Harm Reduction Works. ‘Wellness Farms’ Won’t.

As an emergency physician, I have treated patients after an overdose when minutes to a lifesaving medication determines survival. I have also worked in substance use clinics, where recovery is rarely immediate and requires meeting patients where they are. In medicine, we are trained to act on evidence, not ideology. When a patient is in front of us, we use the tools that work, even if they are imperfect, because the alternative is unacceptable. We don’t let people die.

If I can save a life in the emergency department (ED), why wouldn’t I? Similarly, if we can prevent an overdose in the community with lifesaving interventions, why wouldn’t we?

Despite this logic, HHS has issued funding restrictions that remove support for lifesaving interventions for those most at risk for an overdose. This will undermine the progress made under the first Trump administration.

For years, drug overdoses continued to rise in the U.S., first driven by overprescribing of opioid pain medications, then by heroin, and now by fentanyl, which is far more lethal. After peaking at 105,000 drug overdose deaths in 2023, we are finally seeing continued declines in these tragic deaths down to approximately 70,000. But 190 deaths a day in this country is still an unacceptable toll.

We still desperately need evidence-based programs that save lives, regardless of political beliefs. In 2015, after an outbreak of HIV among people who were injecting drugs and sharing needles in Scott County, Indiana, then-governor Mike Pence (R) approved the state’s first syringe exchange program. He didn’t agree with the approach personally, but his state health official Jerome Adams, MD, MPH, showed him the data. As surgeon general, Adams later issued a 2017 advisory encouraging broader access to naloxone (Narcan).

Around the same time, acting HHS Secretary Eric Hargan, JD, declared a public health emergency for drug overdoses in 2017 under the direction of President Trump during his first term. This led to increased coordination, regulatory flexibility, and improved data reporting to combat the overdose epidemic; much of that effort advanced under the leadership of Admiral Brett Giroir, who made it a key HHS priority.

In 2019, when I was the director of the National Center for Injury Prevention and Control, we scaled up our work with state health departments into the national Overdose Data to Action program with bipartisan congressional support. It focused on safer opioid prescribing, linkage to care, state-level data, and partnership with law enforcement and other community groups. Since then, CDC has invested billions of dollars to support state and local health departments in preventing overdose deaths.

These CDC programs have demonstrated real results. Oklahoma distributed hundreds of thousands of fentanyl test strips and saw a decrease of 250 overdose deaths. Similarly, Kentucky has a leave behind naloxone program where EMS literally leaves behind naloxone, fentanyl test strips, and treatment information after reporting to a call for a suspected overdose. And in 2024, the state saw a decrease of more than 600 deaths in a year. This is not by accident. It is because we used the right tools to reach people and save lives.

Prevention remains the priority. But a comprehensive response requires more tools. Evidence shows that fentanyl test strips reduce drug use and other risky behaviors, and people who engage with syringe service programs are significantly more likely to seek treatment and even stop using drugs altogether. Even universities are now handing out naloxone and fentanyl test strips, reflecting how mainstream these tools have become.

We know what works, and it’s not “wellness farms.” It’s expanding access to naloxone to reverse overdoses. It’s faster, more actionable data so communities can respond to emerging hotspots. It’s initiating medications like buprenorphine in emergency departments. It’s investing in youth prevention and community-based programs that meet people where they are. And yes, it’s harm reduction strategies that have long been debated but are now also undeniably part of what is working.

While preventing drug use in the first place is the goal and has been central to CDC’s public health approach, harm reduction interventions that focus on people already using drugs are also essential, as these individuals are at highest risk for an overdose. Just as I did as an emergency physician, in public health we must do everything we can to save lives.

We are making progress with the largest decline in overdose deaths since the epidemic began. We cannot abandon what works now. Our friends, our neighbors, our families depend on it.