Trump’s sudden cut in substance testing is ‘going to kill people’, experts warn

The Trump administration’s decision to restrict use of federal funds for fentanyl test strips, in what officials described as a “clear shift away from harm reduction”, could have fatal consequences, experts and critics have warned.

The Substance Abuse and Mental Health Services Administration (Samhsa) issued an open letter in April ordering an end to the use of its funding for all substance testing strips, including fentanyl, xylazine and medetomidine, the latest novel street drug to wreak havoc across the US.

The letter claimed that testing strips facilitate “illicit drug use” and are “incompatible with federal laws”.

But the move could substantially reduce the availability of drug-testing strips for people at risk of overdose amid an ever-changing drug supply, harm reduction advocates warned.

“It’s going to kill people,” said Maia Szalavitz, a New York Times columnist and the author of Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction. “God forbid you should have a safe supply of something that might get you high.”

She described the pro-abstinence US Department of Health and Human Services (HHS) secretary, Robert F Kennedy Jr, as “somebody who represents himself as being in recovery” but is in fact “the worst thing that has happened to the addictions field for decades and decades”.

Use of federal funds to purchase fentanyl test strips was first permitted in 2021 by the Biden administration in an effort to reduce overdose deaths from the inadvertent consumption of the potent synthetic opioid fentanyl, which drug dealers mix into heroin with other drugs to increase their profits.

At the time, the interim Samhsa leader said the decision “will save lives”. But, the new administration has a more anti-drug ideological bent, said Szalavitz.

“What we keep hearing from the administration is that they believe that fentanyl test strips promote drug use,” said Daniel Fishbein, policy manager of federal affairs for the Drug Policy Alliance advocacy group. “Based on the research that I’ve reviewed, that’s simply not the case.”

However, in the National Drug Control Strategy published last week, the White House offered a completely different view – suggesting a fragmentation of views and influence across the administration. “Rapid test strips and similar technologies that detect fentanyl and other drugs are an important tool that should be legal,” it said.

Yet in light of the Samhsa guidance, some states have already paused statewide purchasing and distribution of fentanyl test strips to comply with the new guidance, which Fishbein described as a “180-degree turn” after Samhsa said in July that its funding could be used in such a way.

“These are tools that can be used to help people make more informed decisions about their drug use,” he added.

Emanuel Sferios, the founder of non-profit DanceSafe, a leading supplier of testing strips, said the move was an attack on the philosophy of harm reduction, which acknowledges that people will take drugs and therefore the most rational and humane course of action is to ensure they do so as safely as possible.

When Biden allowed federal grant recipients to use funds for fentanyl test strips, which cost less than a dollar each, DanceSafe’s sales swiftly quintupled, he said.

“We now have these reactionary, anti-drug authoritarians in control who don’t see the value of harm reduction and how the approach has saved so many lives,” said Sferios, who now heads the non-profit Grassroots Harm Reduction, another test strip distributor. “In those small places where you can still find heroin, these are absolutely lifesaving strips.”

It is generally difficult for people who use drugs to find pure heroin on the streets of the US, given the widespread introduction of the more dangerous opioid fentanyl, which even in tiny quantities can kill people with no opioid tolerance.

Now, after the flesh-destroying drug xylazine was mixed into the supply several years ago, the potent sedative medetomidine – which has excruciating withdrawal symptoms – is becoming more prevalent.

But medetomidine withdrawal can lead to a heart attack, and some people who use drugs may not have been aware the sedative was in their system had it not been for the test strips available at harm reduction hubs across major cities.

“Three programs that purchase [test strips] from us are scrambling right now to get other funding sources,” said Sferios. “This is going to be very significant.”

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

Congress only recently recognized the value of drug-testing strips in a December law signed off by Donald Trump. The Support for Patients and Communities Reauthorization Act authorizes state and tribal opioid response grantees to facilitate “access to products used to prevent overdose deaths by detecting the presence of one or more substances, such as fentanyl and xylazine test strips”.

“The new guidance is a violation of congressional intent,” said Fishbein. “Test strips are supported by Congress as a public health tool.”

Last year, the president issued an executive order which also banned the use of federal grant funding on safer drug-consumption facilities, which first opened in the US in 2021 in New York City. Within two years, they had reversed 1,000 overdoses.

“No HHS funding can be used to support ‘overdose hotlines’ that have a primary function of facilitating illicit drugs use by providing people using drugs a virtual or telephonic companion while they are using drugs,” the Samhsa letter said.

The Biden administration was applauded for backing some public health measures which contributed to a significant decline in overdose deaths, by 26% from 2023 to 2024. But even while almost 80,000 people die from overdoses each year, Samhsa has cut $350m in addiction and overdose prevention funding since Trump came to office.

In recent weeks, however, Trump surprised drug reform advocates in issuing an executive order to accelerate research and widen access to psychedelic therapies, while removing cannabis from the strictest drug control bracket.

A HHS spokesperson said access to overdose reversal medications such as naloxone was being expanded and that it was critical that taxpayer funds went on “effective, commonsense solutions that have been proven to keep people out of an endless cycle of addiction and save lives and moves them into a life of recovery”.