To support harm reduction or not to support harm reduction, that is the question. And the livelihoods of those who use drugs hang in the balance as it echoes throughout Baltimore, the state of Maryland and the United States.
Fear and uncertainty about the future of compassionate care for drug users came to a head after the U.S. Substance Abuse and Mental Health Administration on Tuesday announced it would slash nearly $2 billion in grant funding for organizations providing mental health and substance use services. The agency insisted the programs didn't align with the agenda of President Donald Trump's administration, fomenting widespread fears that nonprofits in Baltimore and beyond would no longer be able to provide services responsible for keeping their vulnerable neighbors alive.
Then, after bipartisan backlash, the Trump administration reversed the decision the next day.
"While we are incredibly proud of this victory, we must be clear that this was chaos that never should have happened in the first place," Mobilize Recovery, an advocacy group that was slated to lose $500,000, said in a statement.
"Putting life-saving lifelines for overdose prevention, naloxone access, and veteran services at risk created unnecessary fear in a community that is already under immense pressure; recovery should never be used as a political bargaining chip."
This week's chaos, however, is about more than just politics. The maelstrom was part of an ongoing, strategic assault on drug users and their right to life — one that is predicated on either sowing confusion, stripping programs of funds, burning down the harm reduction infrastructure or all of the above.
The administration's move would have impacted more than just harm reduction initiatives, with substance use and mental health treatment also in the crosshairs. Yet programs dedicated ensuring people can use drugs as safely as possible have been a primary target under the Trump administration.
The shakeup highlighted a critical weakness within the harm reduction movement, namely that many of the organizations comprising it rely, at least in part, on government funding. These dollars can be pulled at any given moment, giving drug-war bureaucrats the ability to hamstring programs in one fell swoop.
Without a comprehensive network of grassroots support, there aren't sufficient means to fill such a gap, meaning whoever's in office can largely dictate both the capacity of programs and what services can exist to begin with.
As evidenced this week, confusion is a powerful weapon. Even after reports surfaced that the Trump administration reversed its decision, local media reports indicated that the move prompted the Pride Center of Maryland to continue with plans to lay off employees, cut wages and scale back services.
Though the organization offers more than just harm reduction services, the move illustrates an important lesson: The harm reduction movement was founded upon boots-on-the-ground organizing, and it must remain organized and capable of weathering government-led assaults to maintain its ability to serve drug users.
Destabilization is a death threat not just to the movement, but to the people it serves.
The recent chaos, therefore, is likely an intentional effort to disrupt harm reduction initiatives by flummoxing the organizations that provide them. The government doesn't need to burn the dollars; it just needs to flex its power and ensure people know who controls them.
That confusion extends to state and local levels of government.
The Maryland Department of Health, for example, recently scrubbed any mention of “harm reduction” from the Advancing Cross-Cutting Engagement and Service Strategies for People Who Use Drugs” program, also known as ACCESS.
The program is the state’s leading grant initiative for organizations that provide care to people who use drugs, and the move has raised questions about whether it’s a pragmatic terminology shift to guard against federal threats or an outright capitulation to the federal government’s assault on public health.
As Trump ramps up the drug war and slashes funding that’s crucial to prevent overdose deaths, the latest request for applications not only abides by the new guidance but also gives little time for organizations to adjust their own language when they apply.
“I don’t think the work will continue at the same volume that it is now, or has been,” said Erin Russell, a harm reduction consultant who started the ACCESS program while chief of the former Center for Harm Reduction Services. “There are plenty of programs that were maybe renting space and offering drop-in services that are not going to move back to the trunk of someone’s car. Or places that were going to buy mobile vans are now not going to do that level of expansion.”
The state's decision to kill the term "harm reduction" is innocuous to some, and experts have insisted that harm reduction programs will continue to provide care. But paired with fears that cuts to the ACCESS grant program are looming in the upcoming fiscal year, the move represents the ongoing denormalization of harm reduction itself.
In Baltimore, the city with the highest fatal overdose death rate in the nation, that comes at a time when sustainable progress is seemingly within reach. There was a historic 25.5% decrease from the year prior in 2024, and preliminary data shows that trend continued well into 2025.
Unfortunately, while city officials claim to embrace harm reduction initiatives, actions speak louder than words.
Scott's new list of legislative priorities omitted legislation to legalize overdose prevention centers for 2026, with harm reduction advocates announcing last month they wouldn't pursue such bills in the upcoming General Assembly session.
The mayor has refused to commit to establishing city-sanctioned sites despite multiple avenues to pursue them, and Health Commissioner Dr. Michelle Taylor has more candidly indicated that the city won't pursue OPCs to avoid risking federal funding.
