SAMHSA Just Told Grantees Their Federal Money Can't Buy Test Strips Anymore. A New Study Put a Body Count on What That Means.

Shreeta Waldon runs the Kentucky Harm Reduction Coalition, and she has about a month of test strips and syringes left before what she calls a “full-blown crisis.” The coalition just lost a $400,000 federal grant — not because anyone found fraud or a performance problem, but because in April, SAMHSA sent grantees nationwide a set of “Dear Colleague” letters drawing a new federal line: grant money can no longer pay for fentanyl, xylazine, or medetomidine test strips distributed to the public, sterile syringes or pipes, sterile injection water, or the phone and text hotlines people call while using alone so someone can send help if they stop responding.

The federal government just decided that knowing what’s in your drugs, and having a clean way to take them, is no longer something your tax dollars can fund — and a study published two months later put a number on what that decision costs.

SAMHSA’s own language, reported first by STAT News on April 27, called the change “a clear shift away from harm reduction and practices that facilitate illicit drug use and are incompatible with federal law.” Naloxone and nalmefene — the opioid overdose reversal medications — are explicitly carved out and remain fundable; a SAMHSA official, Art Kleinschmidt, has said the agency doesn’t count overdose-reversal drugs as “harm reduction” in the restricted sense. Test strips still qualify for funding when used by law enforcement or medical staff. What’s cut is the version that puts a strip in the hand of the person about to use.

The on-the-ground math is not abstract. Harm Reduction Ohio told WOSU Public Media in mid-July it distributed more than a million test strips last year and expects to manage roughly a quarter of that this year. Each strip costs about a dollar. Executive director AmandaLynn Reese put the constituency plainly: “Everyone from your school nurse to your person who is injecting substances… wants these supplies.” Tonja Catron, who runs the SOAR Initiative, was blunter still: “We can’t buy anything that keeps people who use drugs safe.”

What “6.9% more overdose deaths” actually means, in people

Here’s the part that turns a funding memo into a mortality statistic. Researchers at the University of Colorado Anschutz Medical Campus, led by Kirk Fetters and senior author Josh Barocas, built a microsimulation model of the national population of people who inject drugs and ran it forward five years under different funding-cut scenarios, published in JAMA Network Open on June 18. An 11 percent cut to syringe service program funding — modest, roughly in line with what’s already happening — produced a 0.1 percent rise in all-cause mortality and a 0.2 percent rise in overdose mortality among people who inject drugs. Run the worst case instead — an 80 percent cut, the kind of funding collapse a coalition losing its only federal grant is staring at — and the model shows a 5 percent rise in all-cause mortality and a 6.9 percent rise in overdose mortality. Translated into actual people: 39,600 additional deaths overall, 15,600 of them additional overdose deaths, among people who inject drugs, over the model’s five-year window.

“Disruptions to SSP funding… are likely to have serious and measurable consequences for public health,” Fetters said. Barocas put it as a direct rebuttal to the framing SAMHSA used to justify the change: “Policies that reduce access to these services will have far-reaching consequences… impede our ability to end the overdose crisis.”

We have done this experiment before and know how it ends. In 1988, at the height of the AIDS epidemic, Congress banned the use of federal funds for syringe exchange programs — the only intervention then proven to slow HIV transmission among people who inject drugs. The ban held for roughly two decades before Congress partially lifted it in 2009, then reimposed geographic restrictions, before a fuller repeal in 2016. Researchers spent those years documenting HIV outbreaks in communities that lost exchange access. The current SAMHSA letters are narrower — they restrict grant dollars rather than banning the activity outright, and naloxone funding survives intact — but the shape of the argument is the same one that lost a generation of syringe-exchange access to a moral objection instead of an evidence review.

Researchers spent those years documenting HIV outbreaks in communities that lost exchange access.

If you or someone you know relies on a needle exchange or a test-strip table, the naloxone in that same building is not going anywhere under this rule — that piece is still federally protected, and still yours to use, whatever else changes on the shelf next to it. What’s disappearing is the rest of the table, one grant renewal at a time, county by county, starting with the organizations like Waldon’s that had the least cushion to begin with.