Washington Will Still Pay for the Antidote. It Won’t Pay for the Warning.

AmandaLynn Reese runs Harm Reduction Ohio, and in 2025 her organization put more than a million fentanyl test strips into the hands of people who use drugs across the state. This year, she’s projecting about 250,000 — a quarter of last year’s number, she told the Ohio Statehouse News Bureau this month. The strips cost about a dollar apiece. “At a dollar a piece,” she said, “how is that sustainable for a nonprofit?” Three counties over in Cincinnati, Suzanne Bachmeyer, who directs prevention work at the HIV organization Caracole, put it more simply: the strips “allow individuals to protect themselves and people in their community.” That is the entire pitch. Dip a paper strip in a cooker, wait two minutes, find out if the pill or the powder has fentanyl in it before it’s in your bloodstream. It is not treatment. It is not even harm reduction’s most controversial idea. It is information, sold at cost, to people who are going to use regardless of whether they have it.

Washington decided this spring that information was the problem.

On April 24, 2026, the Substance Abuse and Mental Health Services Administration sent two letters to the state and county agencies that receive its block grant money. The first barred federal dollars from paying for fentanyl and xylazine test strips, sterile syringes and pipes, sterile water, saline, and overdose hotlines when those items are handed directly to people who use drugs — though the same letter, according to the National Association of Counties, still permits federal money to pay for naloxone, nalmefene, medication lock boxes, disposal kits, and HIV and hepatitis testing. The second letter told grantees to stop treating methadone and buprenorphine as adequate on their own, and to build in mandatory counseling and annual conversations about tapering off medication entirely. Both letters were signed by Chris Carroll, SAMHSA’s acting leader. Ten weeks later, on July 6, the same agency announced $281 million in new funding opportunities to fight addiction and overdose, including $68.2 million specifically earmarked to expand access to medications for opioid use disorder.

Both of those things happened. Neither one is a lie. And the space between them is where the incoherence lives: an agency that will fund the medication and the antidote but not the dollar strip that tells you whether you need either one yet.

What a test strip actually does, and why “supports drug use” is the wrong frame

Start with the plain mechanics, because the policy debate keeps floating above them. A fentanyl test strip works the same way a home pregnancy test does — paper treated with an antibody reagent (the lab term is lateral-flow immunoassay) that changes when it contacts a target molecule — dipped into a diluted drug residue instead of urine. It returns a line in about two to five minutes: fentanyl present, or not.

The people doing that dipping aren’t hypothetical, and they aren’t only the subject of a policy memo. Harm reduction outreach workers in Ohio describe the same routine at needle exchanges and street outreach vans: someone arrives, asks for strips before anything else, tests before they use, comes back for more before the batch runs out. That’s the actual transaction the April letters cut in half. Not a philosophy. A person, a paper strip, and thirty seconds of information they didn’t have before. It does not treat addiction. It does not supply drugs. It gives a person who is about to use a piece of information they did not have thirty seconds earlier, in a market where the DEA’s own lab data shows a meaningful share of counterfeit pills and adulterated powder now carry fentanyl or the veterinary sedative xylazine at doses the buyer never priced in and never asked for.

A person, a paper strip, and thirty seconds of information they didn’t have before.

The Trump administration’s framing, laid out across the April letters and in earlier guidance dating to July 2025’s “Ending Crime and Disorder on America’s Streets” executive order, is that supplies “intended for use by people using drugs” send the wrong signal — that handing someone a test strip normalizes, or at minimum tolerates, the use itself. Janet Childerhose, an Ohio State University researcher who studies fentanyl test strips, told the Statehouse News Bureau flatly that “simply taking harm reduction supplies away is not going to dissuade drug use.” That’s not spin from an advocacy group; it’s the consensus finding across the harm reduction research literature for two decades, and it’s why the American Society of Health-System Pharmacists formally opposed the restrictions in April, urging SAMHSA to reconsider a policy the professional group said runs against the evidence base its own clinical guidance is built on.

Here is the sentence that should sit under all of it, in plain terms, because it’s easy to lose in the acronyms: a person cannot be talked out of a craving with a pamphlet, but they can be kept alive long enough to have the conversation about treatment on a different day. That’s the entire theory of harm reduction, and it’s also the theory behind naloxone, which nobody at SAMHSA is trying to defund. The inconsistency is not abstract. It is the difference between paying to reverse an overdose after it happens and paying to prevent the ingestion that causes it — and choosing, deliberately, to fund only the first one.

