Despite the Trump administration’s efforts to reduce federal funding for harm reduction initiatives, several Republican-led states have expanded support for programs aimed at reducing overdose deaths, according to a July 18 report from Politico.
U.S. drug overdose deaths have fallen, marking the longest sustained drop in decades, with the 2025 total roughly in line with 2019 pre-pandemic levels.
Approximately 69,973 Americans died of drug overdoses in the 12-month period ending December 2025, marking a 13.9% decline from the previous year and the third consecutive year that figure has dropped, according to CDC data published May 13,
But addiction leaders warn the gains remain fragile.
“The decline is promising, though I also have concerns,” Itai Danovitch, MD, chair of the department of psychiatry and behavioral neurosciences at Los Angeles-based Cedars-Sinai Medical Center, told Becker’s. “The positive drivers include sustained efforts to increase access to effective treatments, harm reduction infrastructure including overdose reversal kits, syringe services, and fentanyl test strips though many of these programs are now imperiled, and improvement in how health systems identify and engage people with opioid use disorder.”
Here are five things to know:
1. Some GOP-led states are increasing harm reduction funding. Florida legalized xylazine test strips, Kentucky awarded $34 million in opioid settlement funding to more than 100 organizations addressing addiction, and Indiana extended its syringe service program through 2031.
2. Federal policy has shifted away from harm reduction. President Donald Trump signed an executive order on July 24, 2025 directing an HHS agency to reduce funding for harm reduction initiatives. Earlier this year, the agency also barred grantees from using federal funds to purchase drug testing strips.
3. HHS Secretary Robert F. Kennedy Jr. has criticized harm reduction programs. Mr. Kennedy has said needle exchanges and supervised consumption efforts do not work and has instead emphasized addiction recovery through approaches such as Alcohols Anonymous and 12-step programs, while continuing to support access to naloxone and medications including methadone and buprenorphine.
4. Republican state leaders cite overdose prevention as a priority. Ohio expanded access to drug test strips through an executive order, while lawmakers in Florida, Indiana, West Virginia and Kentucky have supported harm reduction initiatives despite opposition from some within their own party.
5. Evidence on harm reduction varies by intervention. Research has consistently shown that naloxone and syringe service programs reduce overdose deaths and infectious disease transmission. Evidence for interventions such as drug test strips and overdose prevention centers remains less conclusive because of limited U.S. research.
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