Federal health programs that receive government funding must adopt new Trump administration priorities within days, in a move that experts say signals an unprecedented level of political control over public health and could deal a significant blow to efforts tackling the opioid crisis.
The US Centers for Disease Control and Prevention (CDC) informed state, territorial, tribal and local health programmes on Wednesday that they have five business days – or until 1 July – to agree to a new list of priorities. The notice, according to a source familiar with the memo, did not originate from the CDC’s own program staff, who were unaware of the requirement. It remains unclear whether all relevant bodies received the directive, although programmes focused on immunisations, HIV, hepatitis and tobacco did. While the requirement is not explicitly tied to funding, the grant note refers to a previous CDC statement that funding may be cancelled if programmes fail to comply with the agency’s terms.
Emily Hilliard, a spokesperson for the US Department of Health and Human Services (HHS), later said that “grantees were directed to review their work plans and ensure their activities align with the Department’s priorities and produce meaningful public health outcomes”.
Among the new priorities, according to a copy of the memo obtained by the Guardian, is an emphasis on “parental authority” and policies giving parents “greater control over their children’s education” – a phrase widely interpreted as a reference to vaccination requirements for school attendance. Vaccine mandates are set at the state and sometimes local level, but requiring grant recipients to agree to the CDC priorities could be used to pressure states into weakening or dropping those mandates. Robert F. Kennedy Jr, the HHS secretary and a longtime vaccine critic, has already sent letters on school vaccine mandates, and the administration has taken steps to review and potentially alter childhood vaccine schedules, including dismissing and reconstituting the Advisory Committee on Immunization Practices. A federal judge has temporarily blocked the reduction in recommended vaccines, citing violations of federal procedures and a lack of expertise among newly appointed committee members.
Dorit Reiss, a vaccines expert and professor at UC Law San Francisco, said the move “might be a next step in the fight against vaccines and vaccine mandates”. She warned that withholding federal funding because a state or locality mandates certain vaccines would be “essentially begging for a lawsuit”, though she added: “Of course, that doesn’t mean they won’t try.”
Opioid crisis at risk
The memo also explicitly deprioritises housing first, harm reduction and safe consumption programmes for substance use – all strategies proven to reduce drug overdoses and help people with substance use disorder. The deprioritisation comes at a time when the illicit drug supply is evolving in dangerous ways. On the east coast, the veterinary sedative medetomidine is increasingly replacing fentanyl as an adulterant, according to Nabarun Dasgupta, a street drug researcher and senior scientist at the University of North Carolina at Chapel Hill’s Injury Prevention Research Center. Medetomidine is more potent than xylazine and can cause severe sedation, dangerously slow heart rate and low blood pressure. Unlike fentanyl, it does not produce a high, but it can trigger heart attacks among people who attempt to quit cold turkey.
Dasgupta described the emergence of medetomidine as “a sea change in street drugs, the likes of which have not been seen in decades” – potentially more consequential than the arrival of fentanyl, which helped drive the US to a record 107,941 known drug overdose deaths in 2022. That figure remained relatively stable compared with 2021, but overall overdose death rates have quadrupled since 2002, with shifts in the types of drugs involved: deaths involving heroin and natural or semisynthetic opioids fell between 2021 and 2022, while those involving cocaine and psychostimulants such as methamphetamine increased.
“This new form of adulterant really is a gamechanger in terms of being able to provide care, and in this exact setting is when you actually need harm reduction more than ever,” Dasgupta said. “You need to help them step down their use to the point where they can go into treatment, but if we use an abstinence-first model, if we move away from harm reduction, if we move away from housing first, then you’re going to end up filling ICUs and emergency rooms with people in this severe form of withdrawal that they weren’t expecting.”
Harm reduction programmes – including syringe services and overdose prevention centres – are described by experts as critical for saving lives and connecting people to care. However, recent federal guidance has already restricted funding for certain supplies such as fentanyl and xylazine test strips and syringes, while continuing to support overdose reversal medications like naloxone. The new priorities, Dasgupta said, “weaken the most critical frontline care of engaging with people who are falling through the cracks”.
The CDC is also prioritising “evidence-based programs to reduce homelessness, drug use and ‘public disorder’”, a term left undefined in the memo. This language aligns with a July 2025 executive order from the White House that took aim at unstably housed and mentally ill people, creating a pathway to criminalise greater numbers of individuals, according to experts. That order directs federal agencies to prioritise grants for jurisdictions that enforce laws against open drug use and unauthorised camping, and restricts funding for harm-reduction programmes, shifting instead toward civil commitment and treatment-based interventions. Critics argue such policies criminalise homelessness and mental illness rather than addressing the root causes.
Expert concerns over political interference
Nabarun Dasgupta said the directive “absolutely” appears to signal greater political interference in public health. “This is a warm-up. This is a warning shot,” he said. “This is a prelude to imposing similar restrictions of other kinds of federal funding, such as direct service provision.”
Dorit Reiss echoed that concern, noting that some of the new policies “are in tension with public health” and would undermine work in this area, including “prioritising parental control over, potentially, children’s health and community health”. She added that “housing programs and harm reduction programs save lives and promote health”.
The changes build on earlier Trump administration initiatives to combat the opioid crisis, which focused on reducing demand through education, preventing over-prescription, cutting off illicit drug supplies and expanding access to treatment. Critics have long argued that law enforcement-focused strategies and insufficient funding for treatment have undermined progress, with overdose deaths continuing to rise. The new directive, combined with the executive order on homelessness, represents a more explicit shift away from evidence-based public health interventions.
“Similarly, housing programs and harm reduction programs save lives and promote health,” Reiss said. “Of course, that doesn’t mean they won’t try.”
