SAMHSA Killed Funding for Fentanyl Test Strips. Then CDC Bragged About Falling Overdose Deaths.

Shreeta Waldon found out on April 25 that her organization was about to lose $400,000. Waldon runs the Kentucky Harm Reduction Coalition, which had just distributed 48,465 fentanyl test strips in the first three months of fiscal year 2026 alone — a dollar apiece, handed out at syringe service sites and mailed to rural counties where the nearest health department is an hour’s drive away. The grant paying for that work, and for the sterile water and safer-smoking supplies that go with it, had come from the Substance Abuse and Mental Health Services Administration. The day before, SAMHSA had told her it was gone.

“It doesn’t make sense that one day something is an evidence-based protocol, and you decide, because of political climate, it is no longer evidence-based,” Waldon told CBS News. Her group now has roughly a month of test strips left before what she calls a “full-blown crisis.”

The federal government cannot simultaneously call fentanyl test strips too dangerous to fund and overdose deaths a public health win it deserves credit for — it has to pick one story, and right now it is telling both.

That contradiction has a paper trail. On April 24, 2026, SAMHSA’s Christopher Carroll signed a “Dear Colleague” letter — a formal notice to every state and grantee — banning federal funding for the purchase or distribution of fentanyl, xylazine, and medetomidine test strips intended for people who use drugs, along with syringes, pipes, sterile water, saline, and “overdose hotlines” that keep someone company on the phone while they use. Five months later, on August 31, CDC opened a new Overdose Prevention Data Channel — a public dashboard timed to International Overdose Awareness Day — announcing that provisional data now predicts 67,798 overdose deaths for the year ending March 2026, a 12.3% drop from the year before. Those two documents were written by the same federal health department, five months apart, and neither one mentions the other. This is the story of what happens in the gap between them.

A Test Strip Was Evidence-Based on Tuesday and Contraband on Wednesday

To understand how a one-dollar strip of paper became a federal flashpoint, you have to trace the chain of paper that got it there. In July 2025, President Trump signed an executive order titled “Ending Crime and Disorder on America’s Streets”, directing SAMHSA to stop funding programs the order called “so-called harm reduction” — treatment that focuses on keeping people alive and reducing damage from drug use rather than requiring abstinence first. SAMHSA issued a Dear Colleague letter that same month translating the order into grant policy. The April 2026 letter is the sequel: a more detailed list of what counties, states, and nonprofits can no longer buy with SAMHSA money.

Read the actual letter, and the line is drawn in an odd place. Naloxone and nalmefene — the medications that reverse an opioid overdose in progress — remain fully fundable, along with wound care, hepatitis and HIV testing, and nicotine cessation. What’s out is anything that touches a drug before it’s used: test strips, sterile syringes, safer-smoking supplies, the sterile water used to prepare an injection. The National Association of Counties confirmed the restrictions apply to two of SAMHSA’s largest funding streams, the Community Mental Health Services Block Grant and the Substance Use Prevention, Treatment and Recovery Services Block Grant — money that flows to nearly every county health department in the country. In plain terms: the government will still pay to reverse an overdose after it happens, but not to help someone know what’s actually in the drug before they take it.

That distinction sounds tidy in a policy memo. On the ground, it’s not. STAT News reported that the shift caught county health departments mid-budget-year, with grant agreements already signed and supplies already ordered. Test strips a health department bought in March with federal dollars were, by the agency’s own logic, retroactively the wrong kind of evidence-based.

Test strips a health department bought in March with federal dollars were, by the agency’s own logic, retroactively the wrong kind of evidence-based.

The Data the Government Just Published Undercuts Its Own Timing

Here is the part that should embarrass whoever scheduled these two announcements five months apart instead of together. The CDC’s new dashboard merges three federal surveillance systems — SUDORS, DOSE, and the National Vital Statistics System — into one public tool, and its headline number is genuinely good news: predicted deaths down 12.3% year over year, continuing a decline that’s now run for roughly three years since the 2023 peak. Grant Baldwin, who directs CDC’s Division of Overdose Prevention, said the point of the tool is that “the most useful data does more than show us what has happened; it helps us decide what to do next.” Fair enough — but decide what, exactly, when the agency’s sister division spent the spring making the opposite decision on the tools researchers most consistently link to that same decline?

Here’s the plain-language version of what “syringe services” actually means, because the term gets thrown around without explanation: it’s a program where someone who injects drugs can trade used needles for clean ones, get wound care, get tested for HIV and hepatitis C, and — critically — get connected to a case worker who can walk them into treatment when they’re ready. The National Institute on Drug Abuse reviewed nearly 30 years of research on these programs and called them “enormously effective,” with one specific, sourced finding worth naming exactly: people who use syringe service programs are five times more likely to enter drug treatment and three times more likely to stop injecting than people who don’t. That’s the NIDA-cited figure, drawn from program-level comparisons rather than a single randomized trial, which is the honest caveat — this is decades of observational and quasi-experimental evidence, the kind public health builds policy on when a controlled trial of withholding clean needles from people would be unethical to run. Fentanyl test strips ride the same evidence base: they don’t stop someone from using, but they let a person decide whether to use less, use with someone else present, or not use that batch at all — decisions that only work if the person has accurate information first.

This isn’t the first time Washington has run this exact experiment. In 1988, at the height of the AIDS crisis, Senator Jesse Helms attached a rider to federal law banning any federal money from touching a syringe exchange program — a ban that held for over two decades while HIV tore through communities that inject drugs, was briefly lifted in 2009, reinstated by Congress in 2011, and only meaningfully relaxed in 2016, when Congress allowed federal funds to support the staff and services around a syringe program while still, notably, refusing to pay for the syringes themselves. Every one of those swings was driven by the same argument now attached to test strips: that giving people who use drugs the tools to use more safely is morally equivalent to endorsing the use itself. The public health evidence didn’t change between 1988 and 2016. The politics did, repeatedly, and people who inject drugs absorbed the cost of that instability each time.

