Health Law Advisor

On July 24, 2025, President Donald Trump issued Executive Order 14321, titled “Ending Crime and Disorder on America’s Streets” (“the E.O.”).

Although the E.O. has a number of elements, the one most notable for behavioral health stakeholders is a policy to increase use of involuntary commitment for mental health and substance use disorder treatment. The introduction proclaimed: “Shifting homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment will restore public order.”

The backlash to the suggestion of a sweeping lock-up of people because of mental illness and addiction was swift and fierce. Many advocates and commenters immediately called out the E.O. as criminalizing mental illness, addiction, and homelessness. However, as a matter of federal policy, the civil commitment provision of the E.O. may have less impact than some of its other components.

Since day one, a policy priority of the Administration has been to discourage and prevent gender-affirming care for children and adolescents that involves surgery or medication. Recent actions show a concerted effort across multiple federal agencies to achieve this goal.

Among the earliest actions by the Administration were two Executive Orders directed at transgender health care: EO 14168, “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” and EO 14187, “Protecting Children From Chemical and Surgical Mutilation.” These Executive Orders immediately were challenged in federal courts. Ultimately, permanent injunctions were entered in the Western District of Washington and the District of Maryland against portions of the Executive Orders. Those injunctions are on appeal in the Ninth and Fourth Circuits.

Nevertheless, the Administration has continued to pursue its policy objectives through a mix of agency actions and communications, often disclaiming reliance on the Executive Orders and referring to other legal sources as the basis for a variety of agency actions.

Those in the tech world and in medicine alike see potential in the use of AI chatbots to support mental health—especially when human support is unavailable, or therapy is unwanted. Others, however, see the risks—especially when chatbots designed for entertainment purposes can disguise themselves as therapists.

So far, some lawmakers agree with the latter. In April, U.S. Senators Peter Welch (D-Vt.) and Alex Padilla (D-Calif.) sent letters to the CEOs of three leading artificial intelligence (AI) chatbot companies asking them to outline, in writing, the steps they are taking to ensure that the human interactions with these AI tools “are not compromising the mental health and safety of minors and their loved ones.”

The concern was real: in October 2024, a Florida parent filed a wrongful death lawsuit in federal district court, alleging that her son committed suicide with a family member’s gun after interacting with an AI chatbot that enabled users to interact with “conversational AI agents, or ‘characters.’” The boy’s mental health allegedly declined to the point where his primary relationships “were with the AI bots which Defendants worked hard to convince him were real people.”

On February 1, 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a final rule revising 42 CFR Part 8, which regulates opioid treatment programs (OTPs). The final rule is the first update to the OTP regulations in over 20 years, and significantly increases access to lifesaving medication while easing operational restrictions.

The agency eased admission requirements and cemented some of the telehealth and take-home dose flexibilities put in place during the COVID-19 pandemic. Other changes streamline OTP operations, reduce restrictions on ...