The progress comes as the Trump administration is proposing to cut funding for many programs believed to have contributed to the improvement.Overdose deaths in the United States fell by nearly 30,000 last year, the government reported on Wednesday, the strongest sign yet that the country is making progress against one of its deadliest, most intractable public health crises.The data, released by the Centers for Disease Control and Prevention, is the latest in a series of reports over the past year offering hints that the drug-related death toll that has gutted families and communities could be starting to ease.Public health experts had been carefully watching the monthly updates, with skepticism at first, and then with growing hope. Wednesday’s report was the most encouraging yet. Deaths declined in all major categories of drug use, stimulants as well as opioids, dropping in every state but two. Nationwide, drug fatalities plunged nearly 27 percent.“This is a decline that we’ve been waiting more than a decade for,” said Dr. Matthew Christiansen, a physician and former director of West Virginia’s drug control policy. “We’ve invested hundreds of billions of dollars into addiction.”Addiction specialists said that changes in the illicit drug supply as well as greater access to drug treatment and the use of naloxone to reverse overdoses seemed to be playing a role, but whether the country could sustain that progress was an open question.In announcing the new numbers, the C.D.C. praised President Trump, saying in a statement that since he “declared the opioid crisis a public health emergency in 2017” the government had added more resources to battle the drug problem.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Public health and addiction experts fear millions could lose access to treatment and prevention services if the administration’s proposed cuts are enacted.President Trump has long railed against drug traffickers. He has said they should be given the death penalty “for their heinous acts.” On the first day of his second term, he signed an executive order listing cartels as “terrorist organizations.”But many public health and addiction experts fear that his budget proposals and other actions effectively punish people who use drugs and struggle with addiction.The Trump administration has vowed to reduce overdose deaths, one of the country’s deadliest public health crises, by emphasizing law enforcement, border patrols and tariffs against China and Mexico to keep out fentanyl and other dangerous drugs. But it is also seeking huge cuts to programs that reduce drug demand.The budget it submitted to Congress this month seeks to eliminate more than a billion dollars for national and regional treatment and prevention services. The primary federal agency addressing drug use, the Substance Abuse and Mental Health Services Administration, has so far lost about half its workers to layoffs under the Trump administration and is slated to be collapsed into the new Administration for a Healthy America, whose purview will reach far beyond mental illness and drug use.And if reductions to Medicaid being discussed by Republicans in Congress are realized, millions of Americans will be unable to continue, much less start treatment.The White House did not respond to requests for comment. The budget itself says that ending drug trafficking “starts with secure borders and a commitment to law and order” and that it is cutting addiction services deemed duplicative or “too small to have a national impact.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

On March 11, about 50 judges gathered in Washington for the biannual meeting of the Judicial Conference, which oversees the administration of the federal courts. It was the first time the conference met since President Trump retook the White House.In the midst of discussions of staffing levels and long-range planning, the judges’ conversations were focused, to an unusual degree, on rising threats against judges and their security, said several people who attended the gathering.Behind closed doors at one session, Judge Richard J. Sullivan, the chairman of the conference’s Committee on Judicial Security, raised a scenario that weeks before would have sounded like dystopian fiction, according to three officials familiar with the remarks, who spoke on the condition of anonymity to discuss internal deliberations: What if the White House were to withdraw the protections it provides to judges?The U.S. Marshals Service, which by law oversees security for the judiciary, is part of the Justice Department, which Mr. Trump is directly controlling in a way that no president has since the Watergate scandal.Judge Sullivan noted that Mr. Trump had stripped security protections from Mike Pompeo, his former secretary of state, and John Bolton, his former national security adviser. Could