The same week, a study that puts a number on the other side of the ledger

On June 18, JAMA Network Open published a microsimulation built by researchers at the University of Colorado Anschutz Medical Campus and the University of Miami, led by Kirk Fetters and senior author Joshua Barocas, a physician who serves as deputy director of Colorado’s Injury and Violence Prevention Center. The model runs a synthetic population of 3.69 million people who inject drugs forward five years, from August 2025 through August 2030, under different scenarios for how much of syringe service programs’ budgets federal money represents — and how much of that money disappears.

In the mildest scenario the researchers tested, where federal dollars make up roughly 11% of program budgets and funding drops accordingly, the model found about 1,100 additional deaths nationally over five years. In the scenario the researchers labeled worst-case — 80% of a program’s budget coming from federal sources, all of it withdrawn and sustained — the projection climbs to roughly 39,600 excess all-cause deaths, a substantial share of them overdose deaths, compared with a scenario where funding holds steady. As Barocas put it, plainly: “These harm-reduction services help keep people alive so that they can enter treatment or recovery.” The study is about syringe service program funding broadly, not test strips specifically — but test strips are exactly the kind of line item inside those same block grants that the April letters now exclude, and the mechanism the researchers describe (fewer supplies, fewer contacts between programs and the people they serve, more overdoses, fewer entries into treatment) is identical.

Calibrate the confidence here the way the researchers themselves would want it calibrated: this is a model, not a randomized trial, and its worst-case scenario assumes a level of funding collapse (80% of a program’s budget, sustained for five full years) that hasn’t happened yet anywhere in the country. The lower-bound scenario — a few hundred to a couple thousand additional deaths — is the more defensible near-term read given what’s actually been cut so far. But models like this one are how public health researchers answer a question nobody can ethically test directly: what happens if you take the thing away. The answer, across every scenario the team ran, moved in the same direction. Not one scenario showed funding cuts saving lives.

The lower-bound scenario — a few hundred to a couple thousand additional deaths — is the more defensible near-term read given what’s actually been cut so far.

We have run this experiment before, and we know how the sequel ends

If any of this feels like an argument the country has already had, that’s because it has — and lost, for years, the first time. In 1988, Senator Jesse Helms attached a rider to a spending bill that banned federal money from funding syringe exchange programs anywhere in the United States, on the theory that clean needles amounted to government endorsement of drug use. The ban held, with a brief lift in 2009 and a re-imposition in 2011, for the better part of three decades, while HIV and hepatitis C spread through networks of people who inject drugs at rates that public health researchers would later describe as directly attributable to the policy. Congress didn’t fully remove the ban until 2016. Nobody who studies that era seriously argues the syringe ban reduced drug use. What it did was remove the contact point — the exchange window, the outreach worker, the conversation — between public health infrastructure and the people it was designed to reach. That is the same contact point a $1 test strip creates today, and it is the same contact point the April letters just narrowed.

If you are the person deciding whether to use tonight, none of this policy history changes what’s in front of you. You already know what a dollar buys: not permission, not treatment, just the difference between finding out what’s in the bag before it’s in you instead of after. That’s not a hypothetical for half of the people reading this. It’s Tuesday.

What’s still standing, and what a hospital or a health department can do this week

None of this means the floor has disappeared. Naloxone and nalmefene distribution remain fully fundable under the April guidance — that has not changed, and it is worth saying plainly, not as a footnote: if you or someone you’re with carries naloxone, that program is not the one under threat right now. HIV and hepatitis testing and vaccination funding also remain intact. Case managers and facility staff reading this over coffee this week have one concrete, low-lift move available: audit which harm-reduction line items in your program’s current SAMHSA-funded budget touch test strips or hotline staffing specifically, versus naloxone, disposal, and testing broadly, and start the conversation now with state or county block-grant administrators about which non-federal funding streams — opioid settlement dollars chief among them — can backfill the gap before your own version of Reese’s “quarter of last year” shows up in your program’s year-end numbers.

The $281 million SAMHSA announced on July 6 is real money, and some of it will genuinely reach people who need medication for opioid use disorder. That is worth saying plainly too — this is not a story about an agency that stopped funding addiction care. It is a story about an agency that drew a line through the cheapest, least controversial, most evidence-backed tool in the harm reduction toolkit, in the same season it was writing checks for everything the field agrees comes after that tool does its job. Reese is already down to a quarter of what she distributed last year. The JAMA model says the number that matters isn’t the dollar per strip. It’s what happens in the room where the strip used to be.