When the Safety Net Is Cut: SAMHSA's Test Strip Ban and the Unraveling of America's Harm Reduction Infrastructure

For the past five years, a fentanyl test strip cost about one dollar and could tell a person whether the drugs they were about to use contained the synthetic opioid responsible for most overdose deaths in America. For the past three years, federal health officials had called those strips “life-saving.” On April 24, 2026, Acting SAMHSA director Chris Carroll sent a letter to every federally funded program in the country: the federal government would no longer pay for them.

The reversal was swift. The consequences are already visible.

What the Guidance Actually Says

Carroll’s “Dear Colleague” letter prohibited SAMHSA grantees from using federal funds to purchase fentanyl test strips, xylazine test strips, medetomidine test strips, sterile water and saline for injection preparation, overdose hotline support, smoking pipes, and other materials the administration categorized as facilitating illicit drug use.

The carveout is narrow: federal funds can still purchase test strips for use by law enforcement, public health officials, and medical workers operating in professional capacities. The everyday use case — a person who uses drugs checking their supply before using — is now defunded at the federal level.

Naloxone distribution remains permitted. But harm reduction practitioners note the distinction is clinical: naloxone reverses an overdose that has already begun; test strips prevent one from happening.

The Organizations This Is Breaking

The Kentucky Harm Reduction Coalition learned it would lose a $400,000 SAMHSA grant. In the first quarter of 2026 alone, the organization had distributed 48,465 fentanyl test strips across the state. After the announcement, the coalition reported having approximately one month of operational reserves remaining.

That story is playing out nationally. The Drug Policy Alliance’s running tracker documents more than $333 million already cut from federal overdose prevention programs: $245 million from SAMHSA grant programs, $173 million from the CDC’s Division of Overdose Prevention, and $41 million in NIH addiction research grants. Texas closed its 24/7 addiction support call line. North Carolina’s Project Lazarus lost its DOJ funding.

SAMHSA itself has been hollowed out. The agency that once employed approximately 900 people now operates with fewer than 450 staff, and for more than 15 months it has lacked a Senate-confirmed director.

The Timing Could Not Be Worse

Medetomidine — a veterinary sedative in the same drug family as xylazine — is now present in 25.1% of opioid samples tested in New York City, with peaks reaching 44.1% in some neighborhoods. In 2024, 18 people in New York City died from medetomidine exposure. In 2025, that number rose to 134. The CDC issued a Health Advisory on April 2, 2026 specifically about medetomidine’s spread.

Nitazenes — a class of synthetic opioids estimated to be 10 to 43 times more potent than fentanyl — continue to appear in illicit supplies. The DEA has identified 22 unique nitazene compounds since 2020. DEA Detroit issued a Public Safety Advisory on May 12 warning of fentanyl adulterated with both medetomidine and nitazenes simultaneously.

Why This Matters for People in Recovery

Harm reduction is not separate from recovery — it is the entry point. The research on test strips, naloxone, and safe use education consistently shows that these tools keep people alive long enough to reach treatment. The 19% national decline in overdose deaths since the August 2023 peak is real and meaningful. Practitioners argue, with substantial evidence, that distributed naloxone and test strips contributed to that decline.

For Arizonans, the stakes are immediate: the state records more than five overdose deaths daily. Arizona’s $1.215 billion opioid settlement has the potential to fund state-based harm reduction at scale — if local leadership allocates it there. Rize’s harm reduction resources include Arizona-specific naloxone access points and fentanyl awareness guides.

If you or someone you know needs help right now, SAMHSA’s National Helpline — 1-800-662-4357 — remains free, confidential, and available 24 hours a day, 7 days a week.