Eight Weeks Without Federal Test Strip Funding: What Harm Reduction Programs Look Like Now

On April 24, 2026, SAMHSA issued a “Dear Colleague” letter telling grantees they could no longer use federal funds for fentanyl test strips, clean syringes, sterile water for injection, or xylazine and medetomidine test kits. We covered that decision when it dropped. Eight weeks later, the question is: what does harm reduction infrastructure look like on the ground right now?

The short answer is thinner. The Kentucky Harm Reduction Coalition, which distributed 48,465 fentanyl test strips in the first quarter of fiscal year 2026 alone, lost a $400,000 SAMHSA grant. Their situation is not unusual. Programs that relied heavily on federal grants for strip procurement have either cut volume, shifted to private fundraising at emergency pace, or stopped distribution entirely in some counties. The populations getting cut off first are not the ones in urban centers with diversified funding — they’re the rural and tribal communities where federal grant dollars were often the only source of harm reduction supplies, and where the distances between a person using alone and the nearest naloxone make test strips the difference between a warning and a death.

Some states have moved to fill the gap with state funds. California, Colorado, Washington, and New York had existing state-funded harm reduction infrastructure and have largely maintained strip distribution. Massachusetts and Maryland have used emergency budget transfers to backstop programs. But most states haven’t. Strip availability in states that were heavily reliant on SAMHSA grants — parts of Appalachia, the rural Southeast, the Mountain West — has declined measurably since April.

There’s a legal tension that hasn’t resolved: fentanyl test strips are not classified as drug paraphernalia in 45 states and Washington, D.C., and the SUPPORT Act (2018, reauthorized 2025) explicitly protected federal funding for harm reduction services. A coalition of public health organizations has challenged the SAMHSA guidance as inconsistent with the SUPPORT Act’s text. That legal argument is working its way through the comment period and may eventually reach court. In the meantime, programs are operating without the funding, and the supplies aren’t in people’s hands.

The administration’s logic — that test strips “facilitate illicit drug use” — has no support in the overdose research literature. Studies consistently show that strip availability does not increase drug use rates; it reduces the probability that any given use event results in a fatal overdose. The strips are effective. That is precisely why removing them has consequences.

The eight-week mark is an important inflection point: programs have now absorbed the initial shock, adjusted what they can, and are running the math on how long they can sustain operations without federal support. The results of that calculus will become visible in overdose data by fall.