Washington Decided Test Strips Send the Wrong Message. Kentucky Has a Month Left.

Shreeta Waldon found out on a Friday. The Kentucky Harm Reduction Coalition, which she runs, was told it was losing a $400,000 federal grant — the money that bought the fentanyl test strips her organization hands out across the state. She did the math the way anyone running a program on a fixed budget does: what’s in the closet, how fast it moves, how long until the shelf is bare. The answer was about a month. After that, she told CBS News, her organization enters “full-blown crisis.”

The federal government spent a decade telling grantees that fentanyl test strips were evidence-based public health practice. In April, it told them the opposite in writing — and the reversal, not the strips, is the thing without evidence behind it.

The letter that did it is dated April 24, 2026, signed by then-acting SAMHSA administrator Chris Carroll, addressed to every organization that takes federal behavioral-health grant money. If you’ve ever picked up a fentanyl test strip from a outreach van, a pharmacy counter, or a peer worker’s backpack, this is the letter that decided whether that will still be free, or still be legal to fund, going forward. Read it yourself — it is four pages, in plain English, and it says what it means: fentanyl, xylazine, and medetomidine test strips can no longer be bought with SAMHSA grant dollars, and neither can sterile syringes, safer-smoking supplies, sterile water, saline, ascorbic acid, or overdose hotlines. (Xylazine and medetomidine are veterinary sedatives that have been turning up cut into the street opioid supply — “tranq” is the word you’ve probably heard for the wounds they cause — which is why test strips for them existed at all.) If you run a program still deciding how to respond, the letter itself, not the outrage coverage of it, is the artifact worth putting in front of your board this week: it names exactly what’s defunded and what isn’t, and that list is shorter and more specific than most of the summaries of it. The letter frames the old policy as “incompatible with federal law” and ties the shift to the White House’s “Ending Crime and Disorder on America’s Streets” executive order — a law-and-order frame applied to a practice that, until this spring, sat inside SAMHSA’s own list of evidence-based interventions.

If you use drugs, or you’re the person who used to hand someone a strip before they used, you already know what changed and what didn’t. Naloxone and nalmefene are still funded. Lock boxes, sharps disposal, wound care, and HIV/hepatitis home test kits are still funded. What’s gone is the layer that sat one step earlier — the tools that told someone what was actually in the bag before it was too late to matter. That distinction is not an accident, and it is worth sitting with: the government kept the intervention that reverses an overdose and cut the one that might have prevented the need for it.

The number nobody wanted to be true at the same time

Here is the part that should embarrass whoever wrote the April letter’s framing. One week before this piece published, the CDC opened a new Overdose Prevention Data Channel — timed, pointedly, to International Overdose Awareness Day — and the provisional numbers in it are good news by any honest reading: 67,798 predicted overdose deaths in the twelve months ending March 2026, a 12.3% drop from the year before. CDC Director Dr. Erica Schwartz called it a matter of “transparency to empower patients, providers and other stakeholders,” and Grant Baldwin, who runs the agency’s Division of Overdose Prevention, put the real point plainly: “The most useful data does more than show us what has happened; it helps us decide what to do next.”

What the data does not do is support cutting the thing credited with a meaningful share of that decline. Naloxone saturation, expanded syringe services, and, yes, fentanyl test strips are the interventions researchers have spent the last decade tying to falling overdose numbers — not abstinence messaging, not law enforcement pressure on supply. STAT News reported that alongside the test-strip guidance, SAMHSA’s own staff has been cut from roughly 900 people to fewer than half that, with $1.7 billion in block-grant funding cancelled and another $350 million in addiction and overdose-prevention money gone. ASAM president Stephen Taylor told STAT his organization was “prepared to engage with federal partners to ensure that national policies reflect evidence-based practices in addiction medicine” — the kind of sentence professional associations write when they are trying not to say the word “wrong” about the agency that funds their members.

What the data does not do is support cutting the thing credited with a meaningful share of that decline.