The One Door This Administration Left Wide Open

The fairest thing this piece can do is not flatten the record, because the record isn’t as simple as “this administration is anti-treatment.” Buried in a less-covered February 2, 2026 letter — signed jointly by SAMHSA’s Carroll, the Administration for Children and Families’ Alex Adams, and CMS administrator Dr. Mehmet Oz — the same federal government took a real step to expand medication treatment. The letter announces that ACF designated medications for opioid use disorder (buprenorphine, methadone, and extended-release naltrexone) as “well-supported” evidence in the Title IV-E Prevention Services Clearinghouse, meaning states can now get a 50% federal match — rising to match each state’s Medicaid rate starting October 1 — to provide those medications to parents at risk of losing custody of their children because of untreated opioid use disorder. The letter cites a 2025 Hadland et al. study in Pediatrics finding that adolescents who stayed on buprenorphine or methadone for a year or more had significantly lower rates of overdose and hospitalization — one study, focused on youth retention specifically, not a claim about medication treatment broadly, which is the honest scope of that finding.

Mehmet Oz — the same federal government took a real step to expand medication treatment.

That’s a genuine expansion of access to the medications that treat the underlying disorder, aimed at keeping families together. It sits oddly next to the April letter’s restrictions on the low-barrier services — test strips, syringes, safer-use supplies — that NIDA’s own review found are often what gets someone who isn’t ready for a clinic into any relationship with a provider at all. Stephen Taylor, president of the American Society of Addiction Medicine, told reporters the organization was “carefully reviewing” the harm reduction restrictions and would “engage with federal partners to ensure” policy “reflect[s] evidence-based practices” — the kind of careful, diplomatic phrasing a physician group uses when it isn’t ready to say the two letters from the same agency are working against each other, even though the SSDP’s Kat Murti was blunter, writing that syringe services “allow people to be cared for without judgement” and that Michigan’s program alone is credited with preventing more than 13,000 hospitalizations between 2018 and 2024. You can read this newsroom’s ongoing policy and funding coverage for how that Title IV-E match plays out as states start drawing on it this fall.

Every State Is Now Running Its Own Version of This Experiment

Because SAMHSA’s letter sets a funding rule, not a law, what happens next varies enormously by zip code — and the variation is its own story. In North Carolina, which posted one of the largest overdose declines in the country — nearly 29% year over year — the state health department temporarily paused purchasing fentanyl and xylazine test strips altogether while it waited for SAMHSA to clarify the guidance. Lauren Kestner, who directs harm reduction work at the Center for Prevention Services in Charlotte, called the fallout “a really nasty ripple effect all the way from top to bottom.” Greg Berry, who runs law enforcement diversion programs at the North Carolina Harm Reduction Coalition, put it in the terms that matter most: “I know people personally who have taken something — thinking it was one thing and it was something else — and lost their life.” Drug policy consultant Roxanne Saucier called the sudden shift “quite the about-face on test strips” — an understatement for a reversal that, a year earlier, the same agency had called a life-saving tool.

In Columbus, Ohio, public health officials told WOSU they’d distributed more than 50,000 test strips over the previous two years and now face relying on “other sources of public health funding which is already being stretched by budget cuts.” Dr. Beth Weinstock, an Equitas Health physician who founded an advocacy organization after her son died from fentanyl in 2021, said losing federal support “hinders health departments who are there essentially to help their community with life or death measures.” In Horry County, South Carolina, A’zhane Powell — who runs Fyrebird Recovery, a “one-stop shop” that hands out fresh produce alongside clean needles and treatment referrals — lost a comparatively small $4,000 grant, but told reporters the money is hard to replace on a nonprofit’s margins, and asked the question underneath all of this: “How far will it go until we’re back to square one again?”

If you’re reading this in recovery yourself, you already know something the letter-writers in Rockville don’t have to reckon with day to day: the moment you decide you want help rarely announces itself on a clinic’s schedule. It shows up at 2 a.m., at a syringe site, in a conversation with an outreach worker who isn’t asking you to be sober first. That’s not an abstraction — it’s the mechanism behind NIDA’s finding that syringe program contact makes someone five times more likely to walk into treatment. Cutting the contact point doesn’t make people ready for treatment faster. It just means fewer of those 2 a.m. conversations happen at all.

That’s not an abstraction — it’s the mechanism behind NIDA’s finding that syringe program contact makes someone five times more likely to walk into treatment.

What’s Still True Tonight

None of this touches naloxone. Under the same April letter that stripped funding from test strips, opioid overdose reversal medications, medication lock boxes, and overdose reversal training remain explicitly, fully fundable — the one piece of harm reduction infrastructure that survived the ideological line-drawing intact. Whatever else changes at your local health department this year, naloxone distribution isn’t the program getting cut, and settlement dollars in nearly every state, including Arizona’s $1.215 billion opioid settlement, are still funding it on top of the federal money. That’s a real door, not a consolation prize.

But it’s worth sitting with what got lost in the space between the April letter and the August dashboard. A federal government that can build a data channel merging three surveillance systems to track every overdose death in the country in near-real time is choosing, in the same fiscal year, not to fund the dollar strip of paper that lets someone find out what’s actually in their drugs before it becomes one of those data points. Shreeta Waldon’s coalition still has, as of this writing, a few weeks of test strips left. When they run out, nothing about Kentucky’s overdose data will announce that the shortage caused whatever happens next. It will just be a number on a dashboard, credited or blamed on something else entirely, in a report nobody in Rockville will connect back to the letter they signed in April.