Do cities’ changing harm reduction measures leave unhoused individuals less safe?

The opioid crisis in the United States has steadily gotten worse over the last two decades, reaching new peaks between 2020 and 2022, when drug overdose deaths exceeded 100,000 per year¹. But the federal government started funding proven harm reduction measures in 2021 and saw success. By 2024, these programs had rolled out across the country, and overdose deaths decreased by almost 30% that year².

Now, the White House has released an executive order aiming to cut back on these programs as part of a new homelessness policy. This decision impacts millions of people in the country, both housed and unhoused.

What to know about the White House’s changing harm reduction policy

On July 24, 2025, the White House released an executive order titled “Ending Crime and Disorder on America’s Streets,” which connects homelessness and drug use and attributes public safety threats and violence to homelessness³. The executive order claims that harm reduction efforts “fail to achieve adequate outcomes” and removes funding from programs throughout the country.

Instead, the federal government seeks to increase funding for efforts that would encourage the institutionalization of unhoused individuals and people who use drugs.

This shifting of funding priorities also includes cutting grants for housing-first policies, which seek to provide shelter for unhoused individuals in need. According to the executive order, these programs “deprioritize accountability and fail to promote treatment, recovery, and self-sufficiency.” But data from the U.S. Department of Housing and Urban Development (HUD) show that housing-first programs can lead to better health outcomes for participants while improving housing stability⁴.

Initially, it was unclear whether the defunding of harm reduction services included the restriction of access to life-saving overdose-reversing drugs, like naloxone, otherwise known as Narcan®. Fortunately, the Substance Abuse and Mental Health Services Administration (SAMHSA) later clarified that funding can still be applied to opioid overdose reversal supplies, fentanyl and xylazine test kits, and needle disposal kits⁵. However, needle exchanges are no longer supported by federal funding. 

What do experts say about these policy changes?

In the wake of these funding cuts, experts in addiction treatment and public health have spoken out against the changes and in favor of evidence-based harm reduction strategies. Experts expect the removal of federal funds for harm reduction to decrease the number of individuals seeking treatment for drug use disorders⁶. Some fear an increase in overdoses due to fentanyl and other opioids in the coming months and years⁷. On the heels of two years of declining overdose deaths, this could be a major setback. 

Others see this executive order as the administration saying that its homelessness policy is designed to further criminalize an already vulnerable population⁸ instead of addressing issues that contribute to people’s lack of adequate shelter.

With the nation’s mental healthcare infrastructure already pushing up against its limits, this policy change could lead to increased rates of incarceration among people who use drugs and the unhoused⁹. 

The executive order’s emphasis on public safety might leave you with an important question: Does homelessness increase crime? The reality is complex, especially when homelessness itself is criminalized. However, a 2022 study from Seattle showed that an increase in the size of homeless encampments was not correlated with any appreciable increase in crime locally¹⁰. This suggests that claims of disorder and rampant crime committed by a growing population of unhoused individuals might not hold up to scrutiny. 

How are cities responding?

Many major cities across the country have responded to the executive order with plans to drastically scale back their municipal harm reduction efforts, while other cities had already been leaning away from harm reduction even before the announcement¹¹. Philadelphia, PA, has halted funding for syringe exchanges, which provide clean needles to people who use injectable drugs. These exchanges have played a vital role in reducing the transmission of viruses like hepatitis and HIV. According to the Centers for Disease Control and Prevention (CDC), they do not lead to increased levels of drug usage¹². 

San Francisco, CA, also intends to move forward with recovery-first strategies that aim to get more individuals into long-term recovery programs while scaling back city funding for safe use supplies and other harm reduction measures¹³. In Pueblo, CO, the city council attempted to ban the city’s syringe exchange program, but the program has been reinstated after a judge overturned the city’s ordinance¹⁴. 

What this means for unhoused individuals across the country

Unhoused communities face numerous challenges in the face of a deepening drug overdose crisis, even without these issues being worsened by the removal of funding for life-saving harm reduction measures.

According to one recent study, approximately 35% of adults experiencing homelessness use illicit drugs, and mental health issues among the homeless are similarly common¹⁵. This makes resources for harm reduction and housing vital for people in need.

Reductions in funding mean worse health and legal outcomes for affected individuals. With less money going toward harm prevention, the nation could lose state and local drug courts, which help keep individuals out of jail and connect them with viable, science-based treatment options. 

Treatment for drug use can already be difficult to access for those who are experiencing homelessness, and addiction can be hard to curb without these resources, making harm reduction a vital service in countless communities across the United States. While there may be less federal funding going toward harm reduction, many groups will keep working tirelessly to ensure their community has the access they need.  

Ophelia’s clinicians are dedicated to providing evidence-backed care and contributing to the growing body of research on meaningful, effective opioid treatment and health outcomes. Our telehealth model is designed to expand access to care for patients with insurance—including Medicaid—and those who wish to pay privately.

Contact us to find out whether your treatment is covered and how our clinical team can support you.