Trump Administration Proposes Contradictory Overdose Prevention Policies

The Trump administration has proposed several policies on overdose prevention in recent weeks that appear at odds with one another. An April letter from the Substance Abuse and Mental Health Services Administration stated the agency would no longer fund test strips for fentanyl and other dangerous adulterants intended for use by people using drugs.

The letter came after the Centers for Disease Control and Prevention moved in January to block "never use alone" messaging while saying it would still consider supporting fentanyl test strips. The administration has continued to back access to naloxone, which reverses opioid overdoses.

One researcher described the combination of ending test strip support while maintaining naloxone funding as inconsistent because test strips can prevent overdoses from occurring.

The White House proposed budget cuts that, if enacted, would strip away $10bn in funding for addiction and overdose prevention and research, according to the Drug Policy Alliance. The following month it announced a National Drug Control Strategy that includes expanding technology for drug interdiction and wastewater surveillance to track drugs in the supply.

For the strategy to be implemented, Congress would have to reject the proposed budget cuts. The apparent contradiction stems from a lack of coordination between the office of national drug control policy, which informed the strategy, and the office of management and budget, which prepared the budget proposal.

University of North Carolina’s Opioid Data Lab said defunding test strips removes people’s ability to identify impure products. The same researcher noted that wastewater surveillance provides an incomplete picture because substances such as nitazines may not appear reliably and individual drug use cannot be determined from aggregate data.

The researcher added that test strips allow individuals to check their drugs and change behavior, such as choosing not to take a particular drug or using more slowly. The researcher described the drug strategy as emphasizing technology that was cutting edge a decade ago.

The White House and the office of national drug control policy did not respond to a request for comment.