When federal funds walk away from test strips

A quiet rewrite of two paragraphs in a SAMHSA grantee letter is, for most Americans, easy to miss. For someone who runs a county-funded syringe service, or trains pharmacists to distribute test strips, or stocks a Phoenix community center’s bathroom with naloxone — it’s the kind of change that reshapes a year’s work in an afternoon.

That’s what happened on April 27, when STAT News reported that the Substance Abuse and Mental Health Services Administration’s updated guidance to grantees formalized a clear stance: federal substance use funds should not be used to purchase sterile syringes, sterile smoking equipment, or test strips for fentanyl, xylazine, or medetomidine. Three days later, the American Society of Health-System Pharmacists publicly opposed the restriction. The Drug Policy Alliance opened a running tracker. And a working assumption that has shaped overdose prevention since 2021 — that the federal government would help pay for the tools used to detect what’s actually in the drug supply — quietly ended.

For people in or adjacent to recovery, the meaningful question isn’t political. It’s practical: what changed, what didn’t, and who’s most affected.

What actually changed

The April 2026 guidance updates a July 2025 directive that flowed from the executive order Ending Crime and Disorder on America’s Streets. It instructs grantees that SAMHSA discretionary funds — the awards that fund things like State Opioid Response (SOR) grants, Tribal Opioid Response (TOR) grants, and Strategic Prevention Framework programs — should support only “evidence-based programs” that don’t appear to facilitate ongoing drug use. The letter, summarized in detail by the National Association of Counties, explicitly removes sterile syringes, sterile pipes, and drug-checking strips for fentanyl, xylazine, and medetomidine from the eligible-supply list.

This sits inside a broader 2026 pattern. In January, SAMHSA sent termination notices to roughly 2,000–2,900 grantees totaling close to $2 billion; the terminations were rescinded within 24 hours after concerted pushback from providers, advocacy groups, and members of Congress. In April, hundreds of additional SAMHSA grants were terminated, with less universal reinstatement. The April harm-reduction-supply guidance is the policy layer that the funding actions sit on top of.

What didn’t change: naloxone. The April letter and the July 2025 EO continue to treat naloxone as a covered, evidence-based intervention. Medications for opioid use disorder — buprenorphine, methadone, extended-release naltrexone — remain fully covered. Treatment, prevention education, peer recovery support, and 988 Lifeline operations were not narrowed by this letter.

Why test strips became a fault line

Fentanyl test strips became part of the federal harm-reduction vocabulary in 2021, when the prior administration explicitly authorized SAMHSA funds to purchase them. The clinical rationale was straightforward: people who use unregulated drugs are dying from substances they didn’t know were in their supply, and a strip that costs roughly a dollar can change a fatal exposure into a survivable one. The pattern repeated for xylazine strips in 2023 and for medetomidine in 2024–2025 as those sedatives spread.

The new guidance reverses the federal recognition of that logic without disputing the underlying data. The Centers for Disease Control’s own Health Alert Network notice from late 2024 describes medetomidine as increasing the risk of severe withdrawal and complicating overdose response. The argument the April letter advances is policy-philosophical, not empirical: that federal funds should not normalize use, regardless of the surveillance value the testing produces.

ASHP’s opposition statement, joined by the National Council for Mental Wellbeing and dozens of state harm-reduction coalitions, argues the empirical case will continue to matter — that people who use drugs and know what’s in them survive longer than those who don’t. The fight will play out across grantees who keep buying strips with non-SAMHSA funds (state, county, settlement, philanthropic) and those who can’t.

The fight will play out across grantees who keep buying strips with non-SAMHSA funds (state, county, settlement, philanthropic) and those who can’t.

What this means for Arizona

In Arizona, the practical effect is muted by a fact unique to states with active opioid-settlement infrastructure: harm-reduction supplies are increasingly purchased outside the federal channel. The state’s $1.215 billion settlement window over 18 years, Maricopa County’s $4.3M April 2025 commitment with $750K specifically earmarked for naloxone procurement, and the Hikma and Amneal naloxone-unit pipelines (6,599 + 33,714 units respectively, with Arizona’s first delivery window concentrated around September 2026) all flow through state and county dollars — not the federal SAMHSA channel.

That doesn’t make Arizona immune. The state’s SOR grant, which funds large portions of medication-assisted treatment expansion and behavioral health workforce development, remains SAMHSA-administered. Tribal programs in northern Arizona that have used test strips as a front-door tool for engagement will lose a covered line item. And smaller, federally-funded community organizations across the state — particularly those operating in counties without a robust settlement-fund pipeline — will feel the change first.

The state-level resilience to this federal shift is one of the structural reasons Arizona is being watched as an early test of whether settlement-funded harm reduction can stand on its own.

Where this is heading

Two things are likely. First, a parallel funding stack will emerge faster than expected. Settlement funds, state general funds, and philanthropic dollars will absorb what federal funds used to cover, with administrative overhead the federal channel didn’t have. Second, the empirical case for drug checking will continue to compound. As medetomidine and the nitazene family proliferate, the difference between an unchecked and a checked supply will become starker, not subtler.

For people in recovery and for families navigating someone else’s substance use, the headline is narrower than the news cycle suggests: the supplies most directly tied to staying alive — naloxone, MOUD, 988 — were not removed. The supplies tied to knowing what you’re using were. That’s a real change, and it falls hardest on the populations whose risk is least visible.

Why this matters for people in recovery

Recovery and harm reduction are often framed as competing philosophies. They aren’t. The same person who needs a treatment match also benefits from staying alive long enough to take it. If you or someone you love is using and worried about the supply, talk to a local harm-reduction program — many in Arizona will continue to provide test strips and supplies regardless of federal funding source. If you’re navigating treatment options, Rize Recovery can help match you to verified Arizona facilities and connect you to naloxone resources in your county.

If you’re in crisis, call or text 988.

Sources verified: STAT, ASHP, NACo, Drug Policy Alliance. Funding status of specific Arizona programs is changing weekly; we will update this post as conditions clarify.