Trump Administration Warns Against Federal Funding for Fentanyl Test Strips

The Trump administration issued guidance on April 24 through the Substance Abuse and Mental Health Services Administration prohibiting federal funds for fentanyl test strips distributed to the public, sterile syringes, and overdose hotlines, marking a sharp reversal from Biden-era harm reduction policies that enthusiastically promoted test strip distribution starting in April 2021. The guidance also discourages using methadone and buprenorphine without accompanying support services, contradicting American Society of Addiction Medicine guidelines stating patients should not be denied pharmacotherapy if they decline other services, despite studies showing these medications vastly reduce opioid overdose deaths. The policy shift comes as the agency operates with less than half its original 900-employee workforce and after abruptly canceling $1.7 billion in block grants and $350 million in prevention funding before reinstating thousands of grants in January. The guidance still permits federal funding for naloxone, sharps disposal kits, and test strips used by professionals in official settings.

Trump Administration's Ban on Harm Reduction Supplies and Fentanyl Test Strips

• ▪The Trump administration banned federal funding for sterile water or saline distributed to help users inject drugs hygienically.
• ▪The Substance Abuse and Mental Health Services Administration warned its grantees on April 24 against using federal funds to buy harm reduction supplies including sterile syringes and pipes.
• ▪The Biden administration pushed test-strip distribution enthusiastically and announced in April 2021 that federal funds could be used to buy test strips.
• ▪The Substance Abuse and Mental Health Services Administration April 24 letter encourages federal funds be used for naloxone, the overdose-reversal medication.
• ▪The Substance Abuse and Mental Health Services Administration April 24 letter encourages federal funds be used for sharps disposal kits and testing and vaccination for infectious diseases like hepatitis and HIV.
• ▪The Substance Abuse and Mental Health Services Administration warned its grantees on April 24 against using federal funds to distribute test strips for fentanyl, xylazine, and medetomidine.
• ▪Tom Coderre served as the Substance Abuse and Mental Health Services Administration's interim leader in April 2021.
• ▪The Trump administration banned federal funding for overdose hotlines that allow people using drugs to communicate remotely with staff who can call 911 if they stop responding.

Restrictions on Medication-Assisted Treatment for Opioid Addiction

• ▪The Substance Abuse and Mental Health Services Administration April 24 letter stated that methadone and buprenorphine should be used as part of the pathway to long-term recovery but not as a default sentence to life-long medication use.
• ▪The Substance Abuse and Mental Health Services Administration warned on April 24 against using certain addiction medications including methadone and buprenorphine without accompanying support services.
• ▪The Substance Abuse and Mental Health Services Administration April 24 letter encourages clinicians to discuss at least annually with patients whether they would like to remain on medication.

SAMHSA's Organizational Turmoil and Policy Reversals

• ▪The Substance Abuse and Mental Health Services Administration cancelled roughly $1.7 billion in block grant funding before January.
• ▪The American Society of Addiction Medicine's annual conference gathered thousands of addiction providers and researchers in San Diego when the April 24 letters were released.
• ▪The Substance Abuse and Mental Health Services Administration head count stood at roughly 900 at the start of the Trump administration.
• ▪The Substance Abuse and Mental Health Services Administration cut $350 million in addiction and overdose prevention funding before January.
• ▪The Trump administration has not appointed a director for the Substance Abuse and Mental Health Services Administration over 15 months after taking office.
• ▪Chris Carroll is the acting leader of the Substance Abuse and Mental Health Services Administration and signed the April 24 letters.

Perspective of American Society of Addiction Medicine

• ▪The Substance Abuse and Mental Health Services Administration's April 24 guidance contradicts current standards of care for opioid addiction treatment.

Perspective of Substance Abuse and Mental Health Services Administration grantees

• ▪The Substance Abuse and Mental Health Services Administration's reduction to less than half its original 900-employee workforce has created administrative challenges for grantees.
• ▪The cancellation of $1.7 billion in block grant funding and $350 million in addiction prevention funding has forced grantees to restructure their programs.

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