The US health secretary will take ‘appropriate action’ to ensure that the discretionary grants issued by the country’s Substance Abuse and Mental Health Services Administration (SAMHSA) do not fund programmes ‘that fail to achieve adequate outcomes’, according to a new executive order from president Donald Trump. These include ‘so-called “harm reduction” or “safe consumption” efforts that only facilitate illegal drug use and its attendant harm’, it states.
The provision is part of a wider push to remove rough sleepers from US streets, including reversing federal and local legislation that restricts authorities from forcing people into mental health treatment. The number of people living on the streets in the US on a single night reached almost 275,000 during the previous administration, says the White House, the highest ever recorded.
‘Endemic vagrancy, disorderly behavior, sudden confrontations, and violent attacks have made our cities unsafe,’ the executive order states. ‘The overwhelming majority of these individuals are addicted to drugs, have a mental health condition, or both. Nearly two-thirds of homeless individuals report having regularly used hard drugs like methamphetamines, cocaine, or opioids in their lifetimes. An equally large share of homeless individuals reported suffering from mental health conditions.’
Federal and local government had spent ‘tens of billions of dollars’ on programmes that failed to address the root causes of homelessness, the order continues, ‘leaving other citizens vulnerable to public safety threats’. Shifting people into ‘long-term institutional settings for humane treatment through the appropriate use of civil commitment’ would help to restore public order, it says. The order also calls for agencies to prioritise funding for the US states and cities that enforce their laws on open-air drug use, loitering and urban camping ‘to the maximum extent’.
‘Surrendering our cities and citizens to disorder and fear is neither compassionate to the homeless nor other citizens,’ the order says. ‘My administration will take a new approach focused on protecting public safety.’
There are currently three consumption rooms operating in the US – two in New York and one in Rhode Island. Although provisional figures released by the US Centers for Disease Control and Prevention (CDC) earlier this year showed a ‘remarkable nearly 27 per cent decrease’ in 2024’s predicted drug overdose deaths compared to the previous year, the figure still stood at more than 80,000, with overdose remaining the leading cause of death for Americans aged 18-44. More than a million people in the US died a drug-related death in the first two decades of this century, with the country’s opioid crisis officially declared a public health emergency in 2017.
The executive order was a ‘dangerous step backwards that will only deepen harm’, said the Legal Action Center (LAC) charity. ‘Instead of investing in affordable housing, voluntary care in community-based mental health and substance use disorder treatment programs, effective overdose prevention strategies, and the public health infrastructure our communities need, the order doubles down on non-evidence-based policies of displacement and forced treatment,’ it stated. ‘If this administration truly seeks to reduce overdose deaths and improve community safety, it must embrace and sustainably fund what public health experts and advocates say works,’ said the LAC’s senior health policy attorney Deborah Reid: ‘Harm reduction programs, overdose prevention centers, and widespread access to voluntary, non-coercive treatment and care. These programs save lives.’
‘The safest communities are those with the most housing and resources, not those that make it a crime to be poor or sick,’ added the National Homelessness Law Center. ‘Forced treatment is unethical, ineffective, and illegal.’
Stanford University addiction psychiatrist and former White House drug czar during the Obama administration Keith Humphreys (DDN, June 2012, page 16) told the Washington Post that the federal government’s power to force people into involuntary treatment was limited. However, ‘lots of Americans across the political spectrum are fed up with homelessness disorder and public drug use,’ he said. ‘And they are right to be. There has been a lot of public policy failure in this area.’
Executive order available here