Many people think the telltale signs of drug addiction include sweating and vomiting. But a prominent addiction medicine physician says the best signals aren’t always so visible. 

Dr. Yngvild Olsen says more accurate signs come from the brain, specifically the compulsion to keep using drugs, including opioids, despite damage to education, career and relationships. 

While it may be harder to understand the true nature of drug addiction, it’s never been more important because of the increased fatality risk of even microscopic amounts of fentanyl, which can be found in many illegal drugs. 

Olsen, who headed the Center for Substance Abuse Treatment at the Department of Health and Human Services in the Biden-Harris administration, has worked in addiction treatment for more than two decades. She is now a healthcare advisor with the law and professional consulting firm Manatt, Phelps & Phillips and a physician at the Institute for Behavior Resources/Reach Health Services in Baltimore. 

Olsen met with Youthcast Media Group to discuss her career, the opioid epidemic and what to know about fentanyl. The physician, a graduate of Harvard Medical School and the John Hopkins Bloomberg School of Public Health, cited her field experiences as key in shaping her perspective on addiction treatment and recovery. This interview is edited for clarity and length. 

What made you believe this work in addiction treatment is important?

I had a couple of experiences really early on in my career that very significantly shaped my interest in addiction and addiction medicine, and my belief that I had a role, and that I could really help people get better from that disease. So the first was during the summer between my first and second year in medical school. I spent the summer on the Eagle Butte and Pine Ridge reservations in South Dakota and really saw firsthand just the devastating impact that substance use — in that case, alcohol — had on not only individuals, but their families and whole communities, and just how profound that impact had been for people who had lost their lives, who had lost family members, who had physically, emotionally and spiritually negative impacts of just feeling very hopeless and and trying to find solace in their substance use, particularly their alcohol use, and doing that without really finding it. I think that was really the lesson that experience taught me. 

What did you learn about treatment practices during your medical education? How was that helpful to your career?

When I was a resident in general primary care at Boston Medical Center, I was really fortunate to have a group of mentors who also were general internists, like I was training to be, who were very interested and focused on medical education and research in substance use. And so they modeled for me many of the interactions that we had with patients. I got to do a research study with one of them looking at smoking cessation among people with opiate use disorder, taking methadone. And really importantly, I got to spend a month with one of them at the Boston City Public Health Department’s Opioid Treatment Program, or what some people call a methadone clinic, because he was their medical director. I got to see people recover, and who had recovered, who had gotten their lives back together, gotten their families back together, had new families (or) businesses. It was unbelievably helpful to see that people could recover, that they did recover, and that I, as a physician, could be part of their treatment. I saw people get better, and recover, with medications like methadone and buprenorphine, and other services designed individually for them. That was really helpful and kind of a big eye-opening moment for me.

What factors contribute to addiction and why is it considered a complex disease?

People come into treatment for their addiction — or when they’re not in treatment, but are in an emergency department or on the street — with a lot of shame. They have a lot of shame about this disease that they have, that for so long, they were told, ‘Well, you know, you should just stop. Why can’t you just stop?’ Well, we know that addiction is a disease. It’s a complex disease that has lots of different factors related to it. So there’s a big genetic component that combines with environmental factors and other risk factors. For example, people have what’s called adverse childhood experiences. Some of these are if they grow up with lots of physical or sexual abuse or emotional abuse or have parents who are in jail. That’s really traumatic and so all those childhood experiences that increase stress are a big risk factor. 

What is the easiest opioid to get addicted to?

It used to be heroin. That was a big problem, particularly in the Northeast and other parts of the country. That shifted to prescription opioids, beginning around the year 2000. So for about 10 years, it was really prescription opioids that were a big problem — people misusing them. And then it switched back to heroin. And then in about 2015, fentanyl came on the scene, and that really changed the game, given just how unbelievably potent fentanyl is, so it doesn’t take a lot to cause an overdose. Now there are all those other synthetic opioids, like the orphines and nitazenes and all those combinations of other substances, but fentanyl is really what’s still kind of driving a really big part of the overdose crisis.

Do LGBTQ individuals face heightened challenges when battling addictions? How do addiction specialists like you account for those challenges?

We certainly know that the prevalence of overdose and the challenges of substances is higher in the LGBTQ+ community. Where I see patients, we did a big LGBTQ+ training and had a grant to specifically provide services to that population. Where we were located, in Baltimore City, there is a big transgender community not that far from us. Particularly in the LGBTQ+ population, they have multiple stigmas. So it just compounds multiple stressors. And stress is a risk factor for substance use, and particularly a risk factor for recurrence of a substance use disorder. And so when you have all these negative factors building up in people, that can make it that much more challenging for people to find the services that they find meaningful and that are welcoming and supportive of them. So we tried very hard — and we still do — to make sure that we are a welcoming and safe space, because I think it is that safety that is really paramount.

