WASHINGTON, D.C. — The Trump administration proposed budget cuts that would remove $10 billion in funding for addiction and overdose prevention and research, according to the Drug Policy Alliance. In May, the White House announced a National Drug Control Strategy that includes initiatives to expand technology to help with drug interdiction, as well as wastewater surveillance to help track the drug supply.

In April, the Substance Abuse and Mental Health Services Administration indicated in a letter that the agency would no longer fund test strips for fentanyl and other adulterants intended for use by people using drugs. The agency said it will continue to support naloxone access. In January, the Centers for Disease Control and Prevention moved to block public health messaging advising people to never use alone while stating it would still consider supporting fentanyl test strips.

Public health departments across the country have used harm reduction interventions such as test strips, nasal naloxone, and public health messaging to never use alone to help prevent overdoses. Harm reduction is a public health strategy first pioneered by AIDS activists.

"If you support these things, then why are you defunding them?" said Maritza Perez Medina, director of federal affairs for the Drug Policy Alliance. She said test strips give people information that can change their behavior. "They may choose not to take that drug. They may choose to use slower. They may choose to use with a friend," Perez Medina said.

Nabarun Dasgupta, director of the University of North Carolina's Opioid Data Lab, said defunding test strips will remove people's ability to identify impure drug products and flag them to dealers. He said wastewater surveillance is not a substitute for individual-level testing. "Things that disappear in urine, like nitazines, will not be showing up in wastewater at any reliable level," Dasgupta said. Nitazines are ultra-potent synthetic opioids that have become more common in the drug supply following international crackdowns on fentanyl.

"The drug supply changes from hour to hour in the same location, and what your individual patient is taking is not something that you can just guess from the aggregate," he said. He also said the National Drug Control Strategy emphasizes technology that was cutting edge a decade ago.

Richard Baum, a former acting director of the White House's national drug control policy, said Congress will have to reject the proposed budget cuts for the National Drug Control Strategy to be implemented. He said the apparent contradiction between the budget proposal and the drug control policy stems from a lack of coordination, with the policy largely informed by the Office of National Drug Control Policy and the budget proposal coming from the Office of Management and Budget.