SAMHSA Defunded the Test Strips That Were Working. Baltimore Is About to Find Out What That Costs.

Candy Kerr runs the Baltimore Harm Reduction Coalition out of a van that parks, most weeks, in Penn North — a neighborhood that has sent 24 or more people to the hospital in a single overnight span this spring, three times in three months, in what the city now tracks as mass-overdose events. Her job, most days, is arithmetic: how many fentanyl test strips are left, how many xylazine strips, how many of the newer medetomidine strips, and how many more she can afford before the grant runs out. As she told NPR in reporting published August 8, that arithmetic just got harder, because as of this spring, the federal government will no longer help her pay for it.

A fentanyl test strip does not become dangerous when a harm-reduction nonprofit hands it out and safe when a police officer carries the same strip in his kit.

But that is now, officially, federal policy — and it is the sentence at the center of a letter SAMHSA sent to grantees in April 2026, reported jointly by NPR and KFF Health News. The letter bars organizations receiving federal harm-reduction dollars from spending that money on drug-checking test strips, syringe-service supplies, or dedicated overdose-response hotlines, on the grounds that these tools “facilitate illicit drug use and are incompatible with Federal law.” Law enforcement and EMS agencies, which have used the same strips for years to identify what they’re dealing with at a scene, are unaffected. The restriction applies only to the organizations that hand strips directly to the people who are about to use.

A police officer can still get one. A nonprofit can’t.

Read the carve-out closely and the logic gets harder to defend, not easier. If a fentanyl test strip in a paramedic’s kit is a legitimate public-safety tool, and the same strip in a harm-reduction worker’s hand is contraband-adjacent, the difference isn’t the strip. It’s who’s holding it, and what SAMHSA has decided that means about the person receiving it.

HHS spokesperson Emily Hilliard defended the policy to NPR as consistent with the administration’s broader stance that federal dollars shouldn’t underwrite programs seen as accommodating ongoing drug use rather than pushing people toward treatment. Yngvild Olsen, who ran SAMHSA’s Center for Substance Abuse Treatment before this administration, told the same reporters the opposite is true in practice: drug checking is one of the only interventions that reaches people before an overdose, not after one, and pulling federal funding for it doesn’t reduce use — it just removes the information people need to survive the use that’s already happening.

Neither side disputes the underlying fact pattern. Baltimore’s overdose deaths have fallen by more than 40% since 2023, a decline city health officials and researchers have credited in part to exactly the combination SAMHSA now restricts: naloxone distribution paired with drug checking, so people know not just that help exists if something goes wrong, but what they’re likely to be dealing with before it does. Kerr’s coalition didn’t invent that combination. It’s the same one cities that saw declines nationally settled on after fentanyl made “just don’t use” a policy with a body count. National provisional data through 2025 shows overdose deaths falling for a third consecutive year, to roughly 69,973 — the decline SAMHSA’s own materials point to as evidence the field’s current approach is working. Baltimore’s version of “the field’s current approach” is precisely what the April letter defunds.

What a dollar strip actually buys you

Here’s what a test strip actually does, in plain terms: you dip a small paper strip into a diluted residue of what you’re about to use, wait about two minutes, and read one or two lines — the same mechanic as a home pregnancy test. A positive line for fentanyl, xylazine, or the newer veterinary sedative medetomidine tells you something you didn’t know sixty seconds earlier about what’s about to be in your body. It doesn’t stop you from using. It was never designed to. What it does is convert a blind risk into an informed one — the difference between using alone versus with someone nearby, using a smaller amount first, or deciding tonight isn’t the night.

If you’ve ever dipped a strip before you used, or wanted to and couldn’t find one, you already know what that negative or positive line is worth. It isn’t permission. It’s information nobody was handing you five years ago, and — under this policy — might not be handing you much longer.

It’s information nobody was handing you five years ago, and — under this policy — might not be handing you much longer.