What advice would you give someone worried about a friend or family member’s substance use?

There are two things. One is: I would talk to that person about your concerns and how that person’s personality changes or their behavior changes when they’re using or in withdrawal, and how that might be impacting their health and how they’re feeling. And then second: you can let them know that there are actual treatments that are really helpful, that can make them feel better and that can help them get back to who they were before they started using. It’s important not to be accusatory because … [people] have a lot of shame already, and so when somebody starts accusing them, that shame just gets worse. And a lot of times, people who have a substance use disorder or are using opioids won’t necessarily agree that they have a problem when you first start to talk to them. But talk to them again every time something happens and say, ‘I’m really worried about you because this now has happened and I see it as being tied to your substance use.’ And let them know that there are people who can help and that they could actually feel a lot better.

This work is part of a partnership between the Washington Blade Foundation and Youthcast Media Group, funded in part through a FY26 Community Development Grant from the Office of D.C. Mayor Muriel Bowser. Adrian Malone is a senior at Bard High School Early College DC, one of Youthcast Media Group’s journalism class partners. Shreya Jyotishi, YMG assistant manager of content and programming, is a former Washington Blade intern and 2026 graduate of American University.

Bet Mishpachah Executive Director Joshua Maxey on Wednesday was among those who spoke at a ceremony in D.C. that marked the third anniversary of the Oct. 7 attack in Israel.

The Jewish Federation of Greater Washington hosted the ceremony that took place at the Washington Hebrew Congregation in Northwest D.C. Bet Mishpachah is the city’s LGBTQ synagogue.

“It was a deeply moving evening, especially hearing the stories of people who knew those who were murdered and those who survived and experiencing music that gave a voice to grief and hope,” Maxey told the Washington Blade.

Hamas militants on Oct. 7, 2023, killed roughly 1,200 people, including upwards of 360 partygoers at the Nova Music Festival near Re’im, a kibbutz that is a couple miles from the Gaza Strip, when it launched its surprise attack on Israel. The militants also kidnapped more than 200 people.

The Hamas-controlled Gaza Health Ministry says Israeli forces have killed more than 74,000 people in the enclave since Oct. 7.

The International Criminal Court in 2024 issued arrest warrants for Israeli Prime Minister Benjamin Netanyahu; former Israeli Defense Minister Yoav Gallant; former Hamas leader Yahya Sinwar; Mohamed Diab Ibrahim al-Masri, the head of Hamas’s military wing known as the Qassam Brigades; and Ismail Haniyeh, chair of the Hamas Political Bureau, after it accused them of committing war crimes and crimes against humanity in Gaza and Israel.

The Israeli government has strongly denied it has committed genocide in Gaza.

An Israeli airstrike on a compound in Khan Younis, a city in southern Gaza, on July 13, 2024, killed killed Deif, one of the alleged Oct. 7 masterminds. Israel less than three weeks later assassinated Haniyah in Tehran, the Iranian capital. Israel Defense Forces soldiers on Oct. 16, 2024, killed Sinwar in Rafah, a city in southern Gaza.

Hamas last October released the remaining hostages in Gaza as part of a ceasefire agreement that President Donald Trump helped broker. Israel has continued to conduct airstrikes and other military operations in Gaza since the official suspension of hostilities took effect.

“For Bet Mishpachah, it was especially meaningful to lift up the names of LGBTQ+ people, those whose identities we know and those whose stories may never be fully known, who were murdered, and to honor the LGBTQ+ survivors whose resilience continues to inspire us,” said Maxey, referring to his participation in Wednesday’s ceremony. “Emily Damari’s story is particularly poignant: while held hostage, she had to hide the fact that she was gay because she feared that revealing her identity to her captors could put her life at even more risk. Yet, she survived.”

“Her story, like so many others, reminds us of the extraordinary courage it takes simply to remain human in the face of hatred,” he added. “May we continue to remember and to mourn, to honor, and to work toward a future rooted in peace and hope.”

(Editor’s note: This article is part of our 2026 contribution to the D.C. Homeless Crisis Reporting Project in collaboration with other local newsrooms. The collective works will be published throughout the week at bit.ly/DCHCRP.)

A decision by President Trump’s administration to eliminate most federal funding for community-based programs to place homeless people in permanent subsidized housing could have a severe adverse impact on LGBTQ people facing homelessness in D.C., according to local advocates.

