This blog post is a collaborative effort written by members of SSDP’s Science Policy and Harm Reduction Committees.

For years, the Substance Abuse and Mental Health Services Administration (SAMHSA) has played a major role in the nationwide effort to reduce overdose deaths. Through block grants, prevention funding, recovery programs, naloxone distribution, treatment infrastructure, and community outreach initiatives, SAMHSA dollars have reached people who are too often abandoned by traditional healthcare systems. These investments have saved lives, yet the organization has recently released two “Dear Colleague Letters” outlining that SAMHSA grants will no longer be supporting a number of these programs to align with the shift in U.S. Health and Human Services (HHS) priorities.

Both letters were released on April 24th, 2026 and expand on a previous letter released in 2025. One of the letters focuses on harm reduction services stating that funding priorities will “shift away from harm reduction and practices that facilitate illicit drug use and are incompatible with Federal laws, consistent with President Trump’s Executive Order on Ending Crime and Disorder on America’s Streets.” Examples of harm reduction supplies are naloxone, fentanyl test strips, sterile supplies, and safer use kits. 

The SAMHSA guidelines will continue to support programs related to naloxone distribution, but  outline that grantees will not be able to receive funding if they use the funds to purchase or distribute the following:

• Syringes or needles used to inject illicit drugs
• Pipes or other supplies for safer smoking kits 
• Fentanyl test strips or any other substance test kits, including xylazine and medetomidine test strips, intended for use by people using drugs
• Overdose hotlines that have a primary function of facilitating illicit drug use by providing people using drugs a virtual or telephonic companion while they are using drugs
• Sterile water, saline, or ascorbic acid (vitamin c) used to facilitate drug use
• Any other drug paraphernalia or supplies that promote or facilitate drug use not listed as acceptable above

For decades, federal policy has already restricted the direct purchase of syringes and other supplies through certain federal funds and many organizations or individuals provide these services through other means of funding or out-of-pocket. Some grants can support staffing and distribution infrastructure, but organizations worry even those pathways are narrowing with these new guidelines.

Harm Reduction Saves Lives

These new guidelines directly defy the evidence that harm reduction works. According to Overdose Lifeline’s 2024 opioid overdose data report, the United States saw a significant decline in overdose deaths nationally, with many public health experts pointing to expanded harm reduction efforts, increased naloxone access, and wider availability of medications for opioid use disorder (MOUD) as key drivers behind the decrease. In 2024 alone, over 80,000 people died of overdoses and 88% of those overdoses were due to fentanyl. Fentanyl test strips are easy to use for identifying the presence of fentanyl in drugs and allow people who use drugs to reduce their risk of overdose. Test strips and other testing kits have also allowed for detection of other dangerous contaminants including xylazine and medetomidine (CDC 2026).

The claims in the letter that these harm reduction tools are promoting illicit drug use ignores the complexity of addiction. Programs like syringe services, pipe exchanges, and supervised consumption sites provide a way to meet people where they are, supporting their health and preventing infection and disease, as well as overdose. Syringe services programs reduce transmission of HIV and hepatitis C, increase connections to healthcare, and improve access to treatment. The National Institute on Drug Abuse recently described syringe services programs as “enormously effective” while emphasizing that they remain underused nationwide (NIDA 2024). 

Harm reduction conversations often focus exclusively on injection drug use, but safer smoking supplies are also critical public health tools. Research and public health advocates have repeatedly shown that distributing safer smoking equipment can reduce burns, cuts, disease transmission, and transitions to injection drug use. The R Street Institute notes that safer smoking supplies are associated with reduced infectious disease risk and create important opportunities for engagement with healthcare and support services.

Further, supervised consumption services continue to demonstrate measurable impact. In New York City, OnPoint NYC reported reversing thousands of overdoses without a single fatality onsite while also connecting participants to medical care, housing support, and treatment services. These programs work because they prioritize dignity and survival over punishment. 

Access to these overdose and disease prevention resources are facilitated by state-specific departments of health and non-profit organizations that utilize SAMHSA funding. Withholding funding from organizations that use the funds to purchase life-saving overdose prevention supplies will increase overdoses and spread of infectious diseases across different communities in the United States. 

Access to Medications for Opioid Use Disorder

The second letter describes new guidelines for those receiving treatment for opioid use disorder. While this letter states the importance and efficacy of medications such as methadone, the guidelines state “services should include medications, where clinically indicated, in conjunction with psychosocial and other treatment and recovery support services.” Many programs already have these support services in place, but patients are not required to receive counseling or other services in order to receive medication.

Many communities have successfully created treatment options that do not require people to navigate impossible waitlists, transportation barriers, abstinence requirements, or endless paperwork. Some of these include mobile buprenorphine programs, outreach-based treatment navigation, peer support services, and low-threshold care models, but they all rely heavily on federal funding streams. Losing funding for these programs risks pushing people back into the same systems that failed them before. 

Therapy and behavioral healthcare are already inaccessible for many people who use drugs, especially those who are uninsured, criminalized, unhoused, or living in rural communities (Center for American Progress 2022). Mental healthcare workforce shortages continue nationwide, and grant-funded behavioral health programs often fill gaps left by traditional healthcare systems. When those grants disappear or become harder to administer, people are left without care. 

If access to these programs is limited to those who can meet requirements for follow-up and counseling, many may find themselves without their medication putting them at a greater risk for relapse and/or overdose. Research published in Drug and Alcohol Dependence Reports found that cessation of methadone or buprenorphine treatment is associated with elevated overdose risk, particularly in the weeks following discontinuation (Domzaridou et al. 2022).

The Impact on Healthcare

Local health departments and community organizations are now trying to navigate increasing administrative burdens, shifting reporting requirements, and uncertainty around allowable language and services.

SAMHSA block grants already require extensive reporting and compliance measures, and these added restrictions to what organizations can do leave public health workers with growing confusion. Many have been told to avoid terms associated with harm reduction entirely out of fear that funding could be jeopardized. In discussions among public health professionals, workers described uncertainty over whether they could publicly discuss supplies like sterile syringes or safer use supplies without risking grant compliance.

This matters because language restrictions are not just semantics, they shape what services organizations feel safe providing. This isn’t just non-profit organizations focused on safe supply and harm reduction. This can also include state-wide health departments and behavioral health programs, hospitals and other emergency services. 

If funding freezes, restrictive guidance, and administrative crackdowns continue, the consequences will not appear first in spreadsheets or grant reports. They will appear in emergency rooms, in outbreaks of HIV and hepatitis C, and in funerals.

Public health evidence supporting these approaches is not controversial among experts. States have begun to report and reaffirm that harm reduction strategies help reduce hepatitis C transmission, reduce overdose, and improve community health outcomes. In the State of Michigan, more than 13,000 hospitalizations due to injection use were prevented between 2018 and 2024. Further, they report people who engage with harm reduction agencies are five times more likely to access treatment services. From 2018 to 2024, harm reduction agencies in Michigan made more than 8,000 referrals for treatment, supporting recovery for thousands of residents (MDHHS, 2025). Harm reduction services don’t enable illicit drug use, they allow people to be cared for without judgement. 

People who use drugs deserve more than survival conditioned on unstable political support. They deserve healthcare, housing, dignity, and evidence-based services without interruption. Every pause in care carries risk and every barrier added to treatment or harm reduction is a barrier that someone may not survive.