DOGE and HHS: Harm Reduction

The Department of Government Efficiency (DOGE) is an entity established within the Executive Office of the President and publicly associated with entrepreneur Elon Musk, which is focused on (among other things) government spending and waste. That is a laudable objective. One area in which the federal government spends a tremendous amount of money is grants to nonprofits. An analysis of these grants from USASpending.gov provides examples of some of the things that DOGE may wish to examine.

While government efficiency should hopefully be a bipartisan aim, DOGE is specifically associated with the second Trump Administration. Accordingly—and for both recentness and simplicity—this analysis focuses primarily on grants with performance periods that began during the Biden Administration. It pays particular attention to grants that conservative Americans might find ideologically objectionable, as well as grants with questionable usefulness or effectiveness. The amounts given refer to the total “obligated amount” according to USASpending.gov, which does not necessarily correspond to the total “outlayed amount” at any given time.

The following are some examples of federal grants made to nonprofits by the U.S. Department of Health and Human Services (HHS), specifically related to the concept of “harm reduction.”

Drug Abuse and Harm Reduction

Drug abuse is a serious national crisis—one which is closely related to other serious national crises such as mental health and homelessness. It is without doubt something the federal government should focus on. The question for DOGE is not whether grants should be made to combat drug abuse and addiction, but whether that grant money is being spent effectively and appropriately. While some of this evaluation naturally requires expertise in the field, all of it is relevant to ordinary Americans who have personally witnessed the impacts of drugs on their communities.

One approach to dealing with substance abuse involves “harm reduction,” which is defined by the National Institute on Drug Abuse (part of the National Institutes of Health, which is part of HHS) as “interventions aimed to help people avoid negative effects of drug use.” Examples of harm reduction interventions—some are more controversial than others—include drug test kits, overdose reversal medications, sterile syringes and injection kits (along with their proper disposal), supervised drug use sites, general medical and health services (for both treatment and prevention), education about disease and overdose risks, and referrals for additional support.

Compassion and a paramount emphasis on preserving human health and life counsels in favor of being open to a wide variety of ways to help someone struggling with addition. That said, harm reduction is controversial, and many argue that it is counterproductive in practice. There certainly seems to be a meaningful line between harm reduction as one element of a dedicated effort to get individuals to stop using drugs and avoid some of the worst consequences of those drugs (chronic disease and death) until they do, and harm reduction as a system that normalizes or even enables drug use. For example, a 2023 local news investigation in San Francisco asked at least three different harm reduction providers if they also offered information about entering treatment or rehab. None of them did. The city’s then-mayor London Breed later declared that “harm reduction, from my perspective, is not reducing the harm. It is making things worse.” The distinction here is between harm reduction as a means to recovery and harm reduction simply as the end itself.

With this framework in mind, consider some of the harm reduction material published by federal agencies within HHS. The director of the National Institute on Drug Abuse explained the basic rationale—quite reasonably—in this way: “getting people into treatment for substance use disorders is critical, but first, people need to survive to have that choice.” At the same time, the institute also criticizes what it calls “negative attitudes and stereotypes” toward people with substance abuse disorders and asserts that “treating drug use as a criminal activity may also contribute to the stereotype of people who use drugs as being dangerous and a risk to society.” It even argues that the phrase drug “abuse” should be avoided because it is associated “with negative judgments and punishment.”

The Substance Abuse and Mental Health Services Administration (SAMHSA) similarly states that harm reduction can, among other things, help “reduce stigma associated with substance use” and that it can “empower people who use drugs (and their families) with the choice to live healthy, self-directed, and purpose-filled lives.” It views harm reduction as “part of a comprehensive prevention strategy and the continuum of care” and claims that it has been “proven to prevent death, injury, disease, overdose, and substance misuse.” The agency’s official harm reduction framework notes that the Biden Administration had “identified harm reduction as a federal drug policy priority.”

That official framework contains some astonishing passages. SAMHSA appears ambivalent toward the goal of actually getting individuals off drugs, explaining that “abstinence is neither required nor discouraged,” and that, while harm reduction is “inclusive of abstinence as a chosen pathway,” it is “not inclusive of abstinence as a coerced pathway.” The agency believes in “centering the perspectives of people who currently use drugs” even over the experiences of those who are in recovery, and it argues that “safety” should be “defined by the people [harm reduction programs] serve.” The same applies to what constitutes “positive change,” with SAMHSA’s framework deferring to what drug users “identify as their needs and goals (not what programs think they need).” It claims that this will offer them “tools to thrive.” The framework blames “structural racism” for limiting “the development and inclusion of research on what works in underserved communities” and favors integrating “community wisdom and expertise” alongside “dominant-society healthcare approaches.” Harm reduction should strive for “systems change” and seek “to reduce the harmful impacts of stigma, mistreatment, discrimination, and harsh punishment of [people who use drugs], especially those who are Black, Indigenous, and other People of Color.”

