A fentanyl test strip can cost about a dollar. It tells someone whether the drug in their hand is laced with something that could kill them.
In April, the Trump administration told the groups that hand them out that its money could no longer pay for them.
The order came from the Substance Abuse and Mental Health Services Administration, the federal agency that funds addiction and overdose programs. In a "Dear Colleague" letter, it said groups could no longer use its grants to buy test strips for fentanyl, xylazine, medetomidine, or other substances that make an overdose more likely — especially when the person doesn't know they're taking them, KFF Health News reported.
Who is paying for them now
Diannee Carden Glenn runs ekiM for Change, a volunteer group that works to prevent overdoses in Greenville, North Carolina, and the rural towns around it. For much of the past decade, the federal grant — a little more than $15,000 a year — bought her test strips.
Now she pays for them herself.
"Well, I'm 81 years old, and I get Social Security," she said, "so I use my Social Security. And I'm lucky to have a husband who can support me."
She puts her other retirement income toward the work too. Once in a while, someone sends a donation. Her group usually gives out strips for fentanyl, xylazine and medetomidine. They cost $1 or more apiece, and giving away several hundred a week adds up.
In North Carolina, the federal agency was the only source of money the state's opioid response program used to buy fentanyl and xylazine test strips for groups across the state. Those cuts are part of a more than $300 million reduction in federal money for overdose prevention and treatment nationwide, according to KFF Health News.
The Good Mind Initiative, which serves Native communities across North and South Carolina, holds monthly gatherings that draw as many as 300 people. It no longer has the money to provide test strips. It raises money with events like target-shooting contests where the prize is a turkey or other meat, but its program manager, Kaya Littleturtle, acknowledged it would take a lot of fundraising to replace the lost federal money.
"It's just a hard time right now, because of politics, and politics should never get in the way of saving lives," Littleturtle said. "But it does."
Why the strips matter
Fentanyl is everywhere in the street supply. But it isn't the only danger. Outreach workers keep finding drugs laced with meth and with newer, even stronger chemicals like carfentanil, medetomidine and nitazenes.
A lab at the University of North Carolina at Chapel Hill has found some 500 different substances in street drugs since it opened in 2022, including an animal deworming drug and an industrial chemical used to protect plastic from sunlight. "It's just, bam, stepping up every single year in the number of substances found in a supply," said Pearson Ripley of the Steady Collective, a group in Asheville.
The government's own health agency backs the strips. The CDC says they can be "the difference between life or death." And research has found that people who use them are more likely to take other overdose-prevention steps, like carrying naloxone and not using alone.
Where the order came from
In July 2025, Trump signed an executive order saying federal grants should not pay for so-called "harm reduction" efforts, which it said "only facilitate illegal drug use and its attendant harm." The April letter followed.
Elyse Powell, who leads the North Carolina Harm Reduction Coalition, called it "an incredibly hostile time" for these services. And it reaches past the groups that lost money: a North Carolina State University professor who studies drug-checking said some federally funded community health centers have told her they're not allowed to take part in any event with the words "drug checking" attached.
In May, Sen. Ed Markey and 20 other Democrats in Congress wrote to the agency that the directive "defies evidence showing that harm reduction for substance use reduces overdose deaths and dangerous infections, threatening to reverse years of progress in combating the overdose epidemic."
The same fight has played out locally. In 2021, when San Diego County voted on a program to fight overdoses there, then-Supervisor Jim Desmond voted against it — in a county where fentanyl deaths rose 2,375% between 2016 and 2021.
The short version
In April, the Trump administration barred overdose-prevention groups from spending its grants on test strips that detect fentanyl and other deadly additives, following Trump's 2025 order against federal money for so-called "harm reduction." In North Carolina, that agency was the state opioid program's only source of money for fentanyl and xylazine strips. An 81-year-old who runs an overdose-prevention group in Greenville now buys them with her Social Security.
Source
Federal cuts hobble efforts to prevent overdoses from contaminated drugs — KFF Health News, via NC Newsline, November 9, 2026
