The Trump administration has decided that the best way to handle the fentanyl crisis is to make it slightly harder to know if your drugs contain fentanyl. In an open letter issued in April, the Substance Abuse and Mental Health Services Administration (Samhsa) ordered an end to the use of its funding for all substance testing strips - including those for fentanyl, xylazine, and the latest party crasher, medetomidine - claiming that testing strips facilitate "illicit drug use" and are "incompatible with federal laws."
Harm reduction advocates, who have historically preferred fewer dead people, were not amused. "It's going to kill people," said Maia Szalavitz, a New York Times columnist and 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 Health and Human Services 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."
The irony is thick enough to test with a strip: The Biden administration first allowed federal funds to purchase fentanyl test strips in 2021, with an interim Samhsa leader saying the decision "will save lives." Now, the new administration has decided that saving lives is less important than making a philosophical point. Daniel Fishbein of the Drug Policy Alliance noted, "Based on the research that I've reviewed, that's simply not the case" that test strips promote drug use. Yet the White House's own National Drug Control Strategy, published last week, contradicted the Samhsa guidance by calling rapid test strips "an important tool that should be legal." So, at least the administration is consistent in its inconsistency.
Some states have already paused purchasing and distribution of test strips to comply with the new guidance - a "180-degree turn" from Samhsa's own July statement allowing such funding. Emanuel Sferios, founder of DanceSafe, said his nonprofit's sales quintupled after the Biden rule change. Now, he's watching programs scramble for alternative funding. The Kentucky Harm Reduction Coalition, which distributed nearly 50,000 fentanyl test strips in the first three months of the year, was informed it would lose a $400,000 federal grant and has only a month's supply left.
Congress, in a rare moment of bipartisan clarity, signed the Support for Patients and Communities Reauthorization Act in December - signed by Trump himself - authorizing grants 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." Fishbein called the new guidance "a violation of congressional intent." But hey, who needs intent when you have ideology?
Meanwhile, the administration has also banned federal funding for safer drug-consumption facilities - which, in New York City, reversed 1,000 overdoses within two years - and cut $350 million in addiction and overdose prevention funding since Trump took office. Overdose deaths have declined by 26% from 2023 to 2024, but nearly 80,000 people still die each year. In a surprising twist, Trump recently issued an executive order to accelerate research on psychedelic therapies and remove cannabis from the strictest drug control bracket, suggesting the administration's drug policy is less a coherent strategy and more a game of ideological roulette. A HHS spokesperson said taxpayer funds should go toward "effective, commonsense solutions that have been proven to keep people out of an endless cycle of addiction and save lives," which apparently does not include telling people what's in their drugs.