SAMHSA implements new harm reduction restrictions in updated guidance

Key Takeaways

On April 24, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a Dear Colleague letter updating guidance on how federal funds may be used for substance use programs. The letter narrows which supplies and services previously considered harm reduction activities can be supported with SAMHSA funding.

Background

The April 2026 letter updates July 2025 guidance issued under President Trump’s Ending Crime and Disorder on America’s Streets Executive Order (EO). The EO directed the Secretary of the U.S. Department of Health and Human Services to ensure SAMHSA discretionary grants support only evidence-based programs and excluded certain harm reduction or “safe consumption” efforts viewed as facilitating illegal drug use.

The July 2025 guidance marked SAMHSA’s shift away from harm reduction as a funding framework, while continuing support for certain life-saving interventions such as naloxone, fentanyl test strips and HIV/hepatitis prevention services. It also prohibited funding for supplies deemed to facilitate drug use, such as syringes and smoking kits.  

Read Letter

New restrictions 

The updated guidance removes funding support for several items previously allowable, including:

• Fentanyl and xylazine test strips, now explicitly prohibited
• Sterile water, saline or ascorbic acid (vitamin c)
• Overdose hotlines (provides telephonic companion for individuals in active drug use) 

SAMHSA funding may still support:

• Purchase and distribution of opioid overdose reversal medications, including naloxone and nalmefene
• Medication lock boxes and disposal kits
• Overdose reversal education and training
• Distribution mechanisms, such as bags or secure containers, for overdose reversal medications
• Other infectious disease prevention services such as wound care supplies and HIV and hepatitis prevention, testing, treatment and care, including PrEP and PEP

Impact on counties

Counties invest more than $130 billion annually in community health systems, including behavioral health services, and rely heavily on SAMHSA block grants such as the Community Mental Health Services Block Grant (MHBG) and Substance Use Prevention, Treatment and Recovery Services Block Grant (SUBG) to fund direct services for high-need populations. These new restrictions may create fiscal and operational challenges for county behavioral health departments and their community partners, potentially requiring counties to reassess how local substance use prevention and response efforts are funded and delivered.

NACo advocacy priorities