May 2026 Monthly Policy Update

May 11, 2026

On April 24, 2026, SAMHSA issued updated guidance on which supplies and services can and cannot be supported with federal funding. This builds on the Agency’s July 2025 Dear Colleague letter and reflects the continued federal shift away from traditional harm reduction frameworks. While this announcement does not come as a shock to the recovery community, it could force some adjustments and potentially create concerns as to the future of providing such services. The document is broken down into two major lists, what practices will still be permitted with the use of federal funds, and what will not.

WHAT IS STILL PERMITTED

  • Naloxone, nalmefene, and other overdose reversal medications
  • Overdose reversal education and training
  • Wound care supplies and sharps disposal kits
  • FDA-approved home testing kits for HIV, HBV, and HCV
  • Navigation and referral to HIV/hepatitis prevention, treatment, and care (including PrEP and PEP)
  • Condom distribution and STI risk reduction education
  • Nicotine cessation therapies

WHAT IS NOW PROHIBITED

  • Syringes, needles, or pipes for illicit drug use
  • Fentanyl test strips and other substance/adulterant test kits (including xylazine and medetomidine strips) intended for use by people who use drugs
  • Overdose hotlines whose primary function is accompanying individuals while actively using drugs
  • Sterile water, saline, or ascorbic acid used to facilitate drug use

The test strip prohibition does not apply to law enforcement, EMS, or healthcare professionals acting in their professional capacity.

Whie there has been no legal challenge to this directive, there is concern in the community that it runs counter to other directives and regulations, especially with regard to syringe exchange. The FY 2026 appropriations bill that funds the department of Health and Human Services says the following:

SEC. 525. Notwithstanding any other provision of this Act, no funds appropriated in this Act shall be used to purchase sterile needles or syringes for the hypodermic injection of any illegal drug: Provided, That such limitation does not apply to the use of funds for elements of a program other than making such purchases if the relevant State or local health department, in consultation with the Centers for Disease Control and Prevention, determines that the State or local jurisdiction, as applicable, is experiencing, or is at risk for, a significant increase in hepatitis infections or an HIV outbreak due to injection drug use, and such program is operating in accordance with State and local law.

In short, 45 states have an agreement with the CDC that allows for the purchase of syringes if it is necessary to control a hepatitis of HIV outbreak. The White House and Congress are unfortunately not in alignment on this issue, which may lead to confusion amongst grantees and state and local public health officials. Finally, in the ONDCP 2026 National Control Strategy, released last week, there is the following language:

Rapid test strips and similar technologies that detect fentanyl and other drugs are an important tool that should be legal and not considered drug paraphernalia…

While the directive to SAMHSA bans the use of federal funds to purchase test strips, other White House documents proclaim them as important. Our goal is to seek clarification on this issue and keep you updated.

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