The Centers for Disease Control and Prevention has told overdose-prevention funding recipients they may no longer promote the “never use alone” message. The Guardian obtained details of a meeting held earlier this month where officials discussed this harm reduction messaging ban.

The CDC held the compliance meeting for recipients of its Overdose Data to Action (OD2A) funding programme. Officials wanted to align grant recipients with recent executive orders, particularly the July directive “Ending Crime and Disorder on America’s Streets”.

The executive order bans federally funded harm reduction and safe consumption efforts. It claims these efforts “only facilitate illegal drug use and its attendant harm”. Harm reduction covers a wide range of interventions that make risky activities safer. These include condoms for STI prevention, clean syringes to prevent HIV and hepatitis, fentanyl test strips, and Narcan for overdose reversal.

The Moral Hazard Philosophy Behind the Ban

Professor Leo Beletsky teaches law and health sciences at Northeastern University. He explained that “moral hazard” thinking drives this policy shift.

“It’s the idea that by making a risky activity less risky, you’re encouraging people to engage in it,” Beletsky said. But he pointed out a flaw in this logic. If imprisonment threats don’t stop drug use, concerns about contaminated equipment won’t either.

CDC officials told participants that funding recipients cannot use any messaging that might encourage substance use. Multiple state and municipal health officials asked whether they could continue promoting overdose prevention strategies that encourage people not to use substances alone. Officials called it a “grey area” and wouldn’t give a clear answer.

How Proven Overdose Prevention Strategies Work

Dr Jenny Hua serves as medical director for Chicago’s department of public health. She stressed that these messages form the backbone of successful overdose prevention strategies. Chicago has seen the biggest improvement in overdose fatalities among major US cities, with deaths dropping by 23% in 2024.

“Our messaging has always been to carry Narcan, never use alone, check your drugs,” Hua explained. She called these the basics of harm reduction.

The executive order creates strange contradictions. CDC officials said Narcan and fentanyl test strips remain allowed. This has left people confused about what the administration actually considers harm reduction messaging.

“It’s an interesting inconsistency because in some states test strips are still considered paraphernalia,” Hua observed.

Beletsky called this selective approach “absurd”. The administration keeps allowing certain interventions that everyone has always considered harm reduction whilst attacking the broader concept.

Evidence Links Isolation to Higher Overdose Deaths

Hua explained that distributing Narcan and test strips works hand in hand with harm reduction messaging that encourages people not to use substances alone. Someone experiencing an overdose needs another person to administer the reversal medication.

Chicago’s west side neighbourhoods show this clearly. Four of the five areas most affected by overdose fatalities saw significant declines in 2024. These were neighbourhoods where people primarily use drugs outdoors. Austin, the fifth neighbourhood where indoor use is more common, didn’t see the same improvement.

“When you are overdosing outside or in public, there’s a much higher chance of someone using Narcan to help you reverse that overdose,” Hua said.

Beletsky reinforced this point. “Isolation is one of the key drivers of overdose fatalities, not necessarily overdoses, because people overdose and survive,” he noted. Isolation generally creates a major barrier to recovery. Connection proves crucial to the recovery process.

The messaging therefore represents “a message of hope and connection and support, which is absolutely critical to resolving this crisis”, Beletsky continued.

Experts Worry About Reversing Progress on Harm Reduction Messaging

Beletsky said people committed to ending overdose fatalities have learned what works “the very hard way”. He worries that coming policy changes could reverse progress “to a time when things were spiralling year after year”. He fears “we will go back to seeing the trends reverse again in the wrong direction”.

Dr Andrew Kolodny works as medical director of the Opioid Policy Research Collaborative at Brandeis University. He argued this debate distracts from inadequate overdose and addiction prevention funding. The government awards grants only in two-year blocks. This makes building a comprehensive substance use treatment system impossible.

Kolodny noted that Biden promised to strengthen treatment infrastructure during his 2020 campaign. He failed to double the nation’s treatment capacity as pledged.

“Under Trump, we’re even less likely to see a new funding stream,” he said. “There are other things I could think of that I’m more concerned about than the language in an executive order.”

A Department of Health and Human Services spokesperson stated: “HHS is committed to implementing the President’s Executive Orders across the Department.” The department oversees the CDC.

Source: theguardian