Last year, Baltimore had three mass overdose incidents in the span of three months in its Penn North neighborhood.
In one incident, more than two dozen people were hospitalized after many were found unresponsive, lying in the streets or on sidewalks. No one died, but some came close.
Follow-up testing found that the street drugs contained high levels of N-methylclonazepam, a benzodiazepine that operates similarly to Xanax or Valium. Like opioids, benzodiazepines suppress breathing. When they’re combined, the risk of overdose goes up. And benzodiazepines don’t respond to opioid overdose reversal drugs.
Afterward, the Baltimore Harm Reduction Coalition created test strips specifically for benzodiazepines. The group distributed them — along with test strips that identify other harmful adulterants, such as fentanyl, xylazine, and medetomidine — at clinics and neighborhood events. The strips, available at no cost, can also be found in bars and spread out on street corners. People testing drugs mix a small amount with water and then dip a test strip into the liquid. The strip will change color if it identifies an adulterant.
“Nobody really knows what they’re getting whenever they’re getting stuff off of the street,” said Candy Kerr, a spokesperson for the coalition. “Having the test strips available for the general public gives them the option to move slower if they’re going to use whatever they’re going to use.”
But a new federal policy could make it harder for organizations such as Kerr’s to give out the test strips, and they’re worried that overdoses could increase. In late April, the Substance Abuse and Mental Health Services Administration banned the use of federal grants for distributing strips to the public and for some other harm reduction practices that have been credited with saving lives. Test strips have been used for nearly 10 years to identify adulterants.
A letter sent to local health departments and nonprofits that provide addiction services explained that the Trump administration believes those harm reduction practices “facilitate illicit drug use and are incompatible with Federal laws.”
According to the letter, grants from the Department of Health and Human Services also cannot be used for programs that support the use of clean needles or drug paraphernalia such as pipes, or to fund a type of specialized hotline that people can call while taking drugs, so someone is aware and can call for help if they overdose.
The Trump administration wants to focus more on other techniques, such as giving out naloxone, an overdose reversal drug available as a nasal spray, according to Emily Hilliard, an HHS spokesperson.
“It is critical that federal funding provided by the American taxpayer goes to effective, common-sense solutions that have been proven to save lives and keep people out of an endless cycle of addiction and moves them into a life of recovery,” she said.
The new policy does not prohibit federal funds from being used to purchase test strips for use by law enforcement officers, public health officials, EMTs, or other medical professionals.
That creates an important exception for government agencies that test drugs and send out regular reports on what adulterants are saturating the drug supply in certain locations.
Still, Yngvild Olsen, who oversaw SAMHSA’s Center for Substance Abuse Treatment in the Biden and Trump administrations, says there is a substantial body of evidence that shows giving test strips to people who use drugs can change behavior.
“There’s some people deciding not to use the substances, some people deciding to reduce, to use less, or take other types of precautions, including naloxone, and making sure that there are people around that can actually then help in the case of an overdose,” Olsen said.
Kerr said the best approach would be to continue to promote the use of test strips while also continuing to give out lifesaving medications like naloxone. She believes that working on all fronts has helped lead to Baltimore’s decline in overdose deaths, which have dropped more than 40% since 2023.
Under the new policy, nonprofits will still be able to hand out test strips, but they will have to find other funding for that work, which Kerr finds worrisome.
“We’ve been making these strides forward because we’ve had these things, because we’ve been funded,” she said. “We’re going to have to pull money from other places.”
To pay for the test strips, Kerr said, the Baltimore Harm Reduction Coalition will have to cut back on services such as giving out hygiene and wound care kits. But she said that option is better than risking another mass overdose in Baltimore — or allowing even just one preventable fatality.
This article is from a partnership that includes WYPR, NPR, and KFF Health News.
Facts Only
* Baltimore experienced three mass overdose incidents in the Penn North neighborhood within three months last year.
* Testing identified N-methylclonazepam, a benzodiazepine, in the street drugs involved in those incidents.
* The Baltimore Harm Reduction Coalition distributes test strips for benzodiazepines, fentanyl, xylazine, and medetomidine.
* In late April, the Substance Abuse and Mental Health Services Administration banned federal grants for public distribution of test strips and certain harm reduction practices.
* Prohibited grant-funded activities include the distribution of clean needles, pipes, and the funding of specialized overdose hotlines.
* Federal funds remain available for test strips when used by law enforcement, public health officials, and EMTs.
* The Department of Health and Human Services supports the distribution of naloxone.
* Baltimore overdose deaths have declined more than 40% since 2023.
* Nonprofits may continue distributing test strips if they secure non-federal funding.
* The Baltimore Harm Reduction Coalition intends to redirect funds from hygiene and wound care kits to pay for test strips.
Executive Summary
The Substance Abuse and Mental Health Services Administration (SAMHSA) has implemented a federal policy banning the use of federal grants for distributing drug test strips and other harm reduction tools—such as clean needles, pipes, and overdose hotlines—to the general public. The Trump administration justifies this shift by stating these practices facilitate illicit drug use and conflict with federal law, advocating instead for a focus on naloxone distribution and recovery-oriented solutions.
While the policy allows government agencies and medical professionals to continue using federal funds for test strips to monitor drug supplies, nonprofits must now secure alternative funding to maintain public distribution. In Baltimore, where overdose deaths have decreased by over 40% since 2023, harm reduction organizations warn that losing these funds may force a trade-off between providing test strips and offering basic hygiene or wound care. There is a fundamental disagreement between federal policymakers, who view these tools as enabling, and public health practitioners, who argue they provide critical data that allows users to modify their behavior to avoid fatal overdoses.
Full Take
The strongest version of this narrative is a conflict between two distinct public health philosophies: "abstinence-based recovery," which views any tool that eases the process of drug use as an endorsement of the behavior, and "harm reduction," which views the prevention of immediate death as the primary prerequisite for any future recovery.
The framing relies on a tension between administrative legality and field-level utility. The push for a "common-sense" approach by federal officials is presented as a moral and legal imperative, while the opposition is framed through the lens of immediate survival and empirical results (the 40% decline in deaths).
Patterns detected: none
The root cause is a paradigm shift in the definition of "effective" intervention. One side defines effectiveness as the total cessation of drug use (recovery), while the other defines it as the reduction of mortality (survival). This echoes a long-standing historical cycle in US drug policy where pendulum swings occur between punitive/abstinence-based models and pragmatic/public health models.
The implications involve a transfer of cost and risk. By removing federal funding, the government does not eliminate the practice—as nonprofits can seek private funds—but it creates a "resource cannibalization" effect. When a nonprofit must choose between wound care and test strips, the cost of federal policy is borne by the most vulnerable individuals through a reduction in overall care.
Bridge Questions:
1. Does the availability of test strips statistically correlate with a decrease in overall drug use, or does it primarily shift the type of substance used?
2. What specific "Federal laws" are cited as being incompatible with harm reduction, and how have those laws been applied to similar public health crises?
Counterstrike Scan: A coordinated influence campaign pushing this narrative would likely employ a "Fear Appeal" by exaggerating the immediacy of mass overdose events to force a political concession. The actual content avoids this by balancing the crisis data with official government justifications. The content is clean.
Sentinel — Human
This analysis reports on the friction between local harm reduction practices and shifting federal funding priorities, supported by specific quotes and factual context.