The evidence Taylor is gesturing at is not new or contested. NIDA has been saying for years that people who use syringe service programs are roughly five times more likely to enter drug treatment than people who don’t, and about three times more likely to cut back or stop injecting altogether. That is not a coincidence of correlation — it is the whole design logic of harm reduction, which nobody has explained better than Ryan Kelly, a University of Minnesota Medical School professor, in four words to MinnPost: these programs “keep people alive and save a ton of money.” The psychology behind the five-times number is not complicated, either. Treatment doesn’t usually start with a hotline call from someone who trusts the system. It starts with a relationship — a syringe worker who shows up on the same corner every Tuesday, who doesn’t flinch, who remembers your name. Cut the program and you don’t just lose the sterile syringe. You lose the one person in someone’s week who is reliably, unconditionally not there to arrest them.

It doesn’t stop at the federal line

Federal cuts don’t stay federal. They move downhill into states, and states move them downhill into the organizations actually doing the work. In Minnesota, Sue Purchase runs Harm Reduction Sisters out of Duluth, and this August she lost roughly $150,000 in state funding that had, in turn, traced back to the federal pullback. “I was honestly surprised to hear that they’d made this decision,” she said — and then offered the quieter, more damning read of why: “My sense is the state doesn’t want or need any more attention from the federal government.” That is not a public health judgment. That is an organization deciding it would rather be invisible to Washington than funded by it, and deciding that on behalf of the people who use its needle exchange. Brad Ray, a senior researcher who sits on Harm Reduction Sisters’ board, named the mechanism directly: “The cultural mood is shifting. Support for harm reduction is drying up. People are distancing themselves from it.” Fear moves faster than evidence. It always has.

We have watched a government decide that a cheap thing which keeps people alive sends the wrong message before. In 1988, at the height of the U.S. HIV epidemic, Congress — led by Senator Jesse Helms — barred federal funds from paying for syringe exchange programs, on the theory that clean needles told people drug use was acceptable. The ban held, with a brief exception from 2009 to 2011, until 2015 — twenty-seven years, spanning the exact period when needle-sharing was driving new HIV infections among people who inject drugs across the country. Nobody who studies that era argues the ban saved lives. It is remembered, when it’s remembered at all, as the moment ideology outran data and stayed ahead of it for a generation. The 2026 letters use different language — “incompatible with federal law” instead of “sends the wrong message” — but they are doing the same arithmetic: subtracting the tool, keeping the crisis.

The outlet that would have covered this closely just closed

There is a second story braided into this one, and it is not a footnote. Filter, the harm-reduction news outlet that launched in 2018 and published thousands of articles about exactly this kind of policy shift, announced on August 11 that it is ceasing operations. Editor-in-chief Will Godfrey put it as plainly as Waldon put her own math: Filter was “unable to survive an increasingly difficult funding landscape, like too many other harm reduction and independent media organizations in these times.” The archive stays up — the board arranged for that — but no new reporting is coming from a newsroom that, for eight years, was often the only outlet tracking state-by-state harm reduction funding in this kind of granular, unglamorous detail. Filter’s board included Morgan Godvin, a journalist and drug-policy researcher who has spent her career writing from inside the experience she covers, having served federal time on a drug charge before becoming one of the field’s more credible voices precisely because she never pretended distance from the thing she was reporting on. When the infrastructure that funds outreach vans and the infrastructure that funds the journalism watching those vans both buckle in the same year, that is not two unrelated funding stories. It is one funding environment, and it is getting smaller from every direction at once.

If you are the person this newsletter is actually for — someone who uses, has used, or loves someone who does — none of this changes what is still true tonight. Naloxone is still funded, still legal, still free through most of the same programs now losing their test strips; the letter that cut so much explicitly left that door open, and it is a door worth walking through if you have not already. What changed is narrower and still corrosive: the tool that told you what you were about to use is being taken out of the hands of the people who used to hand it to you, for reasons that have nothing to do with whether it worked. It worked. That was never actually in dispute. The only thing that moved between March and April of this year was who was in the room deciding it didn’t matter.

The only thing that moved between March and April of this year was who was in the room deciding it didn’t matter.