As fentanyl crisis evolves, experts say US is still ‘behind the eight ball’

Michael Watkins wipes sweat from his brow as he steps up to a stranger’s door. It’s a scorching day in Dallas, Texas; the sun has been hammering the pavement for hours.

Watkins, a 50-year-old man with glasses, a goatee and a gauge in both earlobes, doesn’t know what to expect beyond the door of the single-storey house. He doesn’t even know if the person on the other side will answer. But these door knocks are a critical part of his job. Within 72 hours of a reported overdose from the dangerous opioid fentanyl, Watkins shows up on a stranger’s doorstep with a brochure full of substance abuse resources and some of the life-saving medication known as Narcan.
He works for the Recovery Resource Council, an addiction treatment nonprofit that’s been tackling the fentanyl crisis in North Texas since it began more than 10 years ago. Their grassroots approach has yielded great results: In 2023, Dallas County — the largest county in North Texas — recorded 280 deaths from fentanyl. Last year, that number was 203.

This is in line with a nationwide decrease in fentanyl overdoses that began several years ago, after the rate of overdose deaths in the United States doubled between 2015 and 2023. However, some show the number of overall overdose deaths once again climbing, as experts warn a disruption in the fentanyl market has been repaired.

Dallas, like all major US cities, has been ravaged by fentanyl overdoses. Because of its relative proximity to the US-Mexico border, and its extensive highway infrastructure, Dallas also has the unfortunate distinction of being a major hub in the drug smuggling routes stretching from Mexico to other major US cities.
Becky Devine, the director of Recovery Resource Council, says her team calls these door-knocks “uninvited interventions”.

“We show up wanting to bridge the gap between where they are in this moment of desperation and isolation to all of the services that are available in our community,” she said.

“The majority of the people we encounter are receptive to us showing up, but they just don’t know what they want yet. We get phone calls weeks, months down the road that say, ‘Hey, I met you on my doorstep six, seven, 10 months ago, and I wasn’t ready then, but I’m ready now.’”

Recently, their work, like the work of similar nonprofits across the country, has been hindered by the administration of US President Donald Trump, just as the country was making consistent progress in the fight against fentanyl.

Despite declaring fentanyl a “weapon of mass destruction”, the Trump administration has slashed hundreds of millions of dollars in addiction services and drug-related research across multiple federal agencies.

Elon Musk’s DOGE team fired a team that rigorously tracked Americans’ drug use for decades, and in January, officials abruptly cancelled roughly $2bn in grants through the Substance Abuse and Mental Health Services Administration (SAMHSA), only to reverse course within days. The whiplash left providers scrambling and deepened uncertainty across the treatment system.

What’s more, in the past year, the Trump administration has reduced SAMHSA’s staff by half. Estimates vary as to how much money in total has been cut from essential treatment programmes, but in late 2025, the health news website STAT reported that at least $1.7bn in block grants for state health departments had been cut, as had about $350m in addiction and overdose prevention funding.

All this comes at a time when the fentanyl threat is evolving, with the market for the chemicals used to manufacture fentanyl largely shifting from China to India.

Chrissie Julianno is the executive director of the Big Cities Health Coalition, which represents health departments in major cities across the US. According to her, the Trump administration has created rampant chaos with far-reaching consequences.

“I think one piece that people don’t necessarily think about is, particularly in large jurisdictions, large counties and large cities, a lot of the dollars that they get from the federal government are then contracted out to community partners,” she said. “It’s not just the health department that can’t do something. It’s not just the health department that’s forced to lay off staff. It’s all of the other pieces that come together in these jurisdictions where there’s partnerships.”