White House Meth Plan Still Includes Harm Reduction, Just Not for Meth

June 10, 2024

Once the federal government designated methamphetamine an “emerging drug threat” in March 2022, the White House Office of National Drug Control Policy (ONDCP) became legally obligated to do something about it. That May, it released the Plan to Address Methamphetamine Supply, Use and Consequences, followed by an update in April 2023 and now the most recent in June 2024.

The ONDCP plan had a “Harm Reduction” section alongside a handful of others like “Supply Reduction and Trafficking” and “Treatment.” When the first progress report was published in 2023, the harm reduction updates weren’t particularly interesting but did address the priorities in the original plan. In the 2024 update, harm reduction has been pared down to one paragraph each on fentanyl test strips, naloxone and a CDC page on polysubstance use that doesn’t discuss meth.

 

Chemsex Pilot

The first harm reduction priority outlined in the 2022 plan was developing a pilot program aimed at “the at-risk group men who have sex with men (MSM) who use methamphetamine or other psychostimulants, but do not yet meet criteria for stimulant use disorder.” It was supposed to “incorporate” people with lived experience—presumably not just as participants—and some form of HIV services.

By 2023, this had turned into one clinical trial which had already wrapped up several years earlier, and two about PrEP and contingency management. Both of those are still ongoing, but the June 2024 update doesn’t mention them. The original pilot program seems forgotten about.

 

Fentanyl Education

The next priority from 2022 was some sort of “fentanyl awareness effort” aimed at people who use meth. The 2023 update discussed the Centers for Disease Control and Prevention “Stop Overdose” website, and its separate Stimulant Guide.

That guide is probably one of the better government resources on stimulants to date, but none of the CDC’s stimulant-specific materials made the 2024 update. The only thing that remains is the polysubstance use page from CDC’s “Stop Overdose” site, which only mentions meth to state that it’s an example of a stimulant. 

 

Naloxone

The harm reduction priority that got the most space in the 2023 update was naloxone distribution in regions with higher rates of meth use. But this was essentially filler, cribbed from other federal-level naloxone access efforts, with no mention of how they’d be adapted to meth-use communities or even why they’d be a good fit in the first place. The exception was Indian Health Service “assessing methods of distributing naloxone to impacted regions, especially areas with high concentrations of methamphetamine use.”

In the 2024 update, this has all been condensed to a paragraph about Naloxone Safety Net Pilot Program for Indian/Tribal/Urban health centers.

 

Meth Antagonists

The 2022 plan directed various federal agencies to support research and development of “an antidote, reversal agent or better means of managing methamphetamine overdose or toxicity.” This translates to something like a meth version of naloxone. But by the 2023 update, this was mostly about the National Institute on Drug Abuse fund meth vaccines that were already under development.

That update did also describe one meth overdose reversal agent that was already in development, but overdose is not the aspect of meth use that could use medications in development—that would be stimulant agonist medications, for something a bit more like a meth equivalent of buprenorphine. Yet the 2024 update continues going in this direction, except it’s moved everything to the “Treatment” section.

 

Fentanyl Test Strips

The final harm reduction priority in 2022 was to build drug-checking capacity at syringe service programs, mostly through fentanyl test strip (FTS) distribution. 

“SAMHSA is tracking promising practices such as mass spectrometry testing,” the ONDCP stated that year, “which are more sophisticated and sensitive than fentanyl test strips and can also detect the presence of non-opioid threats, such as xylazine.”

Ideally federal agencies would be tracking these practices closely enough to know that “mass spectroscopy” technically does not encompass the drug-checking equipment they’re talking about (Fourier-transform infrared spectroscopy). FTS are actually more sensitive than the fancier forensic drug-checking equipment, not less. And they cannot detect all opioids—only fentanyl and its analogs, so they don’t detect e.g. heroin or nitazenes. But none of those are really the problem here.

What’s more likely to be a problem in real life is that FTS instructions aren’t written for meth, and the water dilution has to be properly adjusted otherwise they’re extremely likely to produce false-positives. The fentanyl awareness efforts could have at least included that.

 


 

Image via New York State

Kastalia Medrano

Kastalia is Filter's deputy editor. She previously worked at a number of other media outlets and wouldn’t recommend the drug coverage at any of them. When not at Filter, she works with drug users in NYC and drug checkers in North Carolina to track hyperlocal supply changes, and cohosts a national stimulant users call with Isaac Jackson.

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