SAMHSA Cut Fentanyl Test Strip Funding. The Timing Couldn't Be Worse.

On April 24, 2026, SAMHSA issued guidance that effectively ended federal grant funding for fentanyl test strips. The letter, which updates July 2025 guidance, explicitly prohibits using SAMHSA grants to purchase “fentanyl test strips or any other substance test kits, including xylazine and medetomidine test strips.” Clean syringes and smoking kits are also now prohibited. The July 2025 version had still allowed test strips; the April update reversed that.

The operational impact was immediate. The Kentucky Harm Reduction Coalition, which had been distributing roughly 48,000 test strips per year through a federal grant, lost its $400,000 SAMHSA funding. The organization reported approximately one month of operational reserves. Similar programs across the country are facing the same calculation.

The policy’s stated logic — that federal funding should support “comprehensive treatment rather than medication-only models” — does not describe what test strips do. Test strips are not a treatment and are not a medication. They are a checking tool: a way for someone who is going to use drugs regardless of policy to know whether their supply contains fentanyl before they use. Multiple peer-reviewed studies have found that strip-based checking programs reduce overdose risk without increasing drug use. The American Society of Health-System Pharmacists — a professional pharmacy association — formally opposed the new restrictions, writing that “the evidence is clear that syringe services programs save lives and do not increase drug use.”

The restrictions arrive as the United States is experiencing what appear to be the benefits of the infrastructure the administration is now cutting. Drug overdose deaths fell 24 percent from 2023 to 2024. Whether harm reduction tools drove that decline or a shift in fentanyl supply potency did is currently under active scientific debate. Both explanations have evidence behind them. Neither is settled. But the administration is defunding tools credited with the improvement before the question of whether those tools caused it has been resolved.

Counties that have relied on SAMHSA block grants to fund harm reduction services are now reassessing their programs. The National Association of Counties, which represents the governments most directly responsible for ground-level public health delivery, warned that the new restrictions “may create fiscal and operational challenges for county behavioral health departments and their community partners.” That is a carefully bureaucratic way of saying: programs will close, and people those programs served will have nowhere to go.

Harm reduction works partly through reach — the syringe program that doesn’t require insurance or sobriety becomes, for many people in active use, the first health system contact in years. Research shows that people who engage with syringe service programs are five times more likely to enter treatment than nonparticipants. When you defund the front door, you don’t just lose the overdose reversals. You lose the entry points into care.

The policy and funding implications for states like Arizona — which ranks 49th for behavioral health access and is counting on a network of community-based programs to connect people with its $1.2 billion in settlement-funded treatment capacity — are direct. There is no treatment capacity utilization without the access infrastructure that delivers people to it.

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See today’s featured article for the full analysis of the overdose decline debate and what the SAMHSA restrictions mean for the infrastructure question. Follow harm reduction for ongoing coverage.