The April Memo That Ended the Test Strip Era

On April 24, 2026, at some point before nine in the morning, a Dear Colleague letter went out from SAMHSA to its grantees. The letter was not long. In six paragraphs, it told every organization receiving federal money that they could no longer use it to purchase fentanyl test strips for public distribution. Or clean syringes. Or sterile water for injection. Or “safe smoking kits.” Or xylazine or medetomidine test strips. The carve-out was specific: public health officials, law enforcement, and clinical professionals could still use the supplies in their own settings. The organizations that actually reach people who use drugs in the places where they use them — on the street, in their homes, at community distribution sites — could not.

One Kentucky harm reduction coalition had distributed 48,465 fentanyl test strips in the first three months of 2026 alone, funded by a $400,000 federal grant. The April letter ended that.

Six paragraphs to retire a public health tool

A fentanyl test strip costs between one and two dollars. It takes thirty seconds to use. The person adds a small amount of their drug to water, dips the strip, and reads one line (fentanyl present) or two lines (none detected). When the result comes back positive, some people stop using that batch entirely. Some call a friend to stay nearby while they use. Some decide to use less at the start, titrating to assess the potency. None of these outcomes are guaranteed — people make complicated decisions under complicated circumstances — but the data from multiple peer-reviewed studies, including research published in JAMA Network Open and the International Journal of Drug Policy, shows consistently that people who have access to test strips are less likely to die. The effect size is not subtle or contested.

The SAMHSA letter is not really a budget decision. It is a position. Secretary Robert F. Kennedy Jr.’s Administration for a Healthy America has explicitly framed harm reduction as a philosophical opponent of recovery rather than a component of it. The administration’s theory is that providing supplies for drug use — even supplies that reduce the risk of death from that use — constitutes “promotion of illegal drug use,” and that federal money should not fund it.

Keith Humphreys, a Stanford addiction policy researcher who served on the White House drug policy office under both Republican and Democratic administrations, has argued consistently that this framing collapses a distinction the public health field has spent two decades building. “There is no evidence that access to test strips or clean syringes increases drug use,” Humphreys wrote in 2024 in STAT News. “The evidence is that it keeps people alive long enough to enter treatment.” The administration’s framework says: if you want to reach people who use drugs, do it in a clinic. Humphreys’ argument — and the public health consensus’s argument — is that people who use drugs, particularly those at highest overdose risk, are frequently the last people to walk into a clinical setting. They are reached, when they are reached at all, by peer-run community organizations. That is the infrastructure the April letter dismantled.

The policy debate about the legitimacy of harm reduction has been running for twenty years. The April 24 letter settled it at the federal level, for now.

Ohio ran out first

The timing reveals the real-world consequence. Many harm reduction organizations carry 30 to 90 days of supply on hand as a buffer against funding disruptions. By June 5, 2026, public health agencies in Ohio were reporting that their test strip supplies were running low, according to WOSU Public Media. Oklahoma’s state fentanyl test strip program was in limbo as of May 27, as KGOU reported. West Virginia’s harm reduction organizations — serving the state with the highest per-capita overdose death rate in the country, and the state that, two years ago, was held up as a model for what community-based harm reduction could accomplish in a rural opioid crisis — had no clear replacement funding plan.

By June 5, 2026, public health agencies in Ohio were reporting that their test strip supplies were running low, according to WOSU Public Media.

The administration’s answer, where it has one, is that states can decide whether to fund these programs from their own budgets or from the patchwork of opioid settlement funds arriving over the next eighteen years. This is technically true. States have the discretion. Most will not use it this way.

The 2026 opioid settlement landscape is real money: Arizona alone is receiving $1.215 billion over eighteen years from pharmaceutical company lawsuits. But settlement funds come with restrictions and reporting requirements tied to evidence-based interventions as defined by state settlement committees. A Phoenix harm reduction organization distributing test strips and naloxone at encampments does not look like a “treatment program” under most settlement fund disbursement frameworks. Settlement agreements tend to direct funds toward residential treatment, MAT expansion, and prevention education — the clinical and quasi-clinical infrastructure that the current administration also prefers. Community-based harm reduction sits in the gap between those categories and discretionary state health budgets. When federal categorical funding protected it, it survived. Now it needs to compete for the same state budget lines as everything else.

Phoenix made it criminal on the same week

Arizona is not a representative state for understanding what happens when federal harm reduction funding ends. It is an extreme case, and it was already in crisis before the April letter.

The Arizona Department of Health Services reported that overdose deaths from January through August 2025 were 20 percent higher than the same period in 2024 — a period during which nearly every other state saw deaths decline. The national trend is real: a roughly 17 percent reduction in drug overdose fatalities from the 2023 peak of 107,000 deaths. Arizona moved in the opposite direction.

