In a concerning move, officials at the Centers for Disease Control and Prevention (CDC) have suggested that recipients of Overdose Data to Action (OD2A) funding may no longer be allowed to promote the message to “never use alone”. This message, which is a key part of “harm reduction 101”, has been credited with contributing to significant declines in overdose fatalities across the United States.
The purpose of the meeting, as detailed in a grant note obtained by The Guardian, was to bring OD2A funding recipients into compliance with President Trump’s executive orders. The most salient of these is the July order “Ending Crime and Disorder on America’s Streets”, which prohibits federally funded “harm reduction” and “safe consumption” efforts, stating that they “only facilitate illegal drug use and its attendant harm”.
This language reflects a “moral hazard” philosophy, where the idea is that making a risky activity less risky will only encourage people to engage in it. However, experts argue that this approach is misguided, as isolation is a key driver of overdose fatalities, not the overdoses themselves.
“‘Never use alone’ is therefore a message of hope and connection and support, which is absolutely critical to resolving this crisis,” said Leo Beletsky, a professor of law and health sciences at Northeastern University.
Dr Jennifer Hua, medical director for the department of public health in Chicago, which has seen the biggest improvement in overdose fatalities among major US cities, emphasised that this messaging has always been a core part of their harm reduction approach. “Our messaging has always been to carry Narcan, never use alone, check your drugs,” she said.
While the CDC officials indicated that Narcan and fentanyl test strips will continue to be permitted, Beletsky described this “hair-splitting” over what does and doesn’t count as harm reduction as “absurd”, given that these interventions have always been considered part of harm reduction efforts.
Harm reduction organisations have been instrumental in promoting take-home Narcan and fentanyl testing strips, which go hand in hand with the “never use alone” message. Hua noted that the neighbourhoods in Chicago most affected by overdose fatalities saw significant declines in 2024, particularly where drug use occurred outdoors, underscoring the importance of this approach.
Andrew Kolodny, a medical director of the Opioid Policy Research Collaborative at Brandeis University, warned that these looming changes could roll back the progress made in recent years, potentially leading to a resurgence in overdose deaths. He emphasised that the real issue is the inadequate funding for addiction treatment and prevention, which has only been awarded in two-year blocks, making it impossible to create a comprehensive substance-use treatment system.
As the Biden administration grapples with the ongoing opioid crisis, harm reduction advocates fear that the Trump-era restrictions could further hamper their efforts to save lives and support those struggling with addiction. The future of this crucial public health approach hangs in the balance.
