While Donald Trump's administration toughens its policy against harm reduction strategies associated with drug use, several states governed by Republicans have begun to follow a different path: reinforcing with their own resources programs aimed at preventing overdoses and containing the opioid crisis that for years hit their communities hard.

The disagreement became evident after Trump signed an executive order in July to reduce federal funding for needle exchange programs, drug testing and other harm reduction initiatives. Additionally, the Department of Health and Human Services (HHS) previously restricted the use of federal funds to purchase test strips that detect fentanyl and xylazine, a mix increasingly present in the illegal drug market.

However, state governments led by Republicans maintain that these tools have contributed to reducing overdose deaths and consider it a mistake to withdraw their support.

In Florida, Governor Ron DeSantis signed a law legalizing test strips to detect xylazine in illicit substances. The promoter of the initiative, Republican legislator Michelle Salzman, defended the measure by stating: “A single xylazine test strip is not going to be the end or the beginning of a person's drug addiction or death.”

He also maintained that the objective is not to encourage consumption, but to save lives: "A mistake should not equal a life. The idea is that we are not providing opportunities for people to consume drugs, we are simply trying to save lives," he declared.

In Ohio, Republican Gov. Mike DeWine expanded access to test strips and detection kits for fentanyl and xylazine through an executive order. After announcing it, he said: “Items like test strips have been shown to reduce the risk of overdose, and these elements are important in Ohio's overall strategy to reduce overdose deaths.”

Kentucky also strengthened its strategy. Attorney General Russell Coleman announced the distribution of $34 million, from legal settlements with opioid manufacturers and distributors, to fund more than a hundred organizations dedicated to addiction treatment, including those that work with harm reduction programs.

In Indiana, the Republican legislature extended the state's needle exchange program until 2031. Rep. Ed Clere, a proponent of the measure since the 2015 HIV outbreak, defended the policy despite opposition within his own party. "It has been the most difficult and expensive political battle I have fought in my 18 years in the House of Representatives, but I would do it again. It has prevented countless cases of infection and saved countless lives," he said.

Even West Virginia's Republican-dominated House of Delegates rejected for the second year in a row a proposal to eliminate its state needle exchange program.

The position of these states contrasts with the vision of Health Secretary Robert F. Kennedy Jr., who has openly questioned the effectiveness of harm reduction. “Harm reduction doesn't work,” he said recently, defending a model focused on spiritual recovery programs, support groups like Alcoholics Anonymous, and treatments with methadone or buprenorphine.

The debate comes as the United States sees a steady decline in overdose deaths following a record high during the pandemic. Provisional data from the Centers for Disease Control and Prevention (CDC) estimate nearly 70,000 deaths in 2025, the third consecutive annual decrease, after the maximum of more than 100,000 deaths recorded in the most critical years of the epidemic.

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