The reasons are documented. Arizona’s fentanyl supply has shifted from pressed counterfeit pills — which people could test individually and for which there was a clear risk calculus — to fentanyl powder, which is mixed unpredictably into methamphetamine and other substances. Surveillance data reviewed by NIDA shows fentanyl present in 12.5 percent of powder methamphetamine samples. A person who is not using opioids, who has developed no opioid tolerance, can encounter a lethal fentanyl dose in a substance they believe is something else entirely. This is the specific scenario the test strip was designed to catch. And this is why cutting test strip funding in a state that is simultaneously watching its overdose rate climb, against a national decline, is not a neutral act.

On June 1, 2026 — one week after the deadline the SAMHSA letter set for compliance — Phoenix’s new parks ordinance took effect, restricting harm reduction distributions in city parks. Public health experts called it, according to Lookout News’s coverage of the proposal, “a disaster waiting to happen.” The federal funding ban and the city ordinance landed within five weeks of each other. The harm reduction organizations operating in Phoenix are now navigating both simultaneously: no federal supply funding, and criminal penalties for distribution in the public spaces where their clients actually are.

Maia Szalavitz, writing in Filter in May 2026, named the logic running through both policies: “The administration is not opposed to helping people who use drugs. It is opposed to helping them in ways that acknowledge that drug use is happening.” The Phoenix ordinance is the municipal expression of that position. The federal funding ban is the federal expression.

What else the $813 million was buying

The grants of regional and national significance that SAMHSA proposed eliminating in the FY2026 budget are not only harm reduction supplies. The $813 million line item covered workforce development programs training peer recovery coaches — people with their own histories of addiction who serve as the most trusted point of contact in the recovery system for populations that don’t trust clinical providers. It covered state-level overdose surveillance infrastructure: the systems that tell public health departments where people are dying, what substances are involved, and what supply trends look like, so they can mount targeted responses. It covered community-based treatment access programs that do the coordination work — finding people, building trust, navigating insurance, making appointments — that exists nowhere else in most counties.

It covered community-based treatment access programs that do the coordination work — finding people, building trust, navigating insurance, making appointments — that exists nowhere else in most counties.

The block grants that states will receive instead carry no categorical requirements for any of these specific functions. States with robust behavioral health bureaucracies and political will to fund harm reduction will redirect some money. States with political pressure against harm reduction, or with behavioral health agencies already stretched, will not.

Arizona is ranked 49th of 51 for behavioral health access. The argument that increased state discretion will lead to increased investment in programs serving the most marginalized people in the least visible situations has no historical support in Arizona’s case. The state has received opioid settlement funds, has AHCCCS coverage that is better than most states’ Medicaid programs for substance use services, and still cannot get MAT to more than one in twenty Arizonans with opioid use disorder. The structural problem is not money alone. It is coordination, navigation, trust, and the outreach infrastructure that connects people to services they would otherwise never find.

The last time Congress made this transition at scale — the ADMS block grant of 1981, which consolidated federal addiction and mental health funding into state discretionary grants under the Reagan administration — it led to systematic underfunding of addiction and mental health services in the years that followed. Congress reversed course in the 1990s and restored categorical requirements specifically because the block grant model had failed the populations it was meant to serve. The institutional memory of why that reversal was necessary appears not to have survived the current policy cycle.

Forty-eight thousand strips

The Kentucky organization that distributed 48,465 fentanyl test strips in the first quarter of 2026 had six weeks of supply remaining when the April letter arrived. The staff there had been through a version of this before: in January 2026, SAMHSA had sent termination letters to between 2,000 and 2,900 grantees, covering approximately $2 billion in funding, before reversing within 24 hours after Congressional and provider backlash. That reversal created the impression that the line could hold. The April letter was narrower, more specific, and has not been reversed.

There is no abstraction available here about what it means for forty-eight thousand test strips to stop being distributed. Each one represents a moment when someone decided to know what was in what they were using before they used it. Some of those moments led to a changed decision. Some led to a call to a friend, a smaller first dose, a different batch entirely. Some led, almost certainly, to someone being alive the next morning who would not otherwise have been.

The administration has made its position clear: the federal government should fund recovery, and recovery requires abstinence from drugs, not tools for safer drug use. The harm reduction field’s response — that you cannot recover if you are dead, and that the tools to keep people alive long enough to reach recovery have a clear evidence base — has been stated, published, studied, and is simply being overruled.

That is what the April memo was. Not a budget decision. A ruling on what this government is willing to count as keeping people alive.

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[Find treatment resources in Arizona and nationwide at rizerecovery.com/find-help. Coverage of harm reduction policy is ongoing at /newsroom/category/harm-reduction.]