community based treatment and recovery programs” and requiring Medicaid to cover FDA-approved opioid use disorder medications.

But he will jeopardize access to these medications and much more if he dismantles the Affordable Care Act in his second term.

Trump has made conflicting statements about repealing the ACA, also known as Obamacare. But even if he doesn’t scrap it, enhanced subsidies will expire in 2025 unless his administration extends them. The program’s Medicaid expansion has granted health insurance to around 1.5 million people with opioid use disorder.

During a MAHA town hall in October, Kennedy, who identifies as in recovery from heroin addiction, said he wants to create self-sustaining treatment communities for “addicts,” particularly in rural areas. He envisions them having organic farms and teaching people trades, and said they’ll be funded by moving cannabis off Schedule I and collecting federal taxes on weed that’s being “sold anyway.”

In the town hall, Kennedy said the country needs to reclaim its “greatest asset” by getting people off drugs. “We’re losing huge resources right now, vast resources, by allowing 120,000 kids to die every year, and then 10 times that remain as addicts who are a drain on our society.”

“Prisons are not recovering people, they’re not designed to. They’re warehouses for people,” he said. “This is an alternative to prison. It’s really a redemption program.”

However, the intention that the communities would host people with drug convictions, who are otherwise threatened with jail, raises the possibility that they could amount to coerced treatment, which harm reduction advocates condemn as unethical, ineffective and often harmful.

Zagorski said Kennedy’s vision will be stymied by bureaucracy and incredibly expensive to implement, even with the cannabis funds if that were ultimately realized. A concept painted to sound nice, she added, could end up being closer to work camps that reflect a “protestant idea of suffering to remove your sins.”

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