Opioid overdose deaths in Ohio, and across the country, fell sharply in 2024 compared to 2023, driven largely by decreases in fentanyl-related deaths.
Nationwide, the total number of deaths dropped about 42 percent and Ohio’s was even steeper, with deaths falling approximately 45 percent. While there are many reasons for the decline in deaths both in Ohio and across the country, one contributing factor that helped Ohio outpace the nation is the state’s acceptance and implementation of harm reduction.
Harm reduction, in its simplest, most inclusive form, is taking steps to minimize risk associated with an activity
Within the lens of drug use, harm reduction is an evidence-based approach critical to engaging with people who use drugs and equipping them with life-saving tools and information to create positive change and potentially save their lives.
Practically speaking, this means syringe exchanges, naloxone, fentanyl and xylazine test strips, safe smoking kits, wound care, among many other services. These services, which not only help individuals stay healthy, but enable them to not die, have consistently been under attack under the current federal administration.
The first regressive Executive Order: mandatory substance treatment before housing eligibility
Last summer, President Trump issued an Executive Order (EO) entitled Ending Crime and Disorder on America’s Streets. This EO largely focuses on the unhoused population in our country and moving away from a housing first approach. Housing first is the most effective approach to ending homelessness. Reverting back to requiring participation in substance use or mental illness treatments programs as a condition of housing is a philosophy that has proven ineffective.
The EO also directs the Secretary of Health and Human Services 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.”
Harm reduction is evidence-based.
Evidence-based lifesaving intervention or harm reduction ideology?
Harm reduction is evidence-based. If preventing a death from an opioid overdose is not an “adequate outcome” one wonders, what would constitute an adequate outcome. This type of language is a serious attack on an important aspect of the continuum of care for substance use disorders. Rhetoric from the current administration surrounding harm reduction and its activities is quite a divergence from the previous administration, and even President Trump’s first term.
Shortly after the EO was released SAMHSA published a Dear Colleague letter doubling down on the move away from harm reduction. Instead, it specifically outlined what can and cannot be purchased with Substance Abuse and Mental Health Services Administration (SAMHSA) funding. It is worth noting that both the Dear Colleague letter and the EO attempt to draw a line between “appropriate” life-saving opioid overdose reversal medications (OORMs), such as naloxone and nalmefene, and what the administration continues to refer to as “ideological concept of harm reduction.”
A second Executive Order added treatment funding, but revived old assumptions
Then, in January 2026, President Trump issued an EO entitled Addressing Addiction Through The Great American Recovery Initiative. While this EO did add three medications for opioid use disorders (MOUD) as prevention services eligible for federal funding, which is objectively good for those seeking treatment. It also doubled down on harm reduction as “enabling future drug use” and civil commitments, furthering the administration’s undermining of harm reduction.
Since the January 2026 EO, the administration had been fairly quiet on the harm reduction front, until SAMHSA sent out another Dear Colleague letter on April 24, 2026.
Test strips can no longer be purchased with federal funding
This letter, much like the first letter, continues to demonize harm reduction and further spells out the administration’s shift away from evidence-based practices. Additionally, it updates what can and cannot be purchased with SAMHSA funding and this time explicitly states that “fentanyl test strips or any other substance test kits, including xylazine and medetomidine test strips” cannot be purchased with SAMHSA funding.
Explicitly banning these test strips from being purchased with federal dollars will cause harm.
Explicitly banning these test strips from being purchased with federal dollars will cause harm. The United States’ drug supply is riddled with Xylazine and Fentanyl and removing a pathway for individuals to know what is in their substance is dangerous.
Harm reduction is an important tool for our nation, and the state of Ohio, to continue utilizing while fighting the opioid crisis. The Center for Community Solutions supported the provision of the state operating budget that provided the Ohio Board of Pharmacy the power to approve additional types of testing strips, outside of fentanyl test strips that may be possessed and used without fear of prosecution and will continue to support harm reduction activities in Ohio.
.png)
