On April 24, 2026, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a 'Dear Colleague' letter barring its grant funding from paying for drug test strips, including fentanyl and xylazine test strips, and for overdose hotlines. The letter updates guidance SAMHSA issued in July 2025 under Trump's executive order on crime and disorder, which declares that SAMHSA funding cannot be used for programs that “only facilitate illegal drug use.” That July 2025 letter had explicitly listed test strips as an allowable life-saving tool. SAMHSA began supporting harm reduction efforts, including test strips, in 2021, and the 2018 SUPPORT Act, reauthorized in 2025, also protected their use, CBS News reported.
The stakes are concrete. Test strips cost about $1 each and let people check drugs for contaminants such as fentanyl. Fentanyl test strips are not considered drug paraphernalia in 45 states and Washington, D.C. The Kentucky Harm Reduction Coalition, which is losing a $400,000 grant, distributed 48,465 fentanyl test strips in the first quarter of fiscal 2026. Fyrebird Recovery in South Carolina lost a $4,000 grant. An HHS spokesperson said the letter furthers the agency's shift away from harm reduction and “practices that facilitate illicit drug use and are incompatible with federal laws,” and that SAMHSA still prioritizes life-saving interventions including the overdose-reversal medication naloxone.
The public-health context makes the timing contested. Overdose deaths peaked at 111,000 in 2023 and dropped to about 68,000 over the 12-month period ending in November 2025, according to CDC data. CBS News reported that the decline can be attributed to several factors, including wider availability of naloxone, a less potent drug supply, and harm reduction efforts including test strips. Maritza Perez Medina of the Drug Policy Alliance: “People are just astonished. There has been a lot of confusion about where this came from.” Shreeta Waldon of the Kentucky Harm Reduction Coalition: “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.”
Correction (October 2, 2026): This entry dated the letter to April 30, 2026, the day CBS News reported it; the letter is dated April 24, and the date has been corrected. It said organizations had been distributing nearly 50,000 test strips per quarter; that figure (48,465) is the first-quarter total for the Kentucky Harm Reduction Coalition alone. It said the CDC and outside researchers attributed the drop in overdose deaths in significant part to test strips and naloxone; CBS News lists several factors, including a less potent drug supply, and the summary now says so. Unsourced claims that the AMA, the CDC and most state health departments recommend test strips, and that no replacement program has been announced, were removed. The entry now notes the letter also bars funding for overdose hotlines and that it reverses SAMHSA's own July 2025 guidance.