This is the language of left-wing activism, being adopted as official policy by a government health agency.

Harm Reduction Grants

An examination of harm reduction grantmaking at HHS further illustrates both the scale and character of the department’s approach to harm reduction.

As of February 2025, a USASpending.gov search for the keyword “harm reduction” in grants made by HHS from FY2021 to FY2025 returned 1,109 results totaling $5.36 billion. Restricting this only to grants made to nonprofits returns 405 awards totaling $729.06 million. Running the exact same search parameters from FY2016 to FY2020 yielded just 28 grants for a total of $72.59 million, and just 6 grants for $13.22 million to nonprofits. Of course, this is a very crude method that for several reasons is bound to significantly misrepresent actual federal funding for harm reduction programs. What it does show is a dramatic increase in the term’s use throughout the department’s grantmaking, apparently in conjunction with the Biden Administration’s policy priorities.

There are some more precise methods of examining the department’s harm reduction grantmaking. In late 2021, SAMHSA announced a Harm Reduction Grant Program “to support community-based overdose prevention programs, syringe services programs, and other harm reduction services.” Funds helped with efforts to encourage individuals “to take steps to reduce the negative personal and public health impacts of substance use or misuse” and to help “address the stigma often associated with substance use and participation in harm reduction activities.” It also noted that grant recipients would make referrals “to appropriate treatment and recovery support services.” Under the program, 50 grants totaling over $19.5 million were awarded in FY2022 and FY2023. Perhaps the most widely known nonprofit recipient under this program was Planned Parenthood of Greater New York, which has been awarded $1.2 million for its harm reduction work since 2022.

A further examination of grants on USASpending.gov suggests that strong ideological motivations—indeed, even radical ones—guide the efforts of at least some prominent harm reduction grantees. This leads to serious questions about the federal government’s funding for their work, which DOGE should investigate.

Consider the National Harm Reduction Coalition, which has been awarded over $2.4 million since mid-2020 (beginning during the First Trump Administration) for “national expansion of syringe service providers technical assistance.” Two of the group’s staff members served on the steering committee for SAMHSA’s official harm reduction framework, meaning they directly influenced harm reduction policy at HHS. The National Harm Reduction Coalition operates as a 501(c)(3) charity, and in 2022 it reported total revenues of just over $12.8 million. Approximately 73 percent of this came from government grants, which means that taxpayers are primarily responsible for subsidizing the group’s messaging.

That message is deeply radical. The National Harm Reduction Coalition describes itself as “a nationwide advocate and ally for people who use drugs,” which works to “heal the harms caused by racialized drug policies.” It explicitly accepts illicit drug use “for better or worse” and rejects abstinence as the benchmark for successful public policy, advocating instead for “non-judgmental, non-coercive” services to lessen harm. For instance, it recommends that fentanyl users “take it slow and use less” and “try snorting or smoking instead of injecting.” It also claims that access to sterile syringes and related items make it “possible to completely avoid or reduce injection-related health risks.” The coalition asserts that “no one knows what’s best for you better than you. Whatever drugs you use, we want you to be safe and healthy.” Is this seriously the approach to hard drug use that ordinary American taxpayers believe should be promoted?

The National Harm Reduction Coalition also blames “white supremacy” and “the racist war on drugs”—not the drugs themselves—for causing disproportionate harm to black Americans, and openly supports far-left efforts to “defund, disarm, and disband the police.” At the same time, the group declares that it is “still learning how to foster an environment of honest inquiry” in “mixed race settings,” and that those in the broader harm reduction movement supposedly must confront their “own internalized oppression or race-based privilege.” The overarching theme promoted by the National Harm Reduction Coalition is to accept illicit drug use while attempting to shift responsibility for its manifest harms onto a malevolent societal system that is wholly beyond the user’s control.

