In late April, the Trump administration reinstated a ban on the use of federal funds for the purchase and distribution of fentanyl test strips. These treated paper strips, which alert drug users to the presence of fentanyl and some other deadly adulterants, are representative of the “harm reduction” approach to drug policy. Harm reduction treats illegal drug use as an inevitability to be facilitated safely rather than a dangerous choice to be discouraged.
Originating among activists in the 1980s and enshrined as federal policy during the Biden administration, harm reduction covers everything from syringe distribution and naloxone (a medicine used to counteract opioid overdoses) to drug “contaminant” test kits and even “clean” crack pipes. It presents these as a compassionate alternative to current drug-treatment approaches.
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The evidence for such interventions, however, is much more ambiguous than harm reduction advocates admit. The current administration is right to question the premise that hard drugs, through careful use, can be made meaningfully less harmful.
Consider what happened during the dramatic expansion of harm reduction programs beginning in 2021. The National Survey on Drug Use and Health showed that 8.3 million Americans aged 12 and up had drug-use disorders in 2019. That number rose to 28.2 million in 2024, a 240 percent increase. Opioid-use disorder specifically grew from 1.6 million Americans in 2019 to 5.7 million in 2023. Overdose deaths increased, exceeding 100,000 in 2021, 2022, and 2023. One would expect an effective approach to have done more to stem this tide.
Fentanyl test strips have become a flashpoint because they illustrate the problem with harm reduction so well. Prior to the Biden administration, the Substance Abuse and Mental Health Services Administration had prohibited federal funding for these strips for a straightforward clinical reason: they sometimes yield false negatives, missing fentanyl even when it is present. Test strips also can’t detect the ever-evolving slate of new synthetic substances—drugs like xylazine, carfentanil, nitazines, and orphines. Finally, the absence of contamination in cocaine or methamphetamine does not make either drug safe to consume by any reasonable public health standard. To suggest otherwise is clinically negligent.
Nor is there much evidence that fentanyl test strips reduce overdose deaths. There’s no discernible geographic correlation between states’ overdose mortality rates and their policies on access to fentanyl test strips. This suggests that access to test strips has no effect on mortality—they don’t save lives.
The federal policy change does not prevent individuals from purchasing their own test strips (which sell for about a dollar). It just means that Washington will no longer subsidize a practice with serious clinical limitations and weak population-level evidence.
And, beyond the question of effectiveness, it is legally and morally suspect for the federal government to support practices, like hard drug use, that are undeniably illegal and dangerous. While private individuals and groups might be willing to embrace that contradiction, the federal government should avoid on principle endorsing the violation of its own laws.
Fentanyl test strips are not unique—even the least objectionable harm reduction programs show limited evidence of effectiveness. Syringe distribution programs and naloxone, the most established pillars of the approach, are supported by far weaker evidence than many public-health advocates care to admit. While naloxone can prevent overdose deaths in individual cases, at a community level, widespread access to naloxone may not reduce mortality from drug use. Naloxone availability does, however, appear to correlate with higher rates of opioid-related property crimes.
The mixed evidence for harm reduction has not stopped harm-reduction advocacy organizations from claiming credit for the decline in drug overdose deaths over the last two years. But even they acknowledge changes in the drug-supply chain as at least a tertiary factor. Indeed, recent research identifies a supply shock to the fentanyl trade as the primary driver of the decline.
State, local, and private programs comprise the vast majority of harm-reduction spending. As a result, even with reduced federal support, harm-reduction programs are at little risk of a funding shortage. California alone recently spent $61 million over four years on harm reduction. And states are handing out tens of millions in opioid settlement funds to harm-reduction groups. For comparison, a Biden-era grant program from the Substance Abuse and Mental Health Services Administration offered only $30 million for community-based harm reduction services nationwide.
While the limited evidence of efficacy does not justify federal support, harm reduction should not be abandoned in all circumstances. But the animating belief behind the most expansive harm reduction programs—that the government should focus on making drug use more survivable rather than helping people survive addiction—is wrong and should be challenged.
The Trump administration’s changes are not just a sensible reprioritization of limited federal dollars. They’re a step toward recognizing that people struggling with addiction are capable of recovery, and that they deserve a country that believes in that possibility.