This is an exclusive BHB+ story
Harm reduction services could face new funding challenges as the practice loses favor with the federal government.
Questions surrounding federal support for substance use disorder (SUD) treatment compounded after the Trump administration consolidated the Substance Abuse and Mental Health Services Administration (SAMHSA) into a new entity. Shortly after, the administration also cut funding and openly criticized harm reduction measures like safe injection and consumption sites and needle exchange programs.
Harm reduction models grew as a response to the HIV-AIDS crisis in the 1980s as a way to prevent disease spread via needle exchanges. Since then, these models have repeatedly been proven to reduce overdose deaths, prevent disease and bolster access to care for adults with substance use disorders (SUDs). Yet, opponents say these practices encourage drug use – one central argument of the Trump administration. Now, the future of harm reduction hangs in limbo.
As part of an executive order issued by President Trump in July promising to curtail crime and disorder on America’s streets, harm reduction was explicitly called out under a section titled “Redirecting Federal Resources Toward Effective Methods of Addressing Homelessness.”
The order states that discretionary grants issued by SAMHSA for SUD prevention, treatment and recovery will not be given to 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.”
As the administration walks back funding and drives forward a law-and-order-focused drug policy, many SUD treatment providers are left wondering what the future holds for them and their patients.
“The main threat to harm reduction at this moment is the dramatic shifts in the funding landscape … ,” Catherine Cook, acting executive director at Harm Reduction International, told Behavioral Health Business. “When funding becomes restricted, harm reduction can often be first to be cut, particularly where it has been hard fought to get harm reduction on the agenda in more hostile environments. Of course, political will and funding go hand in hand. The funding environment, combined with a pushback on rights, is a real threat to harm reduction.”
Harm Reduction International is a non-governmental organization that holds special consultative status with the United Nations Economic and Social Council.
Laura Guzman, executive director of the National Harm Reduction Coalition (NHRC), a similar organization based exclusively in the U.S., told BHB, that the organization has already felt some of the funding reduction impacts. She is concerned about viability going forward, with uncertainty still looming around the SAMHSA block grants that NHRC has previously relied on.
“We had a contract for three years with SAMHSA federal funding through the American Association of Addiction Psychiatry, and we were told that SAMHSA has directed us not to continue under that contract,” Guzman said. “So we’ve already lost $285,000 for 2026 and another $280,000 for 2027. We were probably one of the first targeted organizations, but we are still waiting to see what that impact looks like.”
What’s even more confusing, she said, is that under the executive order, some of the funding priorities that target harm reduction are “kind of uneven,” since there is still an incentive to fund overdose prevention methods like naloxone distribution.
“They still are funding overdose provincials, which of course, to us, is harm reduction, but they will definitely target funding that goes to syringe service programs for folks who are really at the forefront of supporting people who use drugs and linking them to treatment,” Guzman said. “We don’t know what the future looks like with regard to what guidance they will give for the block grants, to the state’s block grants, and how that will far impact the work in the field.”
Nationwide, overdose deaths decreased almost 27% in 2024, which underscored substantial progress in the SUD field. However, now with funding cuts to some of the prevention and harm reduction measures, it’s unclear how this trend will change going forward.
“I think the logical step would be to continue to invest in things we know work,” Dr. Avik Chatterjee, assistant professor at Boston University School of Medicine and physician at Boston Health Care for the Homeless Program, told BHB. “So, we are very worried that any retreat from things that clearly have been effective will likely mean an increase in overdose deaths.”
Chatterjee said the initial impact he has seen in the field so far is a newly induced fear among colleagues and peers about how to even apply for grants for the life-saving work they have routinely executed for years.
“What I see, unfortunately, is people now being afraid to write into their grants or to pursue funding for harm reduction type programming and harm reduction innovations,” Chatterjee said. “Despite the fact that many of those innovations could potentially save even more lives – I’m thinking about things like the safe spot hotline and the restroom, overdose detection devices – and things that are newer that need to still show their efficacy. There is a lot of hesitancy to try to apply for funding for all that.”
That fear, he explained, could stall innovation and hinder productivity across the SUD treatment space.
“Because people are afraid to write in these types of things into grants and programs for both research and clinical public health outreach, I foresee in the near future that a lot of this stuff will start to be pared back,” Chatterjee said.
As addiction treatment has evolved, so has a clinical understanding of what it means for a patient to be completely abstinent from drug use while in recovery – and while that is ideal in theory, in practice, that is much harder to achieve. This is where harm reduction methods come into play.
The American Society of Addiction Medicine (ASAM) emphasizes support for evidence-based harm reduction strategies like safe injection sites and needle exchange programs, but that work may become harder to do under the current federal administration.
“How do we navigate harm reduction within this framework?” Dr. Brian Hurley, ASAM’s immediate past president, told BHB. “I think by focusing on our principles and doing what we can within the systems that we have available to us in order to help keep people as well as possible.”
Some of it may need to come down to a change in rhetoric, he said. Explaining that harm reduction is not a stand-alone service for SUD treatment but rather a component of primary care, street medicine and addiction treatment, which might make services more accessible and “palatable” to those who ordinarily oppose such methodologies.
“I don’t think there’s much public opposition to preventing overdose,” Hurley said. “So making sure that we continue to have systems that are focused on delivering on those principles, I think, will be the future of harm reduction during this administration.”
Chatterjee also reiterated that finding new ways to talk about harm reduction could create a path forward during uncertainty.
“Maybe if we rebrand things and rename things, talking about overdose prevention might be more palatable than the term ‘harm reduction,’” Chatterjee said. “Overdose prevention, certainly, or even ending HIV transmission might be things that people might be willing to invest in if you don’t call it harm reduction.”
Ultimately, it might be time to reinvest in sources where harm reduction originated, he said, such as communities and grassroots organizations that have been doing this work from the start.
“I think that is how we can keep this work going, even without federal and other dollars,” Chatterjee said.
Failure to do so or the further restriction of harm reduction work that can be funded and executed across communities will lead to an increase in deaths and adverse outcomes, ultimately, Hurley and Chatterjee agreed.
“The War on Drugs has not succeeded and a law and order approach where we are trying to arrest our way out of addiction, has not been shown to be successful at all,” Hurley said. “The more that we rely on policing and incarceration to address the disease of addiction, the farther we’re getting from evidence-based practices, and the more interference with harm reduction, treatment and prevention we’ll have.”
Because harm reduction is often a key entry point for people with SUDs to access a full range of services, including treatment or recovery programs, additional scrutiny and lack of funding will hurt access.
“I think that’s the thing that people don’t understand, you want to keep someone alive until they can make the decision they want to stop using, and harm reduction is a way to do that,” Chatterjee said. “Abstinence, unfortunately, is not because people who abstain, especially if they aren’t on medications, are at a high risk for relapse and overdose death. Harm reduction keeps people alive.”