A nonprofit called OnPoint NYC was awarded over $2 million from HHS for harm reduction and medication-assisted treatment efforts. OnPoint NYC “vigorously advocates for social justice” and works to “combat stigma and embrace people who use drugs and engage in sex work instead of pushing them to the margin.” Material published on the group’s website calls the war on drugs a “made-up war” that “has been a key weapon used to destroy, destabilize, and criminalize Black, Brown and low-income communities for over 50 years,” and it claims that “mass criminalization” has “exacerbated the overdose crisis.” OnPoint NYC provides a variety of harm reduction services, but its supervised drug consumption facilities—which were the first in the country—are particularly controversial. The group says it has reversed at least 1,700 overdoses since 2021 without a single death. OnPoint NYC does not encourage drug users to seek treatment for their addiction, though it helps connect those who request it.

The Harlem United Community AIDS Center was awarded $1.2 million beginning in 2022 for its harm reduction work. The grant description explained how the group’s efforts were informed by its recognition of “the intersectional nature of racism, trans and homophobia, sexism, and socioeconomic discrimination.” In 2020, the group signed on to a letter declaring that law enforcement and the broader criminal justice system had “subjugated, dehumanized, and murdered Black people for centuries” and that “bold and immediate” legislation was needed to “pull power away from the system that has made clear that Black lives, Black pain, Black existence, and Black humanity do not matter.” In 2021, Harlem United signed on to another letter opposing the presence of Chick-fil-A restaurants along the New York State Thruway simply because the company’s CEO had reportedly made donations to the National Christian Charitable Foundation and the Salvation Army. The irony of this—considering the Salvation Army’s extensive substance abuse rehabilitation programs—is hard to overstate.

Another nonprofit called the TransLatin@ Coalition (which has also received funding from the Departments of Labor and Justice) was awarded $600,000 from SAMHSA beginning in 2023 for “prevention navigation for transgender, gender nonconforming, and intersex individuals,” including through harm reduction education. Among many other radical proposals designed to achieve what the group calls “trans liberation,” the TransLatin@ Coalition’s Trans Policy Agenda 2024 calls for the decriminalization of “survival crimes” and guaranteed access to “puberty blockers, [hormone replacement therapy], and in rare cases, gender affirming surgery” for “trans and gender expansive youth.” It also describes the total abolition of police as an “ideal” outcome, though one it admits is presently unrealistic.

Final Thoughts

A few points on all of this. First, drug possession is criminalized under federal law, hence the reasonable instinct to treat it as a criminal activity—though whether this is always the best way to deal with addiction is another question entirely. Drugs are illegal principally because of the manifest harms that they cause, and not just to the user. “The correlation between substance abuse and violent behavior has been well documented,” according to the American Addiction Centers—which also notes that “80% of child abuse cases involve the use of drugs or alcohol” and that parental addiction is unsurprisingly associated with a host of other horrible impacts on children. Communities where drug abuse is rampant become virtually uninhabitable for residents, despite extensive harm reduction efforts.

As conceptualized by HHS, harm reduction seeks in part to reduce the stigma associated with drug abuse, but the opposite of stigma is acceptance. The profound personal, familial, and societal damage caused by drug abuse should never be accepted—indeed, it would be morally wrong to do so. It is drug abuse itself that is the ultimate harm that must be reduced, so abstinence must be the ultimate objective. This will not always be achievable, and those gripped by addiction should be treated with humanity, compassion, and support—to include lifesaving harm reduction services—but “love the sinner, hate the sin” should be the guiding policy. It is also unclear what relevance someone’s race or ethnicity should have in the formulation of national drug policy, though such considerations appear to be a major priority for HHS. This seems to be part of a disturbing and rather revealing gravitation toward left-wing sociopolitical activism in the implementation of the department’s harm reduction efforts.

Nobody should pretend that there is some simple, easy solution to the country’s drug crisis. If there were, discussions about harm reduction wouldn’t even be on the table. In the context of federal grantmaking and DOGE, the question isn’t even so much whether harm reduction efforts are effective in the literal sense. The availability of overdose reversal medications and drug testing kits would seem certain to reduce fatal overdoses, and the availability of clean syringes would seem certain to reduce disease transmission. Viewed in isolation, these are objectively good outcomes—and that might be enough for the purposes of a privately funded charity. The question for the federal government, however, is whether its current harm reduction efforts are as effective as they could be at furthering what should always be the public’s lodestar objective: getting people off drugs and into recovery.

Source: https://capitalresearch.org/article/doge-and-hhs-harm-reduction/