In April, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a letter notifying funding recipients that the agency is taking a “clear shift away from harm reduction,” including eliminating funding for fentanyl testing strips, clean syringes and needles, and “overdose hotlines.”

Harm reduction at its core is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use,” according to the National Harm Reduction Coalition. The organization further details that some of those strategies could include the safer use, managed use, abstinence, meeting people who use drugs “where they’re at,” and addressing conditions of use along with the use itself.

SAMHSA’s decision has had immediate and life-threatening consequences for Kentucky organizations doing the work to close critical gaps in care for those in need, including for marginalized people.
“When they put this letter out there, they literally just handcuffed a lot of people,” said Shreeta Waldon, executive director of the Kentucky Harm Reduction Coalition (KyHRC), a Louisville-based nonprofit that works to reduce substance use disorder overdoses and deaths.

The letter cited a White House executive order from July 2025 to justify the policy changes. The order, “Ending Crime And Disorder On America’s Streets,” details those changes among a list of other line items including homelessness and crime. “Do not fund programs that fail to achieve adequate outcomes, including so-called ‘harm reduction’ or ‘safe consumption’ efforts,” the order reads.

It describes such strategies like harm reduction as ineffective; however, harm reduction is actually an evidence-backed practice that has been backed by scientific research.

What Kentucky Lost When SAMHSA Cut Harm Reduction Funding

These changes and attacks on harm reduction initiatives have hit the already limited ecosystem of harm reduction services built by and for Black and brown communities.

“SAMHSA award terms are now prohibiting federal grant funds from supporting several traditional harm reduction supplies, including syringes for illicit injection, safer smoking supplies, and fentanyl and other substance test strips,” Waldon explains. “That means that organizations are now navigating a much narrower definition of what federally funded harm reduction can include and not include.”

Recent research revealed that Trump’s elimination of federal funding for programs that provide syringe exchange and other harm reduction interventions will directly contribute to an increase in overdose deaths and non-fatal overdoses. Outcomes that Black and brown communities already feel more intensely.

KyHRC is one of the few groups in the state still delivering harm reduction care and resources for BIPOC communities, despite these concerning changes. In addition to new limitations, Waldon’s group immediately lost a $400,000 grant after the SAMHSA decision. However, instead of deferring programs or shortening their impact, the organization found new ways to deliver care to communities.

KyHRC began working with partners across the country to source harm reduction resources that they no longer could get from federal funding. Waldon mentioned that, among other groups, the Connecticut-based organization Reduce Harm Inc. has supported KyHRC with clean syringes, testing strips, and other supplies that are no longer accessible.

The redefinition of what the government will fund comes after a well-documented body of evidence pointing to harm reduction as a key strategy to prevent drug-related deaths. Studies show that fentanyl testing strips prevent overdoses, and research shows that providing clean syringes prevents the transfer of blood-borne diseases. A 2025 study including 67 communities, some of which were in Kentucky, found that when offered harm reduction strategies, those communities experienced a 15% reduction in non-fatal opioid overdoses and an estimated savings of $190,100 in healthcare spending per community.

Why Black Kentuckians Feel the Cuts Hardest

For Black communities in Kentucky, these new limitations are felt even more deeply than their neighbors. In 2023, the overall number of drug overdose deaths in Kentucky declined for the first time in years, while Black Kentuckians experienced an 8% rise in overdose deaths. Black Kentuckians continue to face worse health outcomes, less access to regular health care, and higher mortality rates compared to other groups. It is these realities that make harm reduction and community resources for Black and brown people all the more critical, according to the organizers delivering care despite greater obstacles.

This story exists because of readers like you. Give $5 a month to keep Queer Kentucky free.

“If you are trying to give me aid and help me based on the statistics that you have for white people, it’s not going to help me because it’s not made for me,” said Adria (AD) Shouse, a master barber at Well Groomed Barbershop Parlor.

Shouse is a barber with the African American Barbershop and Beauty Salon Initiative (BBSI), a public health program part of Project Ricochet, a nonprofit organization working to improve outcomes for minority youth in Lexington and beyond. BBSI transforms “relationship-rich environments” like barbershops and beauty salons into spaces where communities can get care and education related to diabetes, sexual health, mental health, drug use, and harm reduction.

“I’ve seen changed behavior in people that I’ve been cutting for years that have utilized resources through BBSI,” said Shouse.

BBSI provides community events based out of these safe spaces that bring care, including harm reduction resources, right to the communities who need it. This direct level of intervention is what Shouse says is missing in much of the conversation around BIPOC public health funding.

“The funding is different when it comes to people of color or minorities,” said Shouse. “They’re trying to keep certain communities and certain people in certain places because it works to their advantage.”

Shouse’s clients are predominantly Black men and young people, and in her work she fulfills a material need while offering support for other challenges.

Doulas Trained in Harm Reduction

It is that same model that other community leaders are implementing to provide support for Black pregnant people as well.

Granny’s Birth Initiative (GBI) is a nonprofit based in Louisville that supports Black parental health, partnering the care a pregnant person needs with the harm reduction resources they are unable to find elsewhere. That starts with training their doulas on harm reduction strategies, including trauma-informed care and Narcan usage.

“We make sure that our doulas are trained in that because doulas do provide resource navigation and it should always be non-judgmental support,” said doula Alexa Scisney, founder and executive director of GBI. “We want them to be well trained on not just keeping a straight face, but genuinely and truly understanding the type of resources that are needed.”

Black pregnant people are at least three times more likely to die due to a pregnancy-related condition, compared to their White counterparts. In Kentucky specifically, 82% of pregnancy-related deaths are deemed preventable. About 1 in 20 pregnant people use illicit drugs during pregnancy. This puts the work that GBI does as ground zero for public health progress and reducing harm.

“I know that doulas are an industry that is new to Kentucky, but a doula is somebody that’s supposed to be providing physical, mental, and emotional, non-judgmental support,” said Scisney. “And here at GBI, that non-judgment is something that we really highlight because it is not our job to do harm to people already seeking harm reduction resources. Our doors are always open.”

In addition to the SAMHSA decision, resources for harm reduction in Kentucky have been rocked by funding cuts and lack of consideration for how harm reduction impacts public health. In May, the University of Kentucky announced that it would formally end its HIV/AIDS prevention and treatment organization. The Target4 Project was part of this elimination, which provided HIV/AIDS intervention and services in addition to harm reduction supplies and targeted outreach.

Kentucky public health leaders say they will continue to step up in their communities, despite the new obstacles in front of them.

“Let us be the voice because we are the people who have experienced it. We’re the closest to it. We’re the closest because we live it every day,” said Waldon.

While the Trump administration and SAMHSA cut opportunities and funding, harm reductionists and community leaders continue to show up in new ways for their neighbors. While groups still hope for more permanent and sustainable funding, it is the promise of safer, stronger communities that pushes them forward, they said.

“For me, harm reduction has always been the radical decision to believe that every human being is worth keeping alive before they change, before they recover, before they become who somebody else thinks they should be,” said Waldon.
This work was supported by the 2026 CNP Media Fund. #CNPMediaFund

Keep reading

JustFundKY to host first Obsidian Ball, a masquerade gala in LexingtonAVOL Kentucky Is Adding Injectable PrEP. One Shot Can Replace Two Months of Pills.Kentucky Black Pride Turns 10 in the Park That Sheltered Queer LexingtonTime Slip Theatre Opens 13th Year of ‘Rocky Horror’ With a Witchy TwistLouisville Pride Put Mental Health Front and Center. The Need Doesn’t End When the Tents Come Down.