the federal judiciary, also a recent target of Mr. Trump’s ire, be next?Judge Sullivan, who was nominated by President George W. Bush and then elevated to an appellate judgeship by Mr. Trump, referred questions about his closed-door remarks to the Administrative Office of the U.S. Courts, which stated its “complete confidence in those responsible for judicial security.”There is no evidence that Mr. Trump has contemplated revoking security from judges. But Judge Sullivan’s remarks were an extraordinary sign of the extent of judges’ anxiety over the threats facing the federal bench. And they highlight a growing discomfort from judges that their security is handled by an agency that, through the attorney general, ultimately answers to the president, and whose funding, in their view, has not kept pace with rising threats.Mike Pompeo. Mr. Trump’s former secretary of state, in National Harbor, Md., in 2023. A White House spokesman said Mr. Trump’s decision to strip security from former officials had no bearing on his approach to sitting judges.Haiyun Jiang /The New York Times“Cutting all the security from one judge or one courthouse — stuff like that hasn’t happened, and I don’t expect it to,” said Jeremy Fogel, a retired federal judge who directs the Berkeley Judicial Institute at the University of California, Berkeley, and is in frequent contact with current judges. “But, you never know. Because it’s fair to say that limits are being tested everywhere. Judges worry that it could happen.”The Marshals Service said in a statement that it acted “at the direction of the federal courts” and “effectuate all lawful orders of the federal court.” The integrity of the judicial process, the statement read, depends on “protecting judges, jurors and witnesses.”Harrison Fields, a White House spokesman, said Mr. Trump’s decision to strip security from Mr. Pompeo and Mr. Bolton, two former officials, had no bearing on his approach to sitting judges. He called worries that the president would deprive judges of their security “speculation” that was “dangerous and irresponsible.”Founded in 1789, the U.S. Marshals Service has a wide range of law-enforcement duties, in addition to its central function of supporting the judiciary. There are now 94 presidentially appointed and Senate-confirmed U.S. marshal positions, one for each judicial district. The agency’s director reportsto the deputy attorney general.The concerns about who oversees the marshals come as threats against judges have been on the rise, expanding the burdens on the service.Statistics released by the agency show that the number of judges targeted by threats more than doubled from 2019 to 2024, before Mr. Trump returned to office. In those years, he disputed the result of the 2020 election in court, and the Supreme Court overturned Roe v. Wade, the ruling that made access to abortion a constitutional right. In June 2022, after the Supreme Court’s ruling on Roe leaked, an armed man made an attempt to assassinate Justice Brett M. Kavanaugh at his home.In his end-of-year report for 2024, Chief Justice John G. Roberts Jr. noted “a significant uptick in identified threats at all levels of the judiciary.”Mr. Trump with his national security adviser John Bolton, right, at the White House in 2018. The president has removed Mr. Bolton’s security protections.Al Drago for The New York TimesSince Mr. Trump took office in January, he and his supporters have insulted individual judges on social media and called for their impeachment in response to rulings they don’t like. In a message posted on Easter, Mr. Trump referred to “WEAK and INEFFECTIVE Judges” who are allowing a “sinister attack on our Nation to continue” in regard to immigration.Judges and their family members have in recent weeks reported false threats of bombs in their mailboxes. As of mid-April, dozens of pizzas have been anonymously sent to judges and their family members at their homes, a means of signaling that your enemy knows where you live.According to Ron Zayas, the chief executive of Ironwall, a company that contracts with district courts, state courts and some individual judges to provide data protection and security services for judges and other public officials, the number of judges using his services for emergency protection is more than four times the average number for last year. He said 40 judges also used their own money to bolster their security with Ironwall, twice as many as on Jan. 1.In a letter to Congress dated April 10, Judge Robert J. Conrad Jr., who directs the Administrative Office of the U.S. Courts, complained that funding for court security remained frozen at 2023 levels through the 2025 fiscal year “at a time when threats against federal judges and courthouses are escalating.” Judges have issued similar warnings for years.The total amount spent has remained nearly flat, rising to $1.34 billion in 2024 from $1.26 billion in 2022, according to statistics from the administrative office and the marshals, despite inflation and staff pay increases.At the same time, burdens on the service have grown.In recent years, the U.S. Marshals said in a statement, they have started helping to protect the homes of the Supreme Court justices, whose security is primarily handled by the separate Supreme Court Marshal’s Office. Last summer, a U.S. marshal stationed outside Justice Sonia Sotomayor’s home in Washington shot and wounded an armed man in an attempted carjacking.The Supreme Court in Washington. After its ruling on Roe v. Wade leaked in 2022, an armed man made an attempt to assassinate Justice Brett M. Kavanaugh at his home.Haiyun Jiang for The New York TimesIn January, the Trump administration gave the marshals, along with other law enforcement agencies, the new power to enforce immigration laws. That move prompted Judge Edmond E. Chang, who chairs the Judicial Conference’s criminal law committee, to write a memo to all district-court and magistrate judges warning about the potential impact on the marshals’ ability to protect them. (Judge Chang declined to comment; his memo was reported earlier by Reuters.)In addition to protecting judges’ lives, U.S. law states the marshals’ “primary role and mission” is “to obey, execute, and enforce all orders” from the federal courts. Enforcing court orders can entail imposing fines and imprisonment for anyone judges find to be in contempt of court, including, in theory, executive branch officials.The Trump administration’s posture in some cases raises the possibility that the already-stretched marshals could emerge as a crucial referee between the branches. In the courtroom, Justice Department lawyers have come close to openly flouting court orders stemming from the unlawful deportation to a prison in El Salvador of a group of nearly 140 Venezuelans and Kilmar Armando Abrego Garcia, whose removal officials admitted was an “administrative error.” Two judges have responded by opening inquiries that could lead to administration officials being held in contempt of court.“What happens if the marshals are ordered to deliver a contempt citation to an agency head that has defied a court order?” asked Paul W. Grimm, a retired federal judge who leads the Bolch Judicial Institute at Duke University. “Are they going to do that? The question of who the Marshals Service owes their allegiance to will be put to the test in the not-too-distant future, I suspect.”Concern over the oversight of the Marshals Service is not new. A 1982 report by the Government Accountability Office called the marshals’ oversight arrangement “an unworkable management condition.” As a possible solution, it proposed legislation to move control of the marshals to the judiciary.Some members of Congress have begun proposing a similar solution.“Do you think you could better protect judges if your security was more independent?” Representative Eric Swalwell, Democrat of California, asked a federal judge testifying on behalf of the Judicial Conference at a hearing in February, two weeks before Judge Sullivan’s remarks.About 50 judges gathered in Washington for the biannual meeting of the Judicial Conference, which oversees the administration of the federal courts. It was the first time the conference had met since Mr. Trump retook the White House.Eric Lee/The New York TimesRepresentative Darrell Issa, Republican of California, responded that he considered the question of independent oversight legitimate. The judge answered that the conference would consider the matter.In an interview, Mr. Swalwell said he was drafting legislation that would put the judiciary in charge of its own security.Last month, Ronald Davis, who led the agency under President Joseph R. Biden Jr., issued a stark warning on LinkedIn of “a constitutional crisis if a president refuses to enforce or comply with a federal court order.” He too proposed measures to insulate the marshals from potential interference by the executive branch.In the meantime, the administration’s immediate goal for the Marshals Service may be to shrink it.On April 15, Mark P. Pittella, the agency’s acting director, sent a letter to more than 5,000 employees of the service as part of the staff-cutting measures associated with Elon Musk’s project, known as the Department of Government Efficiency, offering them the opportunity to resign and be eligible for more than four months of administrative leave with full pay. In the letter, obtained by The New York Times, Mr. Pittella wrote that agency leadership would review applications to ensure they did not “adversely impact U.S.M.S. mission-critical requirements.”But a spokesman for the service said the offer was open to employees in all areas of responsibility, including marshals tasked with protecting judges.

