Key Highlights
- The most salient is the July order “Ending Crime and Disorder on America’s Streets”. The order prohibits federally funded “harm reduction” and “safe consumption” efforts, stating that they “only facilitate illegal drug use and its attendant harm”.
- Harm reduction refers to a wide array of interventions to make risky activities less risky, and has traditionally encompassed everything from condoms to prevent STIs, clean syringes to prevent HIV and hepatitis, fentanyl test strips and the overdose-reversal drug Narcan.
- “Safe consumption” refers specifically to drug-related interventions like clean syringes. Leo Beletsky, a professor of law and health sciences at Northeastern University, said the philosophy behind this language is called “moral hazard”.“It’s the idea that by making a risky activity less risky, you’re encouraging people to engage in it,” Beletsky said, adding that if the threat of imprisonment won’t stop someone from using drugs, a dirty syringe won’t either. The officials leading the meeting told participants that anything that could be construed as encouraging drug use is now prohibited for funding recipients.
- Multiple officials from state and municipal health departments asked whether they would be allowed to continue spreading the message to “never use alone”.
- The officials said it was a gray area and would not provide a clear answer. A spokesperson for the Department of Health and Human Services, which oversees the CDC, said: “HHS is committed to implementing the President’s Executive Orders across the Department.”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 – said this message is part of “harm reduction 101 … our messaging has always been to carry Narcan, never use alone, check your drugs”. While the language of the executive order demonizes harm reduction in general, CDC officials also explained that Narcan and fentanyl test strips will continue to be permitted, creating confusion around the administration’s definition of harm reduction.“It’s an interesting inconsistency because in some states test strips are still considered [illegal] paraphernalia,” Hua said. Beletsky said this “hair splitting” over what does and doesn’t count as harm reduction is “absurd”, because the administration is still allowing certain interventions that have always been considered harm reduction even while disparaging the concept. Harm-reduction organizations have indeed promoted take-home Narcan for decades and have also been instrumental in promoting fentanyl and other test strips to help alert users to contaminants. Hua said that providing Narcan and test strips goes hand in hand with “never use alone” messaging, since a person who is overdosing needs someone else to administer Narcan. While Hua emphasized that this example is anecdotal, she noted that four out of five of the western Chicago neighborhoods most affected by overdose fatalities saw a significant decline in 2024.
