Federal Policy Changes Opioid Harm Reduction Funding: What EMS Providers Need to Know

The opioid crisis in the United States is changing. Overdose deaths are declining nationally, but emergency medical services continue to encounter an increasingly unpredictable illicit drug supply involving fentanyl, benzodiazepines, xylazine, medetomidine, stimulants, and other substances.

At the same time, a 2026 change in federal funding policy is reshaping how some organizations can pay for overdose prevention and harm reduction programs.

For EMS professionals, the change is especially important because federal guidance places new restrictions on the public distribution of drug testing supplies while specifically preserving an exception for EMS and other healthcare professionals using drug testing technologies as part of their professional duties.

Overdose Deaths Are Declining, but the Crisis Is Far From Over

According to the Centers for Disease Control and Prevention, provisional data estimate that 69,973 people died from drug overdoses in the United States during 2025.

That represents a decline of almost 14% from the estimated 81,313 overdose deaths recorded in 2024. It was also the third consecutive year that overdose deaths decreased nationally.

Deaths involving opioids declined as well. The CDC estimated that opioid-involved overdose deaths fell from 55,296 in 2024 to 44,564 in 2025.

Those improvements are significant, but nearly 70,000 overdose deaths in a single year demonstrate that overdose remains a major public health and emergency response challenge.

A Major Federal Funding Policy Changed in 2026

On April 24, 2026, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued updated guidance explaining which overdose prevention and related services can and cannot be supported with federal funding.

Under the new guidance, HHS funding cannot be used to purchase or distribute fentanyl test strips or other substance testing kits, including xylazine and medetomidine test strips, when those products are intended for use by people using drugs.

The guidance also restricts federal funding for several other supplies and activities, including syringes or needles used to inject illicit drugs, safer-smoking supplies, certain drug paraphernalia, and overdose hotlines whose primary function involves providing a virtual or telephone companion while an individual uses illicit drugs.

SAMHSA stated that the administration is shifting federal resources toward prevention, treatment, overdose reversal, and long-term recovery.

The complete guidance is available directly from SAMHSA's Updated Funding Guidance for Grantees on Supplies and Services.

The Policy Does Not Ban Drug Test Strips

An important distinction is that the federal policy does not make fentanyl or other drug test strips illegal.

Instead, it determines how certain federal funds can be spent.

Community organizations may still distribute drug test strips using funding sources that are not prohibited by the federal guidance. However, organizations that previously relied on federal funding for those programs may now have to locate state, local, private, or philanthropic funding to continue them.

That distinction matters when discussing the policy. The issue is primarily one of federal funding eligibility rather than a nationwide prohibition on drug checking.

There Is a Specific Exception for EMS

For emergency medical professionals, one provision of the SAMHSA guidance is particularly relevant.

The restriction on federally funded drug testing technologies does not apply to law enforcement, emergency medical services, public health officials, or healthcare professionals who use those technologies during the regular course of their professional duties.

In other words, the restriction on purchasing test strips for distribution to people who use drugs should not be interpreted as a blanket restriction preventing EMS or healthcare agencies from using drug testing technologies professionally.

EMS leaders involved in overdose surveillance, community paramedicine, public health partnerships, or federally funded overdose programs should still carefully review the requirements associated with their specific grants and programs.

Why Drug Checking Has Been Used in Overdose Prevention

One argument for drug checking is straightforward: individuals purchasing illicit substances often do not know exactly what those substances contain.

Fentanyl can be present in drugs sold as heroin, cocaine, or counterfeit prescription medications. Other substances may also be added without the person's knowledge.

Research suggests that learning a drug contains fentanyl can influence behavior.

In a Brown University study involving 93 young adults at risk for overdose, researchers provided participants with fentanyl test strips and overdose prevention education.

Among participants who used the strips and detected fentanyl, 45% reported using a smaller amount of the substance, 42% reported using it more slowly, and 39% reported using it with another person present.

The study was relatively small and should not be interpreted as proof that test strips alone reduce overdose mortality on a population level. However, the findings suggest that information about fentanyl contamination can lead some individuals to modify behaviors associated with overdose risk.

The Illicit Drug Supply Is Becoming More Complicated

For EMS clinicians, fentanyl itself is only part of the challenge.

Data from Maryland provide an example of how complex the illicit drug supply can become.

Maryland's Rapid Analysis of Drugs program analyzed 378 samples during the second quarter of 2025. According to the Maryland Department of Health, 30% of the samples contained multiple active ingredients.

Among the substances identified were fentanyl, cocaine, amphetamines, xylazine, medetomidine, and benzodiazepines.

The report also examined a July 10, 2025 mass overdose event in Baltimore's Penn North neighborhood in which 35 people experienced nonfatal overdoses.

Two syringe samples collected from the area contained acetaminophen, caffeine, fentanyl, quinine, and N-methylclonazepam, a benzodiazepine derivative with powerful sedating effects.

Laboratory testing found approximately 10 times more N-methylclonazepam than fentanyl in those samples.

Cases such as this demonstrate why an apparent opioid overdose may involve considerably more than opioids alone.

Naloxone Remains Essential

Despite changes in the drