The Trump administration is overhauling federal addiction policy and moving away from harm reduction strategies through steps like cutting federal funding for fentanyl test strips.

Why it matters: Many Republicans have long argued these strategies can promote addiction, but clinicians and treatment advocates worry the shifts underway could deter people from getting care.

State of play: The Substance Abuse and Mental Health Services Administration last month cut off federal funding for test strips used to check if street drugs are laced with fentanyl, except if they're used by law enforcement or health care professionals.

• It also halted funding for programs that distribute sterile syringes to people who inject drugs. The syringes have become a key part of the opioid response and are credited with slowing infectious disease spread.
• "It is essential that the use of federal funding is aligned to common-sense public health strategies that focus on prevention, treatment, and long-term recovery," Christopher Carroll, SAMHSA's principal deputy assistant secretary, wrote to program operators.
• The administration continues to make funding available for overdose reversal medication like naloxone.

Between the lines: The moves build on previous administration efforts to encourage more counseling and other prevention-focused approaches.

• But the pivot appears at odds with the White House's own National Drug Control Strategy, which endorses efforts to keep watch on the drug supply to understand emerging threats.
• The administration in its 2027 budget request also proposed about $10 billion in cuts that would affect community-based treatment and overdose response.

Zoom out: Some clinicians say the administration's mixed messaging also extends to medication-assisted treatment for opioids, like methadone.

• SAMHSA last month reaffirmed support for medication treatment but directed clinicians to talk to patients at least once a year about whether they should stay on it, and said lifelong medication should "not [be] the default for all patients."

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Senate health committee Chair Bill Cassidy's defeat in Louisiana's GOP primary on Saturday could complicate the Trump administration's efforts to fill top positions at the FDA and CDC and the surgeon general post.

• And in the long term, it opens the door for a new committee chair if Republicans hold the Senate in November, or a new ranking member if they don't.

The big picture: As a lame duck who lost to a Trump-endorsed challenger, Cassidy may have less incentive to shepherd administration picks through the Senate confirmation process — or provide a decisive vote the way he did last year to help confirm Health Secretary Robert F. Kennedy Jr.

• Lingering ill will could mean some posts go unfilled past the midterm elections.

Driving the news: Cassidy finished third behind Rep. Julia Letlow and state Treasurer John Fleming, who will now square off in a June 27 runoff.

• President Trump — who endorsed Letlow — lashed out again at Cassidy on Saturday for voting to convict him in his second impeachment trial. Earlier, Kennedy blamed Cassidy for stalling MAHA-backed surgeon general pick Casey Means, whose nomination was later pulled.

The intrigue: The question now is how Cassidy treats Trump nominations before his committee, and whether delays will lead some potential candidates for FDA commissioner to withdraw from consideration.

• The uncertainty could also have a ripple effect on talks to reauthorize user fees that help pay for prescription drug reviews.

What we're watching: It's early for the committee chair race, but Sen. Rand Paul (R-Ky.) is the next Republican in line, so it's worth watching to see if he makes moves for it — or decides to keep his Homeland Security chairmanship instead.

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The shakeup in the top ranks of the FDA continued late Friday, when acting top drug regulator Tracy Beth Høeg was fired and two other deputies of former commissioner Marty Makary left their posts.

Why it matters: The moves could be a prelude to the nomination of a more mainstream nominee for FDA commissioner this summer.

Driving the news: Høeg was the fifth person to lead the agency's drug center during the Trump administration and became a polarizing figure with moves like investigating RSV drugs for children and her involvement in overhauling the childhood vaccine schedule.

• "I learned so much & leave with no regrets," the sports medicine doctor wrote in an X post announcing her own firing.
• Also out were Katherine Szarama, acting director of the biologics and vaccines center, and Jim Traficant, who was chief of staff, Stat reported.

What's next: Acting FDA commissioner Kyle Diamantas can remain in the post through early December. But the administration is expected to nominate a permanent replacement for Makary well before then.

• That person would presumably have to pass muster with both Kennedy and Cassidy, whose Senate health committee would preside over confirmation hearings.
• Names that have been floated include former officials in Trump's first administration, such as former acting FDA commissioners Ned Sharpless and Brett Giroir.

Obamacare enrollees will have more access to high-deductible health insurance next year under a policy finalized Friday.

Why it matters: Health officials say the plans will bring down premiums and offer more flexibility. But they could leave enrollees exposed to higher costs in the long run.

Driving the news: The Trump administration will allow more people to qualify for so-called catastrophic coverage for longer periods of time.

• The plans have low monthly costs but very high deductibles.
• The change comes after about 1.2 million fewer people signed up for Affordable Care Act coverage compared with a year ago after Congress let enhanced subsidies expire.

HHS will also allow health plans without in-network providers to be sold on the Obamacare exchanges next year.

The other side: Consumer advocates and providers worry the changes will make it harder to access health care.

• "Policymakers are right to focus on lowering the cost of coverage, but premiums are only part of the affordability equation," Charlene MacDonald, CEO of the Federation of American Hospitals, said in a statement.

🐓 Three multistate salmonella outbreaks tied to backyard poultry sent dozens to the hospital. (CIDRAP)

💊 Amgen is the latest pharma company to seek changes in the 340B drug discount program, with new data demands on providers. (Bloomberg Law)

🚘 Some physicians say autonomous vehicles are already saving lives and should be a public health imperative. (Axios)