How the Trump White House works against itself in its efforts to prevent overdoses | Trump administration
In just a few weeks, the Trump administration has proposed multiple conflicting policies related to overdose prevention — some that could help save lives and others that experts say could further strain health care resources and put people at risk of overdose.
These policies include a new ban on funding for fentanyl test strips, which help people avoid overdoses; proposed budget cuts that would weaken the nation’s overdose prevention efforts; and an ambitious drug control strategy that will be impossible to implement if the above reductions are implemented.
An April letter from the Substance Abuse and Mental Health Services Administration (Samhsa) said the agency would no longer fund test strips for fentanyl and other dangerous adulterants “intended for use by people who use drugs.” Dr. Nabarun Dasgupta, director of the University of North Carolina’s Opioid Data Lab, said funding the test strips “is a win for the cartels,” noting that it would deprive people of the ability to identify impure products and report them to their dealers.
It’s the latest in a series of attacks by the Trump administration on harm reduction — a public health strategy first launched by AIDS activists that helps people reduce the risks inherent in sex and drug use. In recent years, public health departments across the country have helped people prevent overdoses by scaling up harm reduction interventions, such as test strips, which allow people to test their drug supply and prevent overdoses; nasal naloxone, an easy-to-administer nasal spray that can reverse opioid overdoses; and public health messages stating “never use alone,” ensuring someone is there to administer naloxone in the event of an overdose.
The Trump administration appears to be removing these interventions one by one.
In January, the Centers for Disease Control and Prevention (CDC) decided to block “never use alone” messages while ensuring it would still consider supporting fentanyl test strips. Samhsa is now defunding fentanyl test strips, which can help people avoid overdoses altogether, while emphasizing that it will continue to support access to naloxone. Dasgupta said it’s ironic that the administration agrees to fund drugs that can reverse an overdose, but not test strips that can prevent an overdose from happening in the first place.
“It just doesn’t make sense,” Dasgupta said.
The picture becomes even more confusing in the context of other recent policy announcements from the Trump administration. In April, he proposed budget cuts that, if enacted, would eliminate $10 billion in funding for drug and overdose prevention and research, according to the Drug Policy Alliance. The following month, the White House announced an ambitious national drug control strategy.
Maritza Perez Medina, director of federal affairs for the Drug Policy Alliance, said she agreed with many aspects of the strategy, which expands access to naloxone and treatment, but asked the question: “If you support these things, then why are you canceling them?”
Medina said Medicaid cuts under the One Big Beautiful Bill Act would already lead to hospitals closing and reducing the availability of drug treatment.
For the policy to be implemented, Congress will have to reject Trump’s proposed budget cuts, says Richard Baum, former acting director of national drug control policy in the White House under Trump and others. The apparent contradiction between the two proposals stems from a lack of coordination between government agencies. Baum said drug control policy is largely inspired by the Office of National Drug Control Policy, while the Office of Management and Budget is behind the White House budget proposal.
The drugs strategy includes initiatives to develop technology to help with drug interdiction, as well as wastewater monitoring to help track the contents of the drug supply. The Trump administration has already cut funding for similar initiatives. Dasgupta finds the focus on wastewater monitoring particularly perplexing given the attack on test strips. Sewage contains urine which can provide clues about the medications people are taking, but it doesn’t give the complete picture.
“Elements that disappear in urine, like nitazins, will not show up in wastewater at a reliable level,” Dasgupta said.
Nitazines are ultra-potent synthetic opioids that have become more common in the drug supply following the international crackdown on fentanyl.
“The drug supply changes from hour to hour in the same location, and what your individual patient is taking is not something you can just guess from the big picture,” Dasgupta said. Tools that allow individuals to check their medications, like test strips, can actually help people change their behavior and avoid harm.
Medina agreed that with the test strips, “they can choose not to take this medication. They can choose to use it more slowly. They can choose to use it with a friend.”
The White House and the Office of National Drug Control Policy did not respond to the Guardian’s request for comment.
Dasgupta emphasized that individual drug monitoring services, including test strips and more advanced mass spectrometry tests, are more in line with precision medicine and the latest medical technologies than wastewater monitoring. In particular, he called the drug strategy “kind of a weak sauce” because it emphasizes technology that was cutting edge a decade ago. He added: “We now have better tools. »
