Before the Senate Votes on SAMHSA's Next Chief, Someone Should Ask About Test Strips

The White House did not announce it. On July 14, Timothy Westlake’s name sat in a list of nominees sent to the Senate, and STAT reported that the pick to run the Substance Abuse and Mental Health Services Administration surfaced that quietly. Westlake is an emergency physician with more than 25 years in the ER and is SAMHSA’s chief of staff; Becker’s Behavioral Health notes his record includes work on class-wide scheduling of fentanyl-related substances.

Two HHS officials wrote on October 12 that the Senate health committee reported him out favorably on September 30 and that they expect full confirmation before year’s end. That is their account; we did not find the vote independently.

A test strip is a piece of paper that tells you whether tonight can kill you, and the next head of SAMHSA should have to say on the record whether it belongs in a federal grant.

Here is why it is the question. On April 24, SAMHSA’s acting leader, Chris Carroll, sent grantees a Dear Colleague letter that, as reported, bars federal funds from paying for substance test kits, including fentanyl and xylazine strips. The Associated Press reported SAMHSA told recipients it would no longer pay for strips and kits that detect highly lethal additives. In May, Senators Markey, Schumer, Warren, Booker and Smith wrote to Carroll asking him to reverse it. We found no response, and no public statement from Westlake on strips, syringes or naloxone.

The Drug Policy Alliance’s tracker, an advocacy source dated April 29, counts at least $245 million cut from SAMHSA’s grant portfolio since the administration took office and says a court temporarily blocked cuts in 23 states and Washington, D.C. That status may have changed since. Check your own state before assuming either way.

If you work at a funded program, do one concrete thing this week: have whoever owns compliance read every grant agreement for the words “test kits” or “supplies,” and if strips sit on a federal line, ask your program officer in writing what happens to inventory you already hold. Get the answer on paper.

If you use, here is what is still yours: naloxone is available over the counter, and SAMHSA announced about $248 million in new awards on September 25, including money for medications for opioid use disorder. The treatment side of the agency is still open for business.

People who dip a strip before they use have already decided to stay alive. A confirmation hearing can find out whether the agency has.