The Trump administration will no longer allow grant funding from the Department of Health and Human Services to pay for drug-checking strips, a reversal that could substantially impact their availability for people at risk of overdose involving fentanyl, xylazine or medetomidine. In a “Dear Colleague” letter dated April 24, the Substance Abuse and Mental Health Services Administration also stated that its grants could not be used to support overdose hotlines.
The letter updates a previous Dear Colleague letter SAMHSA issued in July 2025, in conjunction with President Donald Trump’s executive order targeting unhoused people who use drugs. In the 2025 letter, SAMHSA explicitly denounced harm reduction, claiming that most efforts associated with the term “only facilitate illegal drug use and its attendant harm.” The premise, however, was that opioid overdose prevention and blood-borne disease prevention are somehow separate from harm reduction. In that letter’s breakdown of which supplies and services were banned from HHS grant funding support, SAMHSA had specified that “[s]ubstance test kits, including fentanyl test strips and xylazine test strips,” were considered life-saving overdose prevention tools and therefore remained eligible.
In 2025 the list of supplies and services that could not be supported with SAMHSA funding consisted of syringes; glass pipes; sterile water; saline; ascorbic acid; or “any other drug paraphernalia.” That list has now been expanded to include “substance test kits” and overdose hotlines, in addition to all the same items included in the 2025 version.
Fentanyl test strips, xylazine test strips and the more recent versions that detect medetomidine are all banned by name, along with “any other substance test kits … intended for use by people using drugs.” None of the funding restrictions apply to law enforcement, or anyone “using drug testing technologies in the regular course of discharging their professional duties.”
SAMHSA claimed that overdose hotlines, meanwhile, go against federal priorities as they “have a primary function of facilitating illicit drugs [sic] use by providing people using drugs a virtual or telephonic companion while they are using drugs.”
Overdose hotlines, which provide support for people using alone, were not mentioned in SAMHSA’s 2025 letter. A few weeks prior to that letter’s release, however, the agency had removed the 988 suicide hotline’s “Press 3” option for LGBTQ+ youth, claiming that this would keep the “focus on serving all help seekers.” Callers who pressed 3 could previously be connected to crisis counselors who’d been specifically trained to talk to queer and trans youth.
SAMHSA also made a third change. In its 2025 letter, the miscellaneous category of supplies and services that were eligible for funding support included food—”snacks, protein drinks, water”—as long as it didn’t exceed $10 per person and was “used in the course of service engagement.” This line item has been dropped from the updated April letter, though food service is not explicitly banned.
For a lot of people, MOUD alone actually is enough as far as treatment services go.
The agency also released a second Dear Colleague letter April 24, this one pertaining to medications for opioid use disorder (MOUD). Though its provisions are non-specific, it implies that future grant funding will be awarded to providers “advancing holistic care models” by prescribing MOUD alongside other interventions, not as a standalone treatment.
“SAMHSA funding should be used to provide comprehensive treatment and recovery support services rather than medication-only models for opioid use disorder,” the letter states. “Services should include medications, where clinically indicated, in conjunction with psychosocial and other treatment and recovery support services.”
The letter also emphasizes tapering and eventual discontinuation over long-term maintenance.
In justifying its stance, it explains that MOUD “alone cannot address the legal, housing, family functioning, and other challenges that people with substance use disorders commonly face.” To a certain extent this is true—nothing addresses the need for housing except for housing—but SAMHSA is obscuring the fact that for a lot of people, MOUD alone actually is enough as far as treatment services go.
This is because legal access to methadone or buprenorphine (but not naltrexone) inherently affects more than just someone’s cravings or withdrawal symptoms. It affects their exposure to law enforcement, their overdose risk, their availability to work a taxable job and the amount of money they can save. Psychosocial treatment and recovery programs don’t really affect any of those things.
Image via Wisconsin Department of Health Services