President Trump’s executive order on homelessness aims to make it easier for states and cities to get people into mental health or addiction treatment, even if that means involuntary civil commitment.
MARY LOUISE KELLY, HOST:
Today we’ve been reporting on the Trump administration’s executive order around homelessness. That order also calls for the elimination of federal funding for drug addiction programs that offer what’s known as harm reduction health care. NPR addiction correspondent Brian Mann is following this. Hey, Brian.
BRIAN MANN, BYLINE: Hi, Mary Louise.
KELLY: OK, so I’m going to hit you with two questions to get us going. First, just explain what is harm reduction health care, and then how big a deal it is that the Trump administration wants to defund it.
MANN: Well, your second question, Mary Louise, is the easiest to answer. This is a huge deal. We’ve seen big cuts and other shocks to the addiction health care system since Trump took office. This is another big one. Harm reduction is now part of almost every addiction program in the country these days. It’s used to help people who are addicted to drugs like fentanyl stay alive and as healthy as possible until they can be guided toward more full recovery. These programs mean everything from needle exchanges that have proven to reduce disease, to distribution of naloxone. That’s the medication that reverses fentanyl overdoses. If federal funding for these programs is frozen, it’ll be a huge disruption.
KELLY: Why does the Trump administration want to defund it then?
MANN: The argument in the president’s executive order is that harm reduction, and I’m going to quote him directly here, “facilitates illegal drug use.” This concern has been around for years, that if you help people avoid the worst health impacts of drug use, including overdose and death, you might wind up enabling and prolonging addiction. Most experts say this fear has been discredited by years of research. Regina LaBelle served in the Biden administration, and she’s now an addiction researcher at Georgetown University.
REGINA LABELLE: Harm reduction does not increase drug use. The most important thing about harm reduction is that it builds trust with people so that folks who wouldn’t otherwise get any kind of care can get the type of care that they need.
MANN: Now, Mary Louise, I did reach out today to federal officials, including the White House, to clarify exactly what forms of harm reduction the president wants cut here. We received just a brief statement from the Department of Health and Human Services saying taxpayer money will go to effective common-sense solutions. But the only harm reduction strategy Trump’s executive order specifically names for cuts are safe consumption sites. These are very rare, controversial programs where people are allowed to use illegal drugs under medical supervision as part of an effort to reduce overdose deaths. But here’s the thing. These programs are incredibly rare, and they already operate without any federal support.
KELLY: Interesting. OK. Now, I am told you did speak with some addiction researchers who voiced support for at least parts of Trump’s approach. What were they telling you?
MANN: Yeah, this is interesting. With severe drug addiction, there are really two linked problems. One’s public health, which we’ve been talking about – that’s people severely ill with addiction. The other problem is the public disorder that can be caused by people in addiction. Sometimes they’re living on the streets. And John Caulkins at Carnegie Mellon University thinks under President Biden there was too much focus on one side – on the public health – and too little focus on making communities feel safer.
JOHN CAULKINS: The pendulum, in some sense, in at least some communities, almost swung too far in the other direction and said that people with addiction are the only stakeholders when it comes to thinking about addiction. And we denied the genuine interest and concerns of other people around them.
MANN: But Caulkins says he thinks this executive order goes too far, defunding too many treatment programs.
KELLY: So Brian, just briefly, if – and it sounds like there’s a lot of questions here – but if the U.S. is not going to fund harm reduction going forward, what are the alternatives?
MANN: The experts I’m talking to say there aren’t good alternatives right now. Even before the big budget cuts the Trump administration has been making, there weren’t enough treatment beds or care providers. So this is a question we’ll be trying to answer – if the president wants people suffering addiction off the streets, where does he expect them to go?
KELLY: NPR addiction correspondent Brian Mann – thank you, Brian.
MANN: Thanks very much.
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