Despite thousands of lawsuits against OxyContin maker Purdue Pharma now being settled, the opioid crisis continues to devastate families and communities. This is why there are massive national efforts to expand addiction treatment, develop non-opioid pain alternatives, promote natural remedies, and confront the Mexican drug cartels flooding America with fentanyl. In recent years, opioid-related deaths have finally begun to decline, suggesting that those initiatives are starting to make a real impact. But that progress may already be slowing.
The introduction of work requirements for Medicaid eligibility under the One Big Beautiful Bill Act is producing unintended consequences for people in addiction recovery. Early studies show that declines in Medicaid enrollment correlate with drops in the number of patients receiving treatment for opioid use disorder. Because Medicaid is the primary source for buprenorphine and addiction services, these enrollment changes threaten fragile but meaningful recovery gains.
Conservatives champion individual responsibility — but responsibility also requires ensuring that systems meant to help people reclaim their lives aren’t working against them.
Work requirements aren’t the problem — they’re sound policy to preserve the financial stability and original intention of the program. The real issue is Medicaid’s regulatory structure, which is too rigid and dysfunctional to absorb yet another layer of complexity.
This crisis didn’t begin with work requirements. Medicaid’s own structure, combined with state policies, had been restricting access to effective OUD treatment for years. Patients face prior-authorization delays, prescriber rules that block lifesaving medications, and certificate-of-need laws that stop treatment centers from opening or expanding. Policymakers often claim these rules protect patients or control costs. In practice, they have choked off reliable care and pushed people in recovery farther from the help they need.
In states where prescriber limits and facility restrictions already make treatment scarce, adjusting Medicaid eligibility has a serious impact on the availability of buprenorphine providers. The problem lies in creating a policy that requires personal responsibility within an already bureaucratic structure that actively slows treatment access. When enrollment pressures combine with supply constraints caused by CON laws and prescription rules, the result is fewer people getting the care that keeps them alive.
This is especially true in Appalachia, which is ground zero of the opioid crisis. Pennsylvania explicitly prohibits off-site methadone “medication units,” while legislation has been floated in West Virginia that aims to ban methadone clinics. Local governments across the region routinely block zoning permits for treatment facilities, often caving to community pushback rather than addressing a staggering public health emergency. Many states still impose CON laws, restricting the ability of hospitals and clinics to add new treatment beds or open new treatment programs.
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On the provider side, well-intentioned prescribing rules have created even more barriers. Despite a dire shortage of addiction specialists, many states limit the prescription of OUD medications to certain providers, leaving primary care doctors — who could dramatically expand treatment access — underutilized or prevented from issuing prescriptions. Lawmakers have inadvertently created a bottleneck: too few qualified providers and too many hoops to jump through for those who want to treat addiction.
As the Trump administration continues to build a populist coalition that includes voters from Western Pennsylvania, Ohio, and other communities deeply scarred by opioid addiction, it must confront this reality head-on. Doing so does not require abandoning conservative principles, nor does it mean reversing work requirements. Those reforms remain both necessary and widely popular. But a serious conservative health care agenda must recognize that Medicaid’s regulatory architecture is undermining progress against opioid addiction — and America cannot afford to lose ground now.
Conservatives champion individual responsibility — but responsibility also requires ensuring that systems designed to help people reclaim their lives aren’t working against them. Addressing Medicaid’s regulatory failures is not just good policy; it is essential to sustaining progress in one of the most consequential public health fights of our time.
Editor’s note: A version of this article was published originally at the American Mind.
President Donald Trump reportedly told attendees at a $1 million-a-plate fundraiser in New Jersey earlier this month that he was contemplating reclassifying marijuana as a Schedule III drug under the Controlled Substances Act. He has since confirmed that the reclassification is on the table.
One of Trump's most outspoken supporters has expressed hope that the president will ultimately decide against easing restrictions on cannabis.
Since 1970, cannabis has been listed as a Schedule I drug, a category of drugs the U.S. Drug Enforcement Administration claims "have a high potential for abuse and the potential to create severe psychological and/or physical dependence" as well as "no currently accepted medical use."
The Wall Street Journal indicated that the fundraiser conversation earlier this month was "part of a campaign by cannabis companies to persuade Trump to pick up where the Biden team left off and reclassify the drug" to a Schedule III substance, which would mean not only fewer federal restrictions but also big tax breaks for marijuana companies.
Among those reportedly in attendance at the fundraiser were Pfizer CEO Albert Bourla; cryptocurrency executives; political advisers close to the president; and Kim Rivers, the CEO of the marijuana giant Trulieve, which donated $750,000 to Trump's inauguration.
