During 2016–17, Manchin read to the Senate several letters from constituents about loved ones' deaths from opioids and urged his colleagues to act to prevent more deaths. Manchin took "an unusual proposal" to President Trump to address the crisis and called for a "war on drugs" that involves not punishment but treatment. He proposed the LifeBOAT Act, which would fund treatment. He also opposes marijuana legalization. In January 2018, Manchin was one of six Democrats who broke with their party to vote to confirm Trump's nominee for Health Secretary, Alex Azar.