President Trump is threatening to withhold funds from supervised drug consumption sites and potentially pursue criminal penalties against them, offering his clearest stance yet against the philosophy of harm reduction and marking a significant escalation of his rhetoric on substance use and addiction.
The new position, announced in a Thursday executive order, pledged to end funding for “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.”
The new policy was unveiled as part of a larger action that could allow authorities more leeway in forcing some mentally ill people into treatment against their will. But Trump’s targeting of harm reduction is also noteworthy. The philosophy boils down to reducing the negative impacts of substance use without demanding abstinence: for instance, helping injection drug users avoid HIV or hepatitis by providing access to sterile syringes.
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While some forms of harm reduction have gained a degree of acceptance, others, like supervised consumption, remain controversial. The practice, sometimes referred to as “safe injection” or “safe consumption,” offers not only sterile supplies for drug use but also supervision from professionals who can provide naloxone, rescue breathing, and other overdose-reversal techniques, if necessary.
Only three such sites are currently operating in the U.S.: two in Manhattan run by the nonprofit OnPoint NYC, and a third in Rhode Island. OnPoint, which has operated its “overdose prevention centers” since 2021, says its staff has reversed roughly 2,000 potentially fatal drug overdoses in the last four years.
The executive order appears to implicate OnPoint most directly. The site run by Project Weber/RENEW in Providence, R.I., is explicitly authorized by a state law. According to the federal government’s online grants database, it has received no federal dollars other than a single $10,000 grant in 2020 at the height of the Covid-19 pandemic.
OnPoint’s two New York City sites, however, are operating on shakier footing, having opened in 2021 with the blessing of then-Mayor Bill de Blasio but without an explicit state law establishing its legality. OnPoint and one of its predecessor organizations, New York Harm Reduction Educators, have won $3 million in grants from the Substance Abuse and Mental Health Services Administration since 2021. The only active grant, which expires in late 2026, shows over $400,000 owed to the nonprofit out of roughly $1 million awarded.
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The executive order faced immediate criticism from progressive-leaning groups that advocate on behalf of people who are homeless or who use drugs.
“If this administration truly seeks to reduce overdose deaths and improve community safety, it must embrace and sustainably fund what public health experts and advocates say works: harm reduction programs, overdose prevention centers, and widespread access to voluntary, non-coercive treatment and care,” Deborah Reid, a senior health policy attorney with the Legal Action Center, said in a statement. “These programs save lives.”
OnPoint NYC did not immediately respond to STAT’s request for comment.
Trump’s executive order implicates harm reduction organizations twice: first by threatening to end grants from SAMHSA, and second, by ordering reviews of recipients of federal money for homelessness and housing programs that offer supervised consumption services or “knowingly distribute drug paraphernalia.” It’s unclear how the administration is defining paraphernalia, and whether the language could potentially apply to less controversial harm reduction programs, like organizations that only offer syringe exchange.
The second reference includes a threat to “bring civil or criminal actions in appropriate cases.” The federal government, dating back to the first Trump administration, has argued that supervised consumption sites violate a law commonly known as the “crack house statute,” which prohibits operating any facility “for the purpose of manufacturing, distributing, or using any controlled substance.” Supervised consumption advocates have countered that the purpose of their operation is not to facilitate drug use, but rather to prevent its potential harms, like disease transmission or death.
The executive order cuts to the core of a basic debate within the drug policy world: whether harm reduction complements efforts to help people abstain from drugs and achieve recovery, or undermines them. One section on homelessness programs called out organizations that “fail to promote treatment, recovery, and self-sufficiency” — in other words, offering housing and harm reduction services without explicitly pushing participants toward treatment and abstinence.
In a statement, the Department of Health and Human Services told STAT that HHS Secretary Robert F. Kennedy Jr. was “wholly aligned” with the executive order.
“It is absolutely critical that federal funding provided by the American taxpayer goes to effective, common-sense solutions that keep people out of cyclic crisis and move them into a life of recovery,” said Vianca Rodriguez Feliciano, an agency spokeswoman.
Some outside advocates also welcomed the new stance, arguing that harm reduction and “housing first” policies have gone too far.
“Some kind of reform is needed,” said Tom Wolf, a San Francisco resident in recovery from opioid addiction who has opposed policies that favor harm reduction over immediately incentivizing abstinence. “Trump basically said that the federal government is no longer going to allow people to camp out on the street and do drugs all day long.”
Harm reduction programs argue that they help people who use drugs stay healthy and alive regardless of their desire to eventually stop. The programs cite data that show services like syringe exchange are highly effective in stopping infectious disease transmission. Data from supervised consumption sites around the world also reliably show they reduce drug mortality.
OnPoint stresses that its services are open to all, and that while recovery is not the explicit goal, it is often the end result. Often, participants come across the organization because of their supervised consumption offering, but later take advantage of the countless services it offers. Many first take advantage of the sterile syringes or smoking supplies, then laundry, mail, hot meals, and acupuncture, and then dedicated case workers, medical care, before finally seeking out a detox program or a medication for opioid use disorder, like buprenorphine.
In an apparent coincidence, a federal court in Pennsylvania issued a ruling Thursday that opened the door for a Philadelphia nonprofit to argue that its proposal to offer supervised consumption services is protected on the grounds of religious freedom. The nonprofit, Safehouse, has sought to open a supervised consumption site since 2018, but has faced resistance from the local, state, and federal government.
A three-judge panel of the 3rd Circuit Court of Appeals ruled that Safehouse is free to argue that offering supervised consumption would be protected under religious freedom law. The nonprofit has argued in previous legal filings that its Judeo-Christian values create an obligation to save lives and reduce harm. The first Trump administration fought Safehouse’s bid to open in Philadelphia, and the Biden administration continued to pursue the federal lawsuit upon taking office in 2021.
“The Court’s opinion recognizes what we have always believed: The law safeguards our mission to preserve human life in an unprecedented overdose crisis,” Safehouse said in a statement.