A $56 million grant to train emergency responders and supply them with the overdose reversal spray, plus other programs that address addiction, could be eliminated.The opioid overdose reversal medication commercially known as Narcan saves hundreds of thousands of lives a year and is routinely praised by public health experts for contributing to the continuing drop in opioid-related deaths. But the Trump administration plans to terminate a $56 million annual grant program that distributes doses and trains emergency responders in communities across the country to administer them, according to a draft budget proposal.In the document, which outlines details of the drastic reorganization and shrinking planned for the Department of Health and Human Services, the grant is among many addiction prevention and treatment programs to be zeroed out.States and local governments have other resources for obtaining doses of Narcan, which is also known by its generic name, naloxone. One of the main sources, a program of block grants for states to use to pay for various measures to combat opioid addiction, does not appear to have been cut.But addiction specialists are worried about the symbolic as well as practical implications of shutting down a federal grant designated specifically for naloxone training and distribution.“Reducing the funding for naloxone and overdose prevention sends the message that we would rather people who use drugs die than get the support they need and deserve,” said Dr. Melody Glenn, an addiction medicine physician and assistant professor at the University of Arizona, who monitors such programs along the state’s southern border.At the scene of an emergency, first responders can hand out extra doses of Narcan and information about addiction recovery services.Arin Yoon for The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Fentanyl overdoses have finally begun to decline over the past year, but that good news has obscured a troubling shift in illicit drug use: a nationwide surge in methamphetamine, a powerful, highly addictive stimulant.This isn’t the ’90s club drug or even the blue-white tinged crystals cooked up in “Breaking Bad.” As cartels keep revising lab formulas to make their product more addictive and potent, often using hazardous chemicals, many experts on addiction think that today’s meth is more dangerous than older versions. Here is what to know.What is meth?Meth, short for methemphetamine, is a stimulant, a category of drugs that includes cocaine. Meth is far stronger than coke, with effects that last many hours longer. It comes in pill, powder or paste form and is smoked, snorted, swallowed or injected.Meth jolts the central nervous system and prompts the brain to release exorbitant amounts of reinforcing, feel-good neurotransmitters such as dopamine, which help people experience euphoria and drive them to keep seeking it.Meth is an amphetamine, a category of stimulant drugs perhaps best known to the public as the A.D.H.D. prescription medications Adderall and Vyvanse. Those stimulants are milder and shorter-lasting than meth but, if misused, they too can be addictive.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The Substance Abuse and Mental Health Services Administration has already closed offices and could see staff numbers reduced by 50 percent.Every day, Dora Dantzler-Wright and her colleagues distribute overdose reversal drugs on the streets of Chicago. They hold training sessions on using them and help people in recovery from drug and alcohol addiction return to their jobs and families.They work closely with the federal government through an agency that monitors their productivity, connects them with other like-minded groups and dispenses critical funds that keep their work going.But over the last few weeks, Ms. Wright’s phone calls and emails to Washington have gone unanswered. Federal advisers from the agency’s local office — who supervise her group, the Chicago Recovering Communities Coalition, as well as addiction programs throughout six Midwestern states and 34 tribes — are gone.“We just continue to do the work without any updates from the feds at all,” Ms. Wright said. “But we’re lost.”By the end of this week, the staff of the agency, the Substance Abuse and Mental Health Services Administration, could be cut by 50 percent, according to senior staff members at the agency and congressional aides who attended briefings by Trump officials.With just under 900 employees and a budget of $7.2 billion for large state grants and individual nonprofits that address addiction and mental illness, SAMHSA (pronounced SAM-sah) is relatively small. But it addresses two of the nation’s most urgent health problems and has generally had bipartisan support.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A group of 15 states have reached a tentative new deal that would require them to set aside hundreds of millions of dollars from the settlement in a legal-defense fund for the family.Seven months after the Supreme Court struck down a deal that would have resolved thousands of opioid cases against Purdue Pharma, the company’s owners, members of the Sackler family, have increased their cash offer to settle the litigation — but with a novel catch.Under the framework for a new deal, the Sacklers would not receive immunity from future opioid lawsuits, a condition that they had long insisted upon but that the court ruled was impermissible.Instead, they would pay up to $6.5 billion — $500 million more than the previous agreement — but with a new condition: Claimants, including states, municipalities and individuals, would have to set aside as much as $800 million in an account akin to a legal-defense fund for the billionaires to fight such cases, according to people familiar with the negotiations.Some details of the framework — but not the legal-defense fund — were announced on Thursday by the New York attorney general, Letitia James. She said the overall settlement totaled $7.4 billion, which would include $897 million from Purdue.New York could receive as much as $250 million, she said.