Unnamed individuals who attended the fundraiser told the Journal that when Rivers personally encouraged Trump to reclassify the drug, the president flagged the matter for those staff members present.
RELATED: Marijuana can stunt or even kill babies in the womb: Study
The matter of reclassification has evidently been on Trump's radar for some time.
ScottsMiracle-Gro CEO James Hagedorn told Fox Business last week that Trump has told him and others "multiple times" that he will reclassify marijuana.
When Trump threw his support last year behind an unsuccessful Florida constitutional amendment to legalize marijuana for adults 21 and older, the then-candidate vowed that if re-elected, he would "continue to focus on research to unlock the medical uses of marijuana to a Schedule 3 drug."
After he announced the federalization of the Metropolitan Police Department in Washington, D.C., on Monday, Trump was asked to square his crackdown on crime and drugs with the reports that he might soon reclassify marijuana.
'Any cannabis use is associated with a 40% increased risk of psychosis.'
Trump said, "We're looking at it. Some people like it. Some people hate it. Some people hate the whole concept of marijuana because ... it does bad for the children, it does bad for people that are older than children. But we're looking at reclassification, and we'll make a determination over the ... next few weeks."
The president noted that it is a "very complicated subject" and that he has heard "great things having to do with medical" and "bad things having to do with just about everything else."
Trump ally and Turning Point USA CEO Charlie Kirk wrote in response to the Journal's report, "I hope this doesn't happen."
"We need to protect public spaces for kids. Everything already smells like weed, which is ridiculous," continued Kirk, who questioned the value of legalizing marijuana and raised concern over the drug's significant increase in potency during his April interview with liberal polemicist Bill Maher.
"Let's make it harder to ruin public spaces, not easier," added Kirk.
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Kirk is not alone in hoping that Trump will decide against reclassification.
Luke Niforatos, executive vice president of Smart Approaches to Marijuana, told Blaze News, "President Trump said today that he has heard a lot of bad things about marijuana. And for good reason."
"Rescheduling marijuana will mean more crime, more homelessness, and more destruction of mental health," continued Niforatos. "We need a strong generation of Americans. Rescheduling marijuana gives the Big Weed oligarchy a multibillion-dollar tax break so they can peddle more high-octane THC products that give our kids and our young adults schizophrenia and other forms of mental illness."
According to the Centers for Disease Control and Prevention, roughly three in 10 people who consume cannabis have cannabis use disorder, which manifests in part as craving cannabis; trying but proving unable to quit using cannabis; using cannabis even though it causes problems at home, work, or school; using cannabis in high-risk situations; and using increasing amounts of the drug to achieve the same high.
The Canadian government, which legalized marijuana nationwide in 2018, claims that "any cannabis use is associated with a 40% increased risk of psychosis" and "earlier-onset cannabis use is associated with an increased risk of earlier-onset psychosis, with cannabis users under the age of 16 at greater risk of developing psychosis or schizophrenia."
Cannabis use has been linked to other health conditions besides dependency and psychosis.
'States that have legalized the drug have launched a panoply of cartel violence.'
For instance, a systematic review published on May 5 in JAMA concluded with moderate confidence on the basis of 51 studies with over 21.1 million participants that cannabis use during pregnancy can result in early births, low birth weights, and unusually small babies.
Blaze News previously reported that the review also indicated significantly increased odds of miscarriages.
Paul Larkin, a senior research fellow at the Heritage Foundation's Edwin Meese III Center for Legal and Judicial Studies, recently argued in JAMA Psychiatry against the Biden Department of Health and Human Services' 2023 recommendation to the Drug Enforcement Administration that it reclassify cannabis as a Schedule III drug.
Larkin and Dr. Bertha Madras noted that HHS failed to properly address the adverse effects of cannabis use such as the high prevalence of cannabis use disorder among users and the mounting evidence linking marijuana use to psychosis.
They also noted that "there is no medical consensus that cannabis is a legitimate medical treatment" and that "the evidence supporting generic 'cannabis' as a treatment for medical conditions remains either low quality or nonexistent."
When pressed for comment, HHS told Blaze News, "HHS continues to follow gold-standard science when determining the safety and efficacy of drugs."
"The president should consider that no major law enforcement or medical association supports scheduling marijuana down to III, because it is a public safety and public health nightmare," Niforatos told Blaze News.
"States that have legalized the drug have launched a panoply of cartel violence, Chinese CCP influence, and mental health carnage. Rescheduling marijuana gives a gigantic financial reward in the form of a tax break to cartels and the giant marijuana operators, like Glass House, the marijuana company ICE recently raided," added Niforatos.
Marijuana has been legalized for medical use in 48 states plus the District of Columbia and legalized for recreational purposes in at least 24 states — a push aided by the drug's normalization in and by the media.