Officials with organizations that provide services for homeless people in the D.C. area and nationally have pointed to an executive order issued by Trump last year that calls for ending federal support for so-called “Housing First” programs that arrange for permanent subsidized housing for homeless people. The officials note that Trump’s proposed fiscal year 2027 budget calls for eliminating funding for the Housing First programs.

Advocates for programs providing support for homeless people note that ending federal funding for permanent housing for homeless people will — and in some cases already has — resulted in occupants of homeless shelters and short-term transitional housing facilities remaining in those facilities far longer than in the past, preventing openings for others who need housing.

A lawsuit filed by several states and homeless advocacy organizations, including the D.C.-based National Alliance To End Homelessness, to block the Trump efforts to cut off those funds has temporarily delayed some of the funding cuts. A decision in August by a federal judge in Rhode Island declared the Trump action a violation of a federal law for failing to open the proposal for the funding cuts to public comment before putting it in place.

Court records show the U.S. Department of Housing and Urban Development (HUD), which provides the federal funding for homeless related programs, appealed the lower court ruling and an appeals court reversed the ruling pending further appeal by the parties that filed the lawsuit.

At least two of the five D.C. organizations that provide housing for homeless LGBTQ youth have said their funding so far has not been cut due to the Trump actions.

Cesar Toledo, executive director of the Wanda Alston Foundation, which currently provides transitional housing for 20 LGBTQ homeless youth, said his organization receives local D.C. government funding but no federal funding so his group has so far not been impacted by the Trump action.

Debby Shore, executive director of the Sasha Bruce Youthwork organization that  provides housing for young people ages 18-24, including some LGBTQ youth, said her organization also had not yet been impacted but it could be impacted soon.

“We have not had that funding cut,” she told the Washington Blade. “What we understand is if HUD is allowed to go through with those changes, then we will,” she said. “Because we have one of our programs that’s funded directly by HUD,” which she said could be considered the type of “long term” housing that HUD wants to cut.

A spokesperson for the local LGBTQ youth advocacy organization SMYAL, which currently provides housing for 55 homeless LGBTQ youth according to its website, didn’t immediately respond to a Blade inquiry into whether they have been impacted by the Trump actions. Toledo of the Alston Foundation said he understood that SMYAL has received federal funding for its homeless program.

At least two other D.C. organizations that provide housing for homeless youth, including some LGBTQ youth – Covenant House and the Latin American Youth Center – also couldn’t immediately be reached for comment on whether they have been impacted by the Trump funding cuts.

The city’s only shelter for homeless LGBTQ adults, which is operated by the D.C. Department of Human Services and is D.C. funded, has not been immediately impacted by the Trump funding cuts, according to a DHS statement sent to the Washington Blade in response to a Blade inquiry.  Called Living Life Alternative, the low-barrier shelter accommodates 40 individuals, the statement says.

It says DHS receives federal funding for its homeless services programs, and it was awaiting HUD approval for its annual federal funding grant for the city’s Permanent Supportive Housing program for homeless residents. It says the current funding for that program expires Jan. 31, 2027.

According to the statement, a separate federal grant DHS receives from HUD for homeless assistance services was approved for next year but included “a slight reduction in funding of $22,808.”

The annual 2026 Point-In-Time (PIT) count of homeless people in D.C., conducted in January, recorded a total of 5,363 people who were homeless, a 4 percent increase over the previous year.

The PIT count report shows 424 adults, or 12 percent of the adults counted, identified as members of the LGBTQ community, a slight increase over the 11.7 percent of homeless LGBTQ people counted in 2025. It shows that 38 percent of “Transition Age Youth” ages 18-24 identified as LGBTQ, an increase of one percent over the 37 percent of LGBTQ youth counted in 2025.

The Trump administration through HUD has said it supports housing for homeless people that lasts no more than two years and participants should be required to get treatment for the mental illness and substance use disorders such as drug addiction and alcoholism that many homeless people suffer from.

The Washington Post has cited studies showing that up to two-thirds of homeless people have a mental illness and two in five have a substance use disorder.

“Housing First has failed our most vulnerable and enabled addiction,” the Post quoted HUD saying in an email message. “HUD’s proposed reforms seek to address the root cause of homelessness and advance recovery, self-sufficiency, and competition that drives accountability,” the Post quoted the HUD statement as saying. 

Shore, director of Sasha Bruce Youthwork, disputes that assessment, saying treatment for disorders should not be a replacement for longer term housing programs, which she said improves the outcome of treatments for disorders.

“I think the idea of putting more services in place – I don’t have any problem with that,” she said. “But suggesting that you do that in exchange for longer term supports for people does not seem to be the right way to go.”