“The Sackler family relentlessly pursued profit at the expense of vulnerable patients and played a critical role in starting and fueling the opioid epidemic,” Ms. James said.When the deal is finalized, she added, the Sacklers will “no longer have control of Purdue and will never be allowed to sell opioids in the United States again.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The positions of Robert F. Kennedy Jr. on vaccines and drug companies are well known. His approach to addiction has been far less scrutinized.In dark bluejeans and work shirt, Robert F. Kennedy Jr. stood in a Texas farm field, faced a camera and outlined his plan to combat drug addiction.“I’m going to bring a new industry to these forgotten corners of America, where addicts can help each other recover from their addictions,” he said in a 45-minute documentary, “Recovering America: A Film About Healing Our Addiction Crisis,” released in June by his presidential campaign.“We’re going to build hundreds of healing farms where American kids can reconnect to America’s soil, where they can learn the discipline of hard work that rebuilds self-esteem and where they can master new skills,” he continued.As Mr. Kennedy prepares for his confirmation hearings to become federal health secretary, he has faced intense focus for his views of vaccines, the pharmaceutical industry, nutrition and chronic disease. But there has been little discussion of his ideas to address the drug crisis, one of the country’s deadliest problems, which he refers to as a “plague.”According to the Substance Abuse and Mental Health Services Administration, a federal agency that Mr. Kennedy would oversee if confirmed, roughly 48.5 million Americans have a substance use disorder involving drugs, alcohol or both. According to the most recent provisional federal data, there were nearly 90,000 drug overdose deaths in the 12 months that ended in August 2024.The way Mr. Kennedy overcame his own addiction to heroin informs his approach to treatment generally. He often invokes his “spiritual realignment,” anchored by a belief in God, and reinforced by more than 40 years of daily 12-step-program meetings.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Californians voted for tougher penalties for dealers. Florida, North Dakota and South Dakota rejected proposals to legalize marijuana. Massachusetts denied a measure allowing possession of psychedelics.An electorate that has grown increasingly restive over flagrant drug use and public disorder sent a sharp message through the ballot box on Tuesday.In state and local elections, voters approved tougher drug penalties and rejected measures to legalize recreational marijuana and psychedelics. San Francisco, one of the most progressive cities in the country, elected a mayor with no government experience who vowed to move aggressively against drug dealers.The results are the latest indications that the American public, besieged by a deadly addiction crisis decades in the making, is growing weary of experiments with more permissive drug policies and their visible impact on residential neighborhoods and downtown businesses.It is a sentiment that President-elect Donald J. Trump echoed on the campaign trail. “Our once-great cities have become unlivable, unsanitary nightmares, surrendered to the homeless, the drug-addicted, and the violent and dangerously deranged,” he said in one speech. “We are making the many suffer for the whims of a deeply unwell few.”The latest election results continue a trend seen across the country this year. In March, San Francisco voters approved proposals to screen welfare recipients for drug use and to expand police powers. New measures in cities and states across the country, such as Idaho, West Virginia and Philadelphia, clamped down on programs that distribute safe drug supplies, like sterile syringes, to prevent users from dying.“The philosophy that the only people who matter in drug policy are people who use drugs, and the only thing that matters for them is just making sure they can continue using without overdosing, has been completely rejected,” said Keith Humphreys, a professor at Stanford who is an expert on drug policy and treatment.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

At the Somerset County jail in rural Maine, prisoners addicted to opioids used to receive a daily pill to keep cravings in check. But as soon as they were released, their access to the medicine ended.As their cravings surged, they were re-entering society at high risk for withdrawal, relapse and overdose — dangers that newly released prisoners confront nationwide.“A lot of these inmates are our neighbors and it’s in our best interest to assimilate them back into the community, but some would end up dying,” said the Somerset County sheriff, Dale P. Lancaster. “For me, that’s not acceptable.”Hoping to change those grim outcomes, Sheriff Lancaster decided to try providing a different — and far less common — form of the medication, buprenorphine: an extended-release shot that subdues urges for about 28 days.According to a recent analysis in the journal Health and Justice about his jail’s pilot project, the switch had a remarkable effect. The long-acting injection afforded newly released prisoners a crucial buffer period after they were discharged, with more time to set up continuing addiction treatment and stabilize their lives.The jail’s experience is “an important step in showing where we as a society can go to cut back on people dying from this disease,” said Dr. Josiah Rich, a national expert in addiction and incarceration at Brown University, who was not involved in the project.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.