America has finally found a way to slow the fentanyl crisis—and Washington is about to throw it away. Preliminary CDC data projects around 72,000 overdose deaths for the 12-month period ending September 2025, an 18.9 percent decline from the prior year. That is not an accident. Deaths fell because policymakers, for once, chose treatment over punishment. Now, with federal funding for those very programs under threat and a renewed push toward criminalization, we are on the verge of reversing every inch of that progress.

Understanding why deaths fell is the whole argument. In 2023, the federal government eliminated the X-waiver, a bureaucratic requirement that forced doctors to complete extra training before they could prescribe buprenorphine, a medication proven to cut overdose death rates. States expanded naloxone access. Methadone regulations were loosened. These were not flashy policies. They were quiet, evidence-based decisions that saved tens of thousands of lives. The data is not ambiguous about this.

The core problem driving the fentanyl crisis has never been a lack of enforcement. It has always been a lack of treatment. Only about 1 in 4 people with opioid use disorder actually receives medication for it. The American Medical Association reported that buprenorphine prescriptions, despite growing 83 percent over the past decade, have plateaued in recent years. Stiffer criminal penalties have not closed that gap. A 2025 study in Colorado found that increased criminal penalties for fentanyl possession produced no meaningful improvement in medication treatment initiation or retention rates. Locking people up does not get them into treatment. It never has.

The medications exist and they work. Buprenorphine and methadone have decades of evidence behind them. The issue is access. States that expanded Medicaid saw buprenorphine prescribing rise by 27.3 percent; states that never expanded it saw prescribing fall by 2.1 percent. The geography of who lives and who dies from this crisis is shaped directly by whether someone has insurance and whether their state invested in treatment infrastructure. That is a policy choice, not a coincidence.

There is also a racial equity dimension that rarely gets enough attention in these conversations, and as a young person watching this play out, it is hard to ignore. While overdose deaths fell nationally in 2024, rates continued rising among Black Americans and American Indian and Alaska Native communities. A treatment-centered approach has to be targeted. Expanding Medicaid, funding community health centers, and removing the remaining regulatory barriers to methadone access are the levers that will actually reach the people most at risk — the ones who have been failed the longest.

The fentanyl crisis is not over. New adulterants like medetomidine are complicating overdose response, and 72,000 deaths a year is still 72,000 too many. But we know what works now. We did not know that ten years ago. Throwing away that knowledge for the comfort of a tough-on-crime talking point would be one of the most preventable policy failures of this generation.

Congress should protect and expand Medicaid funding for opioid use disorder treatment, make permanent the telehealth flexibilities that increased buprenorphine access during the pandemic, and remove the federal restrictions that limit where and how methadone can be dispensed. States should follow the lead of those that expanded Medicaid and invest in community-based treatment infrastructure. The medicine is there. The evidence is there. The only thing still missing is the political will to use them.

Works Cited

American Medical Association. "AMA 2025 Report on Substance Use and Treatment." AMA, January 12, 2026. Accessed March 16, 2026. https://www.ama-assn.org/press-center/a ma-press-releases/ama-2025-report-substance-use-and-treatment.

Beetham, Tarlise, et al. "Scaling Up Treatment and Harm Reduction Programs to Reach More People Who Would Benefit." Health Affairs 44, no. 9 (September 2025). https://doi.org/10.1377/hlthaff.2025.00340.

Centers for Disease Control and Prevention. "Data Resources: Overdose Prevention." CDC, February 11, 2026. Accessed March 16, 2026. https://www.cdc.gov/overdose-prevention/data-research/facts-stats/index.html.

Gupta, Sumedha, et al. "States With Substantial Increases in Buprenorphine Uptake Did So With Increased Medicaid Prescribing, 2018-24." Health Affairs 44, no. 9 (September 2025). https://doi.org/10.1377/hlthaff.2025.00343.

Jurecka, Courtney, et al. "Impact of Increased Criminal Penalties for Fentanyl Possession on Initiation and Retention on Medications for Opioid Use Disorder in Colorado." International Journal of Drug Policy 143 (2025): 104905. https://doi.org/10.1016/j.drugpo.2025.104905.

Lindenfeld, Zoe, and Angeli I. Mauri. "Availability of Medications for Opioid Use Disorder in Opioid Treatment Programs." JAMA Network Open 8, no. 1 (2025): e2454772. https://doi.org/10.1001/jamanetworkopen.2024.54772.

Saloner, Brendan, et al. "Progress Under Threat: The Future of Overdose Prevention in the United States." Brookings Institution, July 21, 2025. Accessed March 16, 2026. https:// www.brookings.edu/articles/progress-under-threat-the-future-of-overdose-prevention-i n-the-united-states/.

Volkow, Nora D. "Reflecting on NIDA's 50th Year and Looking to 2025." National Institute on Drug Abuse, January 2025. Accessed March 16, 2026. https://nida.nih.gov/about-ni da/noras-blog/2025/01/reflecting-nidas-50th-year-looking-to-2025.

Volkow, Nora D. "To Address the Fentanyl Crisis, Greater Access to Methadone Is Needed." National Institute on Drug Abuse, July 29, 2024. Accessed March 16, 2026. https://nid a.nih.gov/about-nida/noras-blog/2024/07/to-address-the-fentanyl-crisis-greater-access-t o-methadone-is-needed.