CDC seeks to block ‘never use alone’ messaging used by overdose prevention groups

Officials at the Centers for Disease Control and Prevention suggested overdose-prevention funding recipients may no longer be allowed to promote the message to “never use alone”, according to details of a meeting held this month the Guardian obtained.

The purpose of the meeting was to bring recipients of Overdose Data to Action (OD2A) CDC funding into compliance with Trump’s executive orders, according to a grant note the Guardian reviewed. The most salient is the July order “Ending Crime and Disorder on America’s Streets”.

The order prohibits federally funded “harm reduction” and “safe consumption” efforts, stating that they “only facilitate illegal drug use and its attendant harm”. Harm reduction refers to a wide array of interventions to make risky activities less risky, and has traditionally encompassed everything from condoms to prevent STIs, clean syringes to prevent HIV and hepatitis, fentanyl test strips and the overdose-reversal drug Narcan. “Safe consumption” refers specifically to drug-related interventions like clean syringes.

Leo Beletsky, a professor of law and health sciences at Northeastern University, said the philosophy behind this language is called “moral hazard”.

“It’s the idea that by making a risky activity less risky, you’re encouraging people to engage in it,” Beletsky said, adding that if the threat of imprisonment won’t stop someone from using drugs, a dirty syringe won’t either.

The officials leading the meeting told participants that anything that could be construed as encouraging drug use is now prohibited for funding recipients. Multiple officials from state and municipal health departments asked whether they would be allowed to continue spreading the message to “never use alone”. The officials said it was a gray area and would not provide a clear answer.

A spokesperson for the Department of Health and Human Services, which oversees the CDC, said: “HHS is committed to implementing the President’s Executive Orders across the Department.”

Dr Jennifer Hua, medical director for the department of public health in Chicago – which has seen the biggest improvement in overdose fatalities among major US cities – said this message is part of “harm reduction 101 … our messaging has always been to carry Narcan, never use alone, check your drugs”.

While the language of the executive order demonizes harm reduction in general, CDC officials also explained that Narcan and fentanyl test strips will continue to be permitted, creating confusion around the administration’s definition of harm reduction.

“It’s an interesting inconsistency because in some states test strips are still considered [illegal] paraphernalia,” Hua said.

Beletsky said this “hair splitting” over what does and doesn’t count as harm reduction is “absurd”, because the administration is still allowing certain interventions that have always been considered harm reduction even while disparaging the concept.

Harm-reduction organizations have indeed promoted take-home Narcan for decades and have also been instrumental in promoting fentanyl and other test strips to help alert users to contaminants.

Hua said that providing Narcan and test strips goes hand in hand with “never use alone” messaging, since a person who is overdosing needs someone else to administer Narcan.

While Hua emphasized that this example is anecdotal, she noted that four out of five of the western Chicago neighborhoods most affected by overdose fatalities saw a significant decline in 2024. These were neighborhoods where people primarily use drugs outdoors. Austin, the fifth west-side Chicago neighborhood, where indoor drug use is more common, didn’t see the same decline.

“When you are overdosing outside or in public, what that means is that there’s a much higher chance of someone using Narcan to help you reverse that overdose,” Hua said.

“Isolation is one of the key drivers of overdose fatalities, not necessarily overdoses, because people overdose and survive,” Beletsky said. “Isolation in general is a major barrier to recovery, and that’s why connection is really key to people’s recovery process.”

“Never use alone” is therefore “a message of hope and connection and support, which is absolutely critical to resolving this crisis”, he continued.

Beletsky said that people concerned with ending overdose fatalities have had to learn what works and what doesn’t “the very hard way”. He’s worried that looming changes could roll the clock back “to a time when things were spiraling year after year” and “that we will go back to seeing the trends reverse again in the wrong direction”.

Andrew Kolodny, a medical director of the Opioid Policy Research Collaborative at Brandeis University, said this conversation distracts from the fact that overdose and addiction prevention funding is inadequate. It’s only awarded in two-year blocks, which makes creating a comprehensive substance-use treatment system impossible. Kolodny noted that Biden promised to bolster treatment infrastructure in his 2020 campaign, but failed to double the nation’s treatment capacity as he said he would.

“Under Trump, we’re even less likely to see a new funding stream,” he said. “There are other things I could think of that I’m more concerned about than the language in an executive order.”