The Trump administration’s harm reduction stance is pulling in opposite directions. On one hand, the president has helped pave the way for more research to ensure drug policy is backed by science. On the other hand, FDA Commissioner Marty Makary clings to the age-old reflex of banning first and asking questions later.
As recently as this week, President Trump has moved to align federal drug policy more closely with the science. Specifically, the president signed an executive order that loosens restrictions on psychedelic drugs, making it possible for rigorous research to be conducted on the drugs’ benefits and risks. In it, he directs the FDA, DEA, and DOJ to “dramatically accelerate access to new medical research and treatments based on psychedelic drugs,” including psilocybin, LSD, MDMA, and ibogaine. The order also allocates $50 million to support state-level psychedelic research programs.
This seems to be part of a broader push to address serious mental illness and substance abuse disorders, especially in the military veteran community. Among military veterans, more than 1 in 10 have a substance abuse disorder, and about one-quarter experience mental health conditions. President Trump deserves thanks for this pivot and the doors he will open for our nation’s veterans.
In expanding research into both psychedelics and medical marijuana, President Trump has signaled a larger pivot to a serious harm reduction agenda. Instead of treating substances as threats, the government should learn from them; using data, not panic, to decide which substances save lives and which pose a risk to Americans.
The second shift in President Trump’s harm reduction efforts is his evolution on vaping. In 2020, Trump expressed regret at a decision made in his first term to ban flavored vapes, acknowledging the public backlash he and others have faced for the decision since.
Additionally, rather than making the vape market safer, the prohibition pushed users toward an unregulated market. Just last month, it was reported that illegal black market vapes make up over 70% of the market. These illicit products, bound by no safety guarantees, expose users to dangerous chemicals while still possessing the harmful “flavors” the ban sought to dispose of in the first place.
Now, the president has smartly reversed course. While some reporting has made it clear that politics played a role, Trump’s boast of “saving flavored vaping” is an acknowledging that e-cigarettes, while not healthy, are an important harm-reduction tool to move consumers away from cigarettes. Shutting down lower-risk options pushes people back to cigarettes, not to abstinence.
Meanwhile, FDA head Marty Makary is pushing policies that undermine the president. For one, Makary has stunted the impact of Trump’s reversal on vapes, blocking specific flavors from hitting the market in direct opposition to the President. Additionally, Makary’s crusade against 7-OH, a derivative of kratom products, has culminated in a possible nationwide ban and DEA scheduling, flying in the face of Trump opening the door to research, rather than ban, other substances.
Rather than commissioning independent research on regulated 7-OH, which has been widely reported as a harm-reduction tool and lifesaver for former opioid addicts, Makary’s FDA seems to prefer seizures, enforcement, and further criminalization. In practice, a Schedule I designation for 7-OH would freeze research, choke off access for consumers, and push demand toward more dangerous synthetics – the same pattern observed after the crackdown on vapes.
A sound harm-reduction strategy distinguishes between more and less risky options and uses incentives (regulation, policy, and market forces) to tilt consumer behavior toward less risky options. Time and again, research concludes that intelligent regulation of substances, not blanket bans, lead to better public health outcomes.
In the case of 7-OH, observational studies and academic research alike have suggested that kratom and its derivatives can be an effective offramp for those struggling with opioids without significant risk. While more research is necessary to ultimately determine 7-OH use cases and effective dosing, Makary’s posture would eliminate any possibility of this research coming to light.
That’s why Makary’s line on 7-OH isn’t just inconsistent with the President, it is politically reckless for the administration. If the White House is serious about building a harm reduction framework, one that learns from the failures of the drug war rather than repeating them, then it cannot let its own FDA commissioner drag it backward.
Gerard Scimeca is an attorney and serves as chairman and co-founder of Consumer Action for a Strong Economy, a free-market consumer advocacy organization.
