NYT Opinion Guest Essay This Approach to Addiction Will Cost Lives May 14, 2026
- cynthiahoffmanmft
- May 18
- 4 min read
Ms. Szalavitz is a contributing Opinion writer who covers addiction and public policy.
After rising exponentially since 1979, overdose rates have finally begun to decline, falling more than 29 percent since 2022. President Trump has repeatedly claimed that stopping these fatalities is a priority. But recent moves by his administration threaten to stall or even reverse this progress.
The Trump administration is now enforcing an executive order against what are known as harm reduction approaches, which emphasize keeping people alive over ending their drug use. Such efforts, the order argues, “only facilitate illegal drug use and its attendant harm.”
This new policy makes federal funding available for saving lives after overdoses or treating other harms that have occurred from drug use but prohibits spending on preventing those harms. It reflects the misguided belief that protecting people’s health during drug use enables continued addiction and deters recovery and that harsher consequences spur abstinence. This notion is not only cruel but also false. And it could cost thousands of lives.
On April 24 the Substance Abuse and Mental Health Services Administration released two “Dear Colleague” letters, which were sent to state health departments and grant recipients to inform them about the kinds of programs that can and cannot receive federal funding. The letters made clear that many harm reduction approaches would no longer receive the agency’s support.
“SAMHSA guidance carries enormous weight in addiction medicine,” says Dr. Ayesha Appa, an assistant professor of infectious disease and addiction medicine at the University of California, San Francisco. Beyond outlining rules on spending, the letters set the tone for professional practice and influence what clinicians may recommend.
While stressing that funding for overdose antidotes and wound care is still acceptable, the first letter bans spending on supplies to prevent such damage — test strips that allow people to determine whether dangerous substances like fentanyl and xylazine are in their drugs and sterilized water to reduce the risk of infected injection wounds. It continues a decades-old prohibition on federal funding for clean needles and bans funding for hotlines that people can call as a safety measure while using drugs. Operators on these hotlines ask for location information from callers and stay on the line, alerting 911 if they believe an overdose occurs.
The second letter to providers focuses on opioid use disorder medications. SAMHSA says it will fund medication for addiction treatment only if other support services such as counseling are involved. It also demands that programs, in conjunction with patients, annually re-evaluate whether addiction medications like methadone and buprenorphine should be stopped, so that treatment doesn’t become “a default sentence to lifelong medication use.”
While those rules sound benign, in reality they will reduce access to the only treatments that are proven to cut the death rate from overdose by 50 percent or more. A recent study found that patients on these medications had an 80 percent reduction in overdose death risk, compared with those participating in treatment programs without medication.
“Our biggest problem is that too few people are accessing these medications to begin with,” says Dr. Appa, noting that her patients are far more likely to stop medication too early than to linger on it too long. SAMHSA’s new approach, with its stigmatizing implication that medication is a life sentence rather than a lifesaver, is not helpful. Right now, 75 percent of people who could benefit from these medications don’t receive them — and that problem will be exacerbated by Medicaid cuts in the administration’s 2025 domestic policy legislation, which could end insurance for about 1.6 million people with addiction. Around 156,000 people could lose access to their current medications, which experts estimate would lead to 1,000 additional overdose deaths each year.
Research shows that harm reduction programs do not hamper people’s recovery. One study, for example, found that people who frequently use syringe exchange programs are five times as likely to enter treatment as those who participate less. Other studies have found that people who frequently go to overdose prevention centers where they can use drugs under supervision are 40 to 70 percent more likely to get treatment than those who show up less often.
A majority of people with opioid addiction who enter even the best treatment programs relapse at least once, typically many times. This is why experts refer to addiction as a chronic disorder. Harm reduction keeps people alive during these relapses.
The White House seems determined to prioritize drug war and antimedication ideology over saving lives, throwing into jeopardy years of progress in bringing down overdose rates. After cutting nearly two-thirds of SAMHSA’s staff and attempting to claw back Covid-era funding, the administration’s new budget proposes $753 million in cuts to the agency, $165 million in cuts to addiction research at the National Institutes of Health and $3 billion in cuts to the Centers for Disease Control and Prevention, including funds to track overdoses and provide overdose reversal medications. None of this is wise. Most people recover from addiction. But no one recovers from death.
Maia Szalavitz is a contributing Opinion writer and the author, most recently, of “Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction.”
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