Baltimore experienced multiple mass overdose incidents in recent years, including an event in which more than two dozen people were hospitalized after exposure to street drugs containing high levels of N-methylclonazepam, a benzodiazepine. In response, the Baltimore Harm Reduction Coalition began distributing test strips designed to identify various harmful adulterants in street drugs, including fentanyl, xylazine, and medetomidine. These strips, provided at no cost, allow people to test small amounts of drugs mixed with water to determine whether dangerous substances are present.
In late April, the Substance Abuse and Mental Health Services Administration implemented a new policy restricting the use of federal grants for distributing test strips to the public and for other harm reduction practices. A letter to health departments and nonprofits stated that the Trump administration views such practices as facilitating illegal drug use and incompatible with federal law. The policy also prohibits federal funding for programs supporting the use of clean needles, drug paraphernalia, and specialized overdose prevention hotlines. An HHS spokesperson stated that the administration prefers to focus on other interventions, such as distributing naloxone, an opioid overdose reversal drug.
The new restrictions contain an exception allowing federal funds to purchase test strips for use by law enforcement, public health officials, EMTs, and medical professionals. According to a former SAMHSA official, evidence indicates that providing test strips to people who use drugs can influence behavior, including decisions to refrain from use, reduce consumption, or take additional precautions. Baltimore’s overdose death rate has declined more than 40% since 2023, a reduction advocates attribute to comprehensive harm reduction efforts.
Nonprofits may continue distributing test strips using non-federal sources, but the Baltimore Harm Reduction Coalition indicates this shift will require redirecting funds from other services, potentially including hygiene and wound care kits. Coalition leadership expressed concern that losing federal support could undermine progress and increase overdose risk.
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