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.
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