Local health officials fear an executive order dictating that the Substance Abuse and Mental Health Services Administration (SAMHSA) can no longer fund harm reduction programs will accelerate the spread of HIV and AIDS, while emphasizing hope that the state may step in to supplement lost funding.
President Donald Trump’s “Executive Order on Ending Crime and Disorder on America’s Streets,” released in late July, prohibits the use of federal funds to purchase or distribute harm reduction supplies such as clean syringes, sterile water, saline or ascorbic acid. The order directed the secretary of health and human services to “take appropriate action to ensure that discretionary grants issued by the Substance Abuse and Mental Health Services Administration for substance use disorder prevention, treatment and recovery fund evidence-based programs and do not fund programs that fail to achieve adequate outcomes, including so-called ‘harm reduction’ or ‘safe consumption’ efforts that only facilitate illegal drug use and its attendant harm.”
“Moving forward, SAMHSA funds will no longer be used to support poorly defined so-called ‘harm reduction’ activities,” SAMHSA Principal Deputy Assistant Secretary Art Kleinschmidt wrote in an open letter. “Rather, SAMHSA is providing guidance to state agency leadership and to grantees through new award terms and conditions that provide clarity on what supplies and services previously defined under the umbrella of harm reduction can be supported with SAMHSA funding.”
The letter lists supplies and services that are still eligible for funding, including opioid overdose reversal drugs like naloxone; substance test kits, including fentanyl test strips and xylazine test strips; and overdose reversal education and training services. Infectious disease prevention services aimed at reducing risk of contracting viral hepatitis or HIV, such as sharps disposal kits, educational materials, home testing kits, wound care supplies and referrals to vaccinations, can also still be funded by SAMHSA.
Harm reduction aims to reduce the negative effects associated with drug use. At Tapestry Health, which offers harm reduction programs across western Massachusetts, examples of services include access to sterile syringes, syringe disposal services and safer-use supplies like alcohol swabs, pipes and sterile water.
“Offering supplies like this is vital to evidence-based harm reduction efforts and can lead to a reduction in HIV and HCV (Hepatitis C) infections,” Tapestry Health’s website explains. “Safer supplies and education can prevent overdoses and reduce the risk of other drug use complications associated with contaminated water, like wound infections and myocarditis.”
Dr. Ruth Potee, an addiction medicine physician who serves as Behavioral Health Network’s medical director for substance use disorders and has been medical director at the Franklin County Jail and House of Correction since 2014, said she expects the SAMHSA funding cuts will likely accelerate the spread of HIV and AIDS, which she said have already been on the rise throughout the state.
Potee explained that because of the federal government’s recent cuts to Medicare and Medicaid, HIV patients who use daily medications to ensure that their illness cannot be spread to others might stop taking their medications.
“What people don’t understand or don’t think about is that one of the reasons we have both low rates of overdose, but as important, low rates of HIV and Hepatitis C transmission, is because people have access to clean syringes and needles,” she said. “When that goes away, lives are at stake because we’re starting to already see spikes in HIV cases in the state of Massachusetts, and that hasn’t hit Franklin County yet, but it will.”
SAMHSA staff cuts have, according to Potee, resulted in reductions to essential services and programming across the state. She explained that while cuts have not yet impacted the delivery of harm reduction services, they will soon.
“We know that SAMHSA has been decimated in terms of the number of employees they have lost, and SAMHSA is the major funder of all research and grants that come to those of us that do work with people with substance use disorders,” Potee said. “Whether it’s at our local jail in Greenfield or any of the service agencies in Franklin County, there is big concern that this money has disappeared.”
Sarah Ahern, a peer recovery coach, said that while she believes the SAMHSA cuts serve as a “caution flag on the field” for recovery support organizations, she feels confident that Massachusetts — perhaps through its opioid settlement funds — can use state money to cover the costs associated with harm reduction services.
Ahern referred to the federal government’s funding priorities as a “dog whistle,” or subtle message, toward “what kind of human lives” it truly values — a criterium in which people who use drugs do not fit, she said. She added that funding for western Massachusetts, either on the state or federal level, is seldom easy to secure either way.
“They’re trying to dial the clock back 50 years, but … there are folks that have been in the field for 40 years and they’re still living,” she said. “The community in general is going to survive. It will make it harder, and there may be an increase in overdose deaths, but here in western Mass, we know what it feels like to not have any funding. … We’ve had to fight for every single cent that comes to Greenfield.”
Potee, however, said she does not believe private or state funds would be sufficient to “make up the loss” of federal funding to lifesaving harm reduction programs. She expects overdose and HIV transmission rates will increase as a result.
“You need money to do the work. There’s no other way around that,” Potee said. “When we’re not getting federal funds back to help take care of people who are sick, we’re not going to be able to make up the loss; it’s just not possible. What I anticipate is more people will overdose, more people will die and we’ll see increased rates of infectious diseases, all of which costs us a lot more money.”