The abandonment of more ambitious drug policies came after the city cut the health department's budget last year and handed the cops an additional $20 million. Those funds have seemingly facilitated even more drug-war policing, with law enforcement recently touting its latest crackdown.
With police data showing drug-related arrests flourished last year, State's Attorney Ivan Bates announced on Wednesday the seizure of "nine kilos of narcotics and over $55,000 in cash" as part of a bust involving a group of people selling drugs in the 1800 block of North Collington Avenue and in the 2600 block of Greenmount Avenue.
“Drug trafficking organizations like this one inflict real and lasting trauma on our communities, creating conditions of fear and instability that erode public safety and diminish residents’ quality of life. They fuel violence, addiction, and disorder in neighborhoods that deserve stability and opportunity. Efforts of this scale are simply not possible without strong collaboration across local, state, and federal partners,” Bates said in a press release.
Like other public officials in Baltimore, Bates has insisted that those who buy and sell drugs in certain neighborhoods foment fear and chaos while peddling lethal substances to residents.
Studies documenting the Iron Law of Prohibition, however, have shown it's actually the police — and the racist drug laws they enforce — are the ones that inflict these plagues on communities in Baltimore and beyond.
The drug war isn't new, nor is the underfunding of harm reduction programs. Public officials' refusal to fully embrace life-saving initiatives has also been an issue that dates back decades.
What is becoming clear, though, is that the wave of funding cuts and strategic disorientation from the Trump administration is highlighting not only the open disdain for harm reduction but also the vulnerabilities within the movement. And it all comes at a time when holding back isn't an option.
At best, there will continue to be uncertainty as to where care for drug users stands in Baltimore and elsewhere in the nation. At worst, the funding sources that those on the frontlines rely on will be gutted.
In Baltimore and the state of Maryland, elected officials haven't shown much evidence they're on our side — or at least have the spines to fight for drug users in times of uncertainty. This dilemma is not something that will be solved by sitting around and hoping for change.
This epoch underscores the need to bolster mutual aid networks, ramp up grassroots organizing, and adapt to create a harm reduction infrastructure that allows services to seamlessly transition underground if necessary.
The movement must become louder. It must become larger. It must become stronger. If it fails to do so, it's drug users who stand to suffer the most.
Read the last Redux Newsletter: "Baltimore City Council wants health officials to do more with less as they look to drive down OD deaths"
With harm reduction initiatives in the federal government's crosshairs and a slimmed-down budget, the Baltimore City Health Department has nonetheless maintained ambitious goals as it looks to curb overdoses.
Health Commissioner Dr. Michelle Taylor proudly presented a two-year draft plan to cut fatal overdoses 40% by 2040 to the Baltimore City Council's Committee on Legislative Investigations on Thursday. The plan, first unveiled in July by the Mayor's Office of Overdose Response, came on the heels of historic declines in fatal overdoses in 2024, with last year's numbers showing promise. However, despite uncertainty about whether that trend will hold — and about just how much President Donald Trump's assault on public health will hit Baltimore — the plan just isn't enough for some council members.
Read the full newsletter here.
Mobtown Redux's Overdose Data has been updated with the latest local, state and national data
There were 777 overdose deaths in Baltimore in 2024, a 25.5% decrease from the year prior, according to preliminary data.
In the 12-month period ending in November, Baltimore saw 554 deaths, a death rate of 94.6 per 100,000 people. Statewide, there were 1,262 deaths, a death rate of 20.4 per 100,000 people.
The data shows that fatal overdoses continue to trend downward after years of climbing, though poor Black neighborhoods in West Baltimore continue to suffer the most.
Check out Mobtown Redux's Overdose Data Dashboard here.
Click here to learn more about harm reduction resources in the Baltimore area.
Filter: "Maryland Scrubs the Term 'Harm Reduction' From Key Grant Program"
The Maryland Department of Health has scrubbed any mention of “harm reduction” from the state’s leading grant program for organizations that provide care to people who use drugs. The move raises questions about whether it’s a pragmatic terminology shift to guard against federal threats, or outright capitulation to the federal government’s assault on public health.
The “Advancing Cross-Cutting Engagement and Service Strategies for People who Use Drugs” program, known as ACCESS, made history in 2020 as the first in the state to provide funding directly to harm reduction organizations.
Years later, as President Donald Trump’s administration ramps up its drug war and slashes funding that’s crucial to prevent overdose deaths, the latest request for applications (RFA) from the Maryland health department’s Office of Harm Reduction—which gives little time for organizations to adjust their own language when they apply—has dropped the name of the movement from which the office takes its title.
Click here to read the full article.
Comments