Red States Reject Trump’s Shift On Overdose Prevention

President Donald Trump and his Health secretary, Robert F. Kennedy Jr., are cutting the federal budget for initiatives that aim to make illicit drug use less deadly, such as needle exchanges and drug testing strips. But some red states are responding by boosting their own funding for those harm-reduction programs.

In GOP-led Florida, Gov. Ron DeSantis recently signed a bill into law legalizing test strips that allow drug users to determine whether their drugs have been cut with a horse tranquilizer, xylazine, that leads to horrific skin wounds. Kentucky's Republican attorney general announced millions of dollars of grant funding to addiction nonprofits this spring. And Republican lawmakers in Indiana this year re-upped a program that provides clean syringes to drug users.

“One xylazine test strip is not going to be the end or the beginning of someone's drug addiction or demise,” said Michelle Salzman, a Republican state representative from Florida’s panhandle who introduced the Florida bill.

The moves come after Trump signed an executive order in July that directed an agency in the Health Department to cut funding for harm reduction programs and safe-consumption efforts. They also happened after that agency told grantees in April that they could no longer use federal dollars to purchase test strips.

Kennedy, a former heroin addict who credits Alcoholics Anonymous and its 12-step group support program with saving his life, has openly slammed harm reduction efforts.

“The Biden administration focused on what they called harm reduction, which was needle exchanges, safe sites for injections, and this led to the proliferation of open-air drug markets around the country,” he said last month. “Harm reduction doesn’t work.”

At the root of the split on the right is the massive increase in fatal overdoses that occurred during the pandemic, when synthetic opioids like fentanyl drove a 50 percent increase, from around 70,000 deaths in 2019 to nearly 105,000 deaths in 2023. The numbers have since plummeted to under 70,000. Republican state officials think those harm reduction efforts deserve at least some of the credit.

Ohio GOP Gov. Mike DeWine signed an executive order last October that helped expand access to drug test strips and kits that detect substances like fentanyl and xylanize.

“Items such as test strips have been shown to reduce the risk of overdose, and these items are important in Ohio’s overall strategy to lower overdose deaths,” DeWine said in a statement after signing.

The debate over harm reduction has long divided conservatives from many who work in public health and addiction recovery. The public health workers cite studies to show the programs save lives, while the conservatives point to the intractability of America’s drug problem, and the quality-of-life harms to the communities where the services are offered, as evidence they don’t work. POLITICO found that Republican state officials increasingly are willing to put aside those concerns in the hopes of avoiding another catastrophic spike in overdoses similar to that during Covid.

There’s no definitive evidence to show why that spike occurred or why it receded, but analysts have offered different theories, that lockdowns drove drug use that fell back when they ended, that the fentanyl supply isn’t as deadly, and that harm reduction efforts worked.

The administration has continued to champion access to the opioid-reversal medication naloxone, and Kennedy has also endorsed continued use of medication that helps people addicted to opioids avoid fentanyl, such as methadone and buprenorphine. But Kennedy has said he views addiction as a “spiritual” disease and favors programs like AA. He’s sought to direct more funding to religious programs to help drug users break the habit.

HHS spokesperson Emily Hilliard told POLITICO that Kennedy “has been consistent in his approach to addiction and his support for effective, common-sense solutions.”

Research into the efficacy of harm reduction, which gained prominence in the 1980s as a response to the HIV/AIDS epidemic, is largely positive. Evidence overwhelmingly suggests that bolstering access to naloxone reduces overdose deaths, while syringe service programs have been shown to help curb the spread of HIV and Hepatitis C. But the evidence is less clear for other interventions, like overdose prevention centers and test strips, due to gaps in domestic research.

Several addiction policy experts told POLITICO that the erosion of federal support for harm reduction could weaken the U.S.’s addiction recovery infrastructure at a time when the country is seeing progress.

“There are many roads to recovery,” said Regina Labelle, a former official in the White House Office of National Drug Control Policy in both the Obama and Biden administrations. “Why would we shut off some of those roads?”

But others disagree. Elinore McCance-Katz, a former Rhode Island public health official who served as chief medical officer at an HHS agency under President Barack Obama and then ran that agency in Trump’s first term, has written that the evidence around harm reduction efforts like test strips is weak. “The current administration is right to question the premise that hard drugs, through careful use, can be made meaningfully less harmful,” she wrote in a recent piece for the conservative City Journal.

That view used to be near consensus on the right, but efforts in the states show that’s no longer the case.

Indiana state GOP Rep. Ed Clere, who was instrumental in ensuring the state’s county syringe service program extension through 2031, says the Trump administration’s stance on harm reduction is one reason he’s switching parties and not running for reelection.

In 2015, he introduced legislation to legalize syringe service programs in response to a deadly HIV outbreak that resulted in more than 230 infections and at least 11 deaths. Clere’s bid sparked mass resistance from his party, including from former Vice President Mike Pence, who was governor at the time.

“It's been the most difficult and costliest political battle I fought in my 18 years in the House, but I’d do it again,” Clere said. “It has prevented countless cases of infection and saved countless lives. I would do it again without hesitation.”

Other GOP state lawmakers are resisting efforts within their party to rein in harm reduction resources. West Virginia’s Republican-controlled House of Delegates sank a GOP proposal to eliminate the state’s syringe service program for a second consecutive year this past legislative session.

And some Republican officials are tapping state troves funded by national lawsuits against opioid manufacturers and distributors to support harm reduction interventions. Republican Kentucky Attorney General Russell Coleman is putting $34 million from its opioid settlement pool toward more than 100 state organizations tackling addiction, including harm reduction-focused groups.

Like Clere, Salzman faced backlash within her own party over the xylazine test strip legislation, saying it was “a fight to get the bill on the agenda.”

She says she needed to take up the measure after hearing countless stories from constituents about fatal overdoses involving young people. Escambia County, which Salzman’s district partially represents, has previously recorded some of the state’s highest rates of overdose deaths.

“A mistake should not equal a life,” she said. “The idea is we're not providing opportunities for people to do drugs, we're just trying to save lives.”