Federal Agency Restricts Use of Funds for Fentanyl Test Strips

The Substance Abuse and Mental Health Services Administration issued an open letter in April ordering an end to the use of its funding for all substance testing strips, including those for fentanyl, xylazine and medetomidine. Officials described the action as a clear shift away from harm reduction.

The letter stated that testing strips facilitate illicit drug use and are incompatible with federal laws. Use of federal funds to purchase fentanyl test strips was first permitted in 2021. At that time, an interim agency leader said the decision would save lives.

The policy change reverses guidance the agency provided as recently as July that its funding could be used for such purchases. Some states have already paused statewide purchasing and distribution of fentanyl test strips to comply with the new guidance.

The Kentucky Harm Reduction Coalition was informed it would lose a $400,000 federal grant. The group distributed almost 50,000 fentanyl test strips in the first three months of the year and now has only a month's supply left.

Three programs that purchase test strips from one distributor are scrambling to find other funding sources. When federal grant recipients were first allowed to buy the strips, which cost less than a dollar each, sales at one leading supplier quintupled.

The founder of that supplier said the new policy represents an attack on the philosophy of harm reduction. Harm reduction approaches acknowledge that some people will use drugs and seek to minimize associated dangers. Fentanyl has largely displaced pure heroin in street supplies across the United States.

Even tiny quantities of the synthetic opioid can kill people with no opioid tolerance.

The National Drug Control Strategy published last week stated that rapid test strips and similar technologies that detect fentanyl and other drugs are an important tool that should be legal. This language differs from the rationale provided in the April letter.

One advocacy group described the situation as a fragmentation of views across the administration. Congress passed legislation in December that authorizes state and tribal opioid response grantees to facilitate access to products used to prevent overdose deaths by detecting substances such as fentanyl and xylazine.

One policy manager said the new guidance violates congressional intent. The Support for Patients and Communities Reauthorization Act was signed into law last year. The agency has also prohibited use of federal grant funding for safer drug-consumption facilities and for overdose hotlines whose primary function is to provide a virtual or telephonic companion while people are using drugs.

An agency spokesperson said access to overdose reversal medications such as naloxone was being expanded and that taxpayer funds should support effective solutions that move people into recovery.