President Donald Trump signed an executive order July 24 that shifts national homelessness policy by promoting involuntary civil commitment and withdrawing federal support — a move that could reverse recent public health progress, Community Medical Services CEO Nick Stavros told Becker’s.
Community Medical Services is a provider of outpatient medication and support for opioid use disorder, operating more than 70 clinics nationwide.
Harm reduction policy changes
After years of efforts to increase awareness of harm reduction, Mr. Stavros said the order rolls back those gains. Discretionary grants issued by the Substance Abuse and Mental Health Services Administration will “not fund programs that fail to achieve adequate outcomes” in reference to harm reduction and safe consumption efforts, according to a July 24 news release from the White House. These efforts include syringe access programs, safe injection sites and naloxone distribution.
“It’s been the last few decades that syringe access programs were illegal,” he said. “Then that only started to change in the last couple years, and now it’s just changing back to the way it was. I don’t think we’ve yet had a chance to see the progress play out, to be able to see much of that progress reversed. It’s almost like we’re not going to see the benefit; we’re going to see a detriment.”
The order said previous harm reduction efforts further facilitate illegal drug use and harms individuals, contradicting CDC research showing that new users of syringe services programs are five times more likely to enter drug treatment and about three times more likely to stop using drugs than those who do not use the programs.
Treatment access and funding challenges
The order withdraws funding from harm reduction programs and encourages involuntary commitment, which could lead to an expansion of access to treatment. But when those individuals are diverted into treatment rather than incarceration, the funding must support greater access to care across the country.
“If a police officer picks someone up and takes them to treatment, they can’t take them into treatment because they don’t have funding to do it, so then they have to find other treatment,” Mr. Stavros said. “Eventually, the person ends up back on the streets and then gets arrested again, and it’s just this revolving door.”
Mr. Stavros referenced a program in Portugal in which individuals are diverted to treatment, and funding previously allocated for incarceration is redirected to treatment services.
He added that President Trump’s order follows major healthcare funding reductions under the One Big Beautiful Bill Act and adds financial stress to programs tasked with treating individuals at no cost.
Stigma and root causes
A lack of affordable housing is a primary driver of homelessness, according to the National Alliance to End Homelessness. The executive order ends support for “housing first” policies that the White House refers to as “deprioritizing accountability.” This contradiction perpetuates a stigma around mental health, implying that homelessness is caused primarily by mental illness or drug use, Mr. Stavros said.
“They’re ending up on the streets because they can’t pay rent and they can’t afford housing,” he said. “That’s why you see these skyrocketing rates of homelessness in places like Seattle and Portland and San Francisco, where it’s incredibly expensive to live. People typically turn to drugs and develop mental health issues and turn to alcoholism after experiencing all of the trauma that goes along with it.”
A lack of access to stable housing makes it harder for individuals to complete treatment. Mr. Stavros noted that many patients reduce drug use incrementally, and he emphasized that the process takes time. When individuals are removed from their housing, that affects their treatment, he said.
