Test Strips Helped Baltimore Survive a New Killer Adulterant. Now Federal Money Can't Buy Them.

Last year, Baltimore's Penn North neighborhood was hit by three mass overdose incidents in three months. In one of them, more than two dozen people were found unresponsive on streets and sidewalks; nobody died, but some came close. Follow-up testing traced the cluster to N-methylclonazepam, a benzodiazepine the city had never seen in its drug supply — a sedative that suppresses breathing like an opioid but does not respond to naloxone.

The Baltimore Harm Reduction Coalition responded by creating test strips specific to benzodiazepines and distributing them alongside strips that detect fentanyl, xylazine, and medetomidine — free, in clinics, bars, and on street corners. Now that work is under financial threat. In late April, the Substance Abuse and Mental Health Services Administration barred federal grant money from paying for test strips distributed to the public, along with several other harm reduction practices, arguing in a letter to grantees that such practices "facilitate illicit drug use and are incompatible with Federal laws."

A Carve-Out for Government, Not for the Public

The policy contains one notable exception: federal funds can still buy test strips for law enforcement, public health officials, EMTs, and other medical professionals. That preserves government drug-checking programs that monitor which adulterants are saturating local supplies — but it cuts nonprofits out of the same supply chain when they hand strips directly to people who use drugs. The same SAMHSA letter also blocked grant spending on syringes, pipes, and a specialized hotline people can call while using drugs so someone is alerted if they overdose.

HHS spokesperson Emily Hilliard said the administration wants funding directed at "effective, common-sense solutions" such as naloxone distribution. Yngvild Olsen, who oversaw SAMHSA's Center for Substance Abuse Treatment under both Presidents Biden and Trump, counters that the evidence for strips is substantial: research shows people who detect adulterants sometimes choose not to use, use less, or take precautions like keeping naloxone and company nearby. For people eventually seeking opioid addiction treatment, groups like Baltimore's coalition are often the first point of contact with any care system at all.

Scrambling for Replacement Money

Nothing in the policy makes distributing test strips illegal — nonprofits can continue, but only with non-federal dollars. Coalition spokesperson Candy Kerr said that means pulling money from other services, including hygiene and wound care kits, rather than risk another Penn North. "We've been making these strides forward because we've had these things, because we've been funded," she told NPR. Baltimore's overdose deaths have fallen more than 40% since 2023, a decline local advocates attribute to working on all fronts at once — strips, naloxone, and outreach together. The question now hanging over the city is whether a funding distinction between who hands out the strip — a paramedic or a peer worker — will quietly undo that progress.