Baltimore’s health department doesn’t release names attached to mass-overdose events, and this piece isn’t going to invent one. But a harm-reduction van that parks in the same eight blocks every week doesn’t mostly meet strangers — it meets the same people, over and over, long enough to know who’s using, who’s trying to stop, and who came back from an overdose last month and is due to come back through the van this one. That’s who this policy is actually about. Not an abstraction called “drug users.” The regulars.

That information matters more than it used to, because the thing in the supply keeps changing under people’s feet. A peer-reviewed study published August 7 in the International Journal of Drug Policy — by researchers David Zhu at Virginia Commonwealth University and Sehun Oh at Ohio State — found that scheduling xylazine as a controlled substance in nine states didn’t reduce xylazine in the drug supply. It was associated with roughly 1,536 additional medetomidine detections per 100,000 samples, using national forensic lab data going back to 1999. Medetomidine matters here for a specific clinical reason: unlike a straight fentanyl overdose, it doesn’t respond cleanly to naloxone, and it can cause dangerous drops in blood pressure and heart rate that need supportive medical care naloxone alone won’t provide. A test strip is the only way most people find out, before it’s in their system, that what they’re about to use has quietly swapped one dangerous adulterant for a worse one. Rize has covered that substitution pattern before — this is the same substitution, now colliding with a funding decision that makes it harder to detect.

We have done this before, and we counted the dead

We have watched a government decide that a cheap thing keeping people alive sends the wrong message before. In 1988, Congress — led by Senator Jesse Helms — banned federal funding for needle and syringe exchange programs, on grounds that funding clean syringes amounted to funding drug use, even as the tool was already proving effective against a spreading HIV epidemic among people who inject drugs. The ban held for two decades. Congress lifted it in 2009, watched public health groups call the reversal historic, then reinstated it in 2012 under a new Congress that revived the same argument in different language. Federal funding for syringe services wasn’t fully stable again until years after that. The disease didn’t wait for the policy to catch up, and neither will the drug supply this time.

Penn North doesn’t get to wait for the next grant cycle

Kerr’s coalition is doing what harm-reduction organizations losing a funding stream generally do: pulling test-strip money from somewhere else in a budget that didn’t have slack to begin with. According to the NPR/KFF reporting, that means diverting dollars that would otherwise go to wound care and hygiene kits — supplies for people who are, by definition, still using and still showing up for care, which is the entire model harm reduction is built on. The irony is that the money hasn’t disappeared from the federal budget. SAMHSA announced more than $281 million in new funding opportunities in July across fifteen grant programs. None of the fifteen can be spent on the specific tool Penn North’s overdose numbers say is working.

If you run a program that touches SAMHSA harm-reduction dollars, this isn’t a philosophical problem to sit with — it’s a line-item problem to solve this week. Go through your budget for anything that could be read as “test strips,” “syringe supplies,” or a “specialized hotline,” and move it off federal funding before your next site visit, not after one flags it. The DEA’s own advisory on the current supply — fentanyl increasingly cut with nitazenes and medetomidine, 22 distinct nitazene compounds tracked since 2020 — is the clearest argument you’ll find for why checking matters more this year, not less. Use it in your case to funders who aren’t federal.

If you run a program that touches SAMHSA harm-reduction dollars, this isn’t a philosophical problem to sit with — it’s a line-item problem to solve this week.

Naloxone itself is not on the restricted list. It remains federally fundable, still free through the same programs, still the thing that reverses an opioid overdose in front of you if someone gets to you in time. That’s not nothing, and if you’re reading this because you or someone you love uses drugs in a place like Penn North, it’s still yours — go get some, and know how to use it, regardless of what happens to the strips.

But naloxone works after something has already gone wrong. Test strips were the part of Baltimore’s model that worked before it did — the sixty seconds where someone found out what they were about to put in their body while they still had a choice about it. SAMHSA’s April letter didn’t touch the intervention that reverses an overdose. It touched the one that might have prevented Kerr from needing to.

Rize’s harm reduction coverage tracks funding fights like this one as they develop; our opioids substance hub has the fuller record of how the supply keeps shifting under policies built for the drug it used to be.