Gallup revealed in November that the number of Americans who reported smoking marijuana had more than doubled since 2013, up to 15% from 7%. Whereas only 4% of respondents polled in 1969 reported trying marijuana, 47% of respondents reported trying the drug when asked last year.
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Drug addicts are reportedly experimenting with an especially destructive drug: the veterinary tranquilizer xylazine.
Xylazine, often called "tranq" or the "zombie drug," has profoundly devastating effects on human beings. Users who do not immediately die by overdose frequently see their skin rot, turn black, and slough off or their injection wounds become infected and compromise entire limbs.
This danger is compounded by the drug's increasing popularity in big American cities such as San Francisco, New York, and Philadelphia.
Los Angeles, another hard-hit city, has witnessed the animal tranquilizer spread into the local street drug supply, prompting the LA County Sheriff's Department to begin actively testing confiscated drugs for traces of xylazine.
The zombie drug, usually purchased online from Chinese suppliers for $6-$20 per kilogram, is neither a controlled substance nor a new drug. It has been long marketed as a veterinary drug and used as a sedative.
According to a 2014 study published in the journal Forensic Science International, "In humans, it could cause central nervous system depression, respiratory depression, bradycardia, hypotension, and even death. There have been publications of 43 cases of xylazine intoxication in humans, in which 21 (49%) were non-fatal scenarios and 22 (51%) resulted in fatalities."
TheBlaze previously reported on a warning provided by the U.S. Food and Drug Administration, which said, "Repeated exposure to xylazine, by injection, has been associated with severe, necrotic skin ulcerations that are distinctly different from other soft-tissue infections (e.g., cellulitis, abscesses) often associated with injection drug use. These ulcerations may develop in areas of the body away from the site of injection."
The drug is reportedly used frequently as an adulterant in recreational drugs — to enhance or mimic the effects of other illicit drugs, such as heroin or cocaine.
While dangerous on its own, used in combination with other drugs, xylazine can prove especially fatal.
For instance, a 2021 American study detected the drug in 42 Connecticut fatal overdoses from March to August 2019.
KTLA reported that the recent rash of xylazine use has seen some users horribly disfigured. Some have been found covered in sores, requiring amputation. Others have had their skin fall off and inner workings exposed.
Tracey McCann, a user, told the New York Times earlier this year that the needle bruises she had from fentanyl were hardening and turning crusty. "I’d wake up in the morning crying because my arms were dying," said McCann.
Brooke Peder, a 38-year-old user in the city, lost her leg as the result of a zombie drug wound that became infected and ate into the bone. She bore her arm for the Times, revealing "patches of blackened tissue, exposed white tendons and pus, the sheared flesh was hot and red."
"The tranq dope literally eats your flesh," said Peder. "It's self-destruction at its finest."
"We had a woman come in and her sister had passed away from a fentanyl overdose," addiction expert Cary Quashen told KTLA. "But not only was it a fentanyl overdose (but) her skin was starting to rot, the muscles on her leg and her arm. So that’s a sure sign of xylazine."
DEA special agent Bill Bodner told KTLA, "It's really gruesomely disfiguring people. ... It’s much more likely to stop someone from breathing and the things that come along with xylazine, it’s a vasoconstrictor. So when you’re injecting it, it’s actually reducing the blood circulation."
The DEA released an intelligence report on the drug in October, detailing instances of exhibits involving the drug in the agency's laboratory system between 2020 and 2021. The report noted a 61% increase in the Northeast U.S. census region, a 193% increase in the South, a 7% increase in the Midwest, and a 112% increase in the West.
As xylazine-positive overdoses in the aforementioned U.S. census regions, the Northeast has seen a 103% increase; the South, a 1,127% increase; the Midwest, a 516% increase; and the West, a 750% increase.
This was not previously a priority, as the drug is not illegal.
Beginning in April, the LACSO's pilot program has had crime lab analysts noting preliminary signs of the tranquilizer when testing confiscated drugs.
"In the greater Los Angeles area, we are seeing xylazine as an additive within fake fentanyl pills," DEA Los Angeles Field Division spokeswoman Nicole Nishida told the Los Angeles Times. "While the numbers are relatively low in our community compared to elsewhere in the United States, the presence of xylazine is now becoming more frequent and the trend is concerning."
The Times indicated that federal data shows that roughly 23% of fentanyl powder and 7% of fentanyl pills seized in 2022 contained the tranquilizer.
If they determine by month's end that the number of xylazine positives is high, they will figure out standards for conducting additional confirmatory tests.
"This is going to be very unique for us, because I’m asking them to track a non-controlled substance," Capt. Ernest Bille, who oversees the department’s Scientific Services Bureau, told the Los Angeles Times.
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