It doesn't make sense that one day something is evidence-based, then it isn't
For five years, a one-dollar test strip stood between a person and an unmarked death — a small, federally funded tool that asked nothing more than that someone know what they were about to consume. In late April 2026, the Trump administration withdrew that support, directing SAMHSA to cease funding fentanyl test strips under an executive order framing harm reduction as facilitation of illegal drug use. The reversal arrives precisely as overdose deaths had begun to fall, raising the question of whether a policy rooted in moral framing can afford to ignore the evidence of what keeps people alive.
- A sudden SAMHSA letter in April 2026 reversed five years of federal support for fentanyl test strips, blindsiding public health organizations that had built entire programs around that funding.
- The Kentucky Harm Reduction Coalition lost a $400,000 grant overnight and now has roughly one month of supplies left before facing what its director calls a full-blown crisis — having distributed nearly 50,000 strips in a single quarter.
- Smaller organizations like Fyrebird Recovery in South Carolina are scrambling for donations to replace even modest $4,000 grants, exposing how thinly resourced the harm reduction ecosystem already is.
- Overdose deaths had dropped from 111,000 in 2023 to roughly 68,000 by late 2025 — progress public health experts directly attribute to tools like test strips, naloxone access, and targeted federal investment.
- Advocates warn the cuts could reverse that trajectory, leaving vulnerable people without the means to make informed, life-saving decisions at the very moment the crisis had begun to yield to intervention.
A single fentanyl test strip costs about a dollar and can tell someone whether what they are about to take contains a lethal contaminant. For five years, the federal government funded these strips as a cornerstone of overdose prevention. That ended in late April 2026, when SAMHSA sent a letter to its grantees announcing it would no longer support test strips — citing a presidential executive order barring funds from programs deemed to facilitate illegal drug use.
The reversal stunned advocates. Test strips are legal in 45 states and Washington, D.C., and their use had been protected by Congress through the SUPPORT Act, passed in 2018 and reauthorized just months earlier. Maritza Perez Medina of the Drug Policy Alliance described the field as astonished and confused by the sudden shift in what had been considered settled, evidence-based policy.
The consequences are immediate. The Kentucky Harm Reduction Coalition, which distributed nearly 50,000 strips in a single quarter, lost a $400,000 grant on a Friday in April and now has about a month of supplies remaining. Executive director Shreeta Waldon struggled to reconcile the logic: an evidence-based protocol, she said, does not stop being evidence-based because the political climate changes. In South Carolina, Fyrebird Recovery lost a smaller but critical $4,000 grant and is now soliciting donations just to maintain its supply.
The cuts arrive at a fragile moment. Overdose deaths had fallen significantly — from 111,000 in 2023 to roughly 68,000 for the period ending in late 2025 — a decline public health experts attribute in part to test strips, expanded naloxone access, and sustained federal investment. Advocates now fear that dismantling these tools will erase that progress. Fyrebird's founder, A'zhane Powell, put the fear plainly: how far does this go before we are back to square one?
A dollar bill buys a test strip that can tell you whether the powder in your hand contains fentanyl, xylazine, or other deadly contaminants. For the past five years, the federal government paid for these strips as part of a deliberate effort to reduce overdose deaths. Then, in late April 2026, that support ended.
The Substance Abuse and Mental Health Services Administration sent a letter to its grantees reversing course on a position it had held as recently as July 2025. The agency would no longer fund fentanyl test strips, citing an executive order signed by President Trump that barred SAMHSA money from supporting programs that "only facilitate illegal drug use." A Health and Human Services spokesperson framed the shift as a clarification of guidance and a deliberate move away from harm reduction practices deemed incompatible with federal law.
The reversal caught public health advocates off guard. Maritza Perez Medina, director of federal policy at the Drug Policy Alliance, described the sudden change as leaving the field astonished and confused. Test strips are not classified as drug paraphernalia in 45 states and Washington, D.C. Some states, including Nevada and California, actively direct people to where they can find them. Congress itself had protected their use through the SUPPORT Act, passed in 2018 and reauthorized in 2025. The strips work by allowing people to know what substance they are about to consume, enabling them to make informed decisions that can mean the difference between life and death.
The funding cuts are already hitting organizations on the ground. The Kentucky Harm Reduction Coalition learned on a Friday in April that it was losing a $400,000 grant. In just the first quarter of fiscal year 2026, the organization had distributed 48,465 test strips. With that funding gone, the coalition has roughly a month of supplies remaining before facing what its executive director, Shreeta Waldon, called a "full-blown crisis." Waldon expressed bewilderment at the reversal: "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."
Smaller organizations are struggling too. Fyrebird Recovery in South Carolina lost a $4,000 grant—a modest sum, but one that matters when operating margins are already thin. The organization is now searching for alternative funding sources and asking for donations to maintain its supply of test strips. Other nonprofits worry about losing access to pass-through block grant funding, where federal money flows through state governments to local agencies. The uncertainty is compounding the immediate financial blow.
The timing of the cuts is particularly fraught. Overdose deaths in the United States have declined in recent years, dropping from a peak during the COVID-19 pandemic. In 2023, there were 111,000 overdose deaths. For the 12-month period ending in November 2025, that number had fallen to approximately 68,000. Public health experts attribute this progress to multiple factors: increased availability of naloxone, a less potent drug supply in some regions, and the use of test strips themselves. The federal government had invested deliberately in these tools, and the investment was working.
Now that progress is at risk. Medina warned that gutting the tools known to work could leave people without help when they seek it. "We're still in the midst of the overdose crisis," she said. "Federal funding cuts, coupled with taking away the real tools to help people, could very well lead to more drug use harms, including overdose." A'zhane Powell, founder of Fyrebird Recovery, voiced a darker concern: "How far will it go until we're back to square one again?" The question hangs over a field that had finally begun to see measurable progress.
Notable Quotes
People are just astonished. There has been a lot of confusion about where this came from.— Maritza Perez Medina, Drug Policy Alliance
We're still in the midst of the overdose crisis. Federal funding cuts could very well lead to more drug use harms, including overdose.— Maritza Perez Medina, Drug Policy Alliance
The Hearth Conversation Another angle on the story
Why would an administration reverse support for something as simple and cheap as a test strip?
The letter cites an executive order declaring that SAMHSA funding can't support programs that "facilitate illegal drug use." The administration is drawing a line between life-saving interventions like naloxone and harm reduction tools like test strips.
But test strips aren't paraphernalia in most states. They're legal.
That's the contradiction organizations keep pointing out. Forty-five states don't classify them as paraphernalia. Congress protected their use. SAMHSA itself supported them just nine months earlier. The legal status didn't change. The political climate did.
What happens to the organizations that relied on this funding?
They're in immediate crisis. Kentucky Harm Reduction Coalition distributed nearly 50,000 strips in three months and now has about a month of supply left. Smaller groups are scrambling for donations or alternative grants. The infrastructure that was built to distribute these tools is collapsing.
Is there data showing test strips actually prevent deaths?
Yes. Overdose deaths dropped from a peak during COVID to about 68,000 annually by late 2025. Public health experts credit multiple factors, including test strips. The decrease was intentional—the government invested in these tools because they work.
So the cuts could reverse that progress?
That's what advocates fear. If organizations can't afford to distribute strips, people lose access to information about what they're consuming. That removes one of the few tools available to people using drugs to protect themselves.
What's the administration's response to those concerns?
The HHS spokesperson said SAMHSA still prioritizes life-saving interventions like naloxone. But organizations point out that the sudden reversal on test strips makes it hard to trust those stated priorities.