When sufferers overdose on a mix of opioids and medetomidine, offering naloxone may help people begin respiratory once more however doesn’t reverse the sedation brought on by the medetomidine. Credit score: Unsplash/CC0 Public Area
The Trump administration is escalating its push in opposition to what has grow to be a key a part of the way in which states, localities and communities reply to the overdose epidemic: hurt discount.
A public well being strategy geared toward mitigating the unfavorable well being results related to drug use, hurt discount goals to forestall overdoses and infectious illness transmission.
Strategies can contain using opioid overdose reversal medicines equivalent to naloxone, offering sterile needles to restrict the transmission of infectious ailments, check strips that detect fentanyl in medicine, and “safe consumption sites,” the place folks can use medicine below supervision in case they want intervention.
Up to now week, the administration started eradicating instructional supplies associated to hurt discount from authorities web sites.
President Donald Trump final month issued an government order concentrating on homeless folks, railing in opposition to “harm reduction” and “safe consumption” efforts.
And the Substance Abuse and Psychological Well being Companies Administration advised states final week that hurt discount is used to “advocate for policies that are incompatible with federal laws and inconsistent with this administration’s policies.”
Drug coverage advocates say this sample may cede floor on progress in decreasing overdose deaths, significantly amongst people who find themselves homeless.
“It’s deeply disturbing that we are moving backwards, and we’re finally in a time where the country is seeing rates decrease from overdose deaths,” mentioned Carla Sofronski, government director of the PA Hurt Discount Community, a Pennsylvania group that advocates and offers training about hurt discount. “Now we’re pulling back from the same models that supported the decrease in deaths.”
Not less than 76,298 folks died from drug overdoses within the 12-month interval ending February 2025—the bottom quantity since March 2020, in keeping with preliminary Facilities for Illness Management and Prevention knowledge revealed in July.
The adjustments come at an already unsure time for dependancy coverage advocates, after the administration in March clawed again $11 billion in funding that included dependancy providers funds, and with Congress dealing with a number of deadlines to take care of current assets.
Lawmakers have till Sept. 30 to increase funds for the Group Well being Heart Fund and renew a pilot program for some Licensed Group Behavioral Well being Clinics. Regardless of the president’s order calling on each applications to assist homeless people, lawmakers have not launched laws to resume both.
Moreover, parts of the wide-ranging 2018 bipartisan opioid legislation, often known as the Assist Act, have already lapsed.
Trump’s government order alarmed hurt discount advocates by directing the Division of Well being and Human Companies to not fund “programs that fail to achieve adequate outcomes, including so-called ‘harm reduction’ or ‘safe consumption’ efforts that only facilitate illegal drug use and its attendant harm.” Whereas not legislation, the order directs businesses to take regulatory motion.
There are only some protected consumption websites in the USA. Their purpose is to restrict the unfold of infectious ailments and reduce deadly outcomes whereas serving as a bridge to attach customers with different assets. Federal legislation already restricts federal funding of some hurt discount practices, together with the price of needles used at syringe exchanges.
However a shift in messaging from the federal government may have a chilling impact on state and native governments, which deal with a lot of the U.S. opioid response.
“I think having messages like this come out of the White House makes it harder for people in communities to do this work, whether because of funding or because of what the public is hearing,” mentioned Chrissie Juliano, government director of the Huge Cities Well being Coalition, which represents city native well being departments.
The order did not specify which hurt discount strategies the administration opposes, however a White Home official advised CQ Roll Name that the administration will proceed to assist, and even develop, entry to naloxone, which reverses opioid overdoses. However the official mentioned there was a line between naloxone and different hurt discount methods, together with syringe exchanges, which the administration says assist illicit drug use.
Company work
The Trump administration tried to dismantle SAMHSA, the company targeted on behavioral well being grantmaking, and reorganize a few of its applications below the brand new Administration for a Wholesome America.
These plans are on pause due to litigation, however within the meantime, SAMHSA has faraway from its web site a model of its overdose prevention toolkit that included sections on hurt discount and a separate “harm reduction framework”—each of which inform of emergency response measures.
In a “Dear Colleague” letter despatched to states final week, Artwork Kleinschmidt, principal deputy assistant secretary at SAMHSA, mentioned he would not think about naloxone a hurt discount methodology and, as such, it might proceed to be funded by the federal government. Kleinschmidt mentioned check kits and different providers will also be funded by way of grants.
However the letter said that federal funding cannot be used to “purchase pipes or other supplies for safer smoking kits or syringes or needles used to inject illicit drugs” or “any other supplies to promote or facilitate drug use.”
“Moving forward, SAMHSA funds will no longer be used to support poorly defined so-called ‘harm reduction’ activities; rather, SAMHSA is providing guidance to state agency leadership and to grantees through new award terms and conditions that provide clarity on what supplies and services previously defined under the umbrella of harm reduction can be supported with SAMHSA funding,” Kleinschmidt wrote.
Senior officers throughout Trump’s first time period confirmed a extra nuanced tackle hurt discount. Then-HHS Secretary Alex Azar supported syringe exchanges as a approach to cut back the unfold of infectious ailments like HIV. However the Justice Division throughout Trump’s first time period threatened localities that have been contemplating protected consumption websites for injectable medicine.
The Biden administration leaned in on hurt discount, releasing the primary “harm reduction framework.”
Skepticism
Kleinschmidt, whom Trump picked as principal deputy assistant secretary at SAMHSA, has mentioned that hurt discount approaches “are only exacerbating the problem” and that he would focus extra on therapy than on decreasing hurt from drug use.
“There seems to be a great misunderstanding between enabling and helping,” Kleinschmidt mentioned in a podcast final 12 months.
“The more you’re sort of funding and feeding the addiction, you’re going to get more addiction. … They’re almost intentionally breeding dependency,” he mentioned, referring to authorities workers engaged on dependancy points. “I sometimes have a hard time coming to any other conclusion.”
Mike Stuart, Trump’s decide for HHS normal counsel, sponsored laws throughout his time within the West Virginia state Senate that may prohibit methadone clinics and ban syringe applications.
Throughout Stuart’s nomination listening to, Sen. Maggie Hassan, D-N.H., famous that the measure “would have effectively ended the use of methadone to treat opioid addiction” within the state.
“I understand that there are bad actors in the methadone clinic space, to be sure, but do you think Secretary Kennedy is wrong to support medication-assisted treatment like methadone?” she requested.
Stuart replied that one of many payments focused clinics that did not supply “wraparound” providers equivalent to counseling or well being care.
The push away from hurt discount is not shocking. A number of Republican lawmakers criticized a $30 million hurt discount grant program, funded by way of a 2021 COVID-19 aid legislation.
Then-Sen. Marco Rubio, R-Fla., pushed to incorporate a ban on utilizing federal funds to “distribute pipes or cylindrical objects intended to be used to smoke or inhale illegal scheduled substances” within the fiscal 2023 omnibus spending legislation.
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