CDC preliminary data show overdose fatalities back to 2019 levels after peaking at nearly 110,000 in 2022. Said Brown University researcher Brandon Marshall: "If deaths are going down rapidly, that means they can increase just as rapidly if we take our foot off the gas." The strategic problem: the Trump administration is already lifting its foot. SAMHSA last month notified grant recipients it will no longer fund fentanyl test strips, and the administration is pulling back on clean-syringe programs and drug-use hotlines — the exact harm-reduction infrastructure researchers credit for the decline. Meanwhile, a federally funded toxicology lab in Horsham, Pennsylvania flagged 23 new drugs in under five months of 2026; it found 27 in all of 2025. The gains are real. The policy bet being made right now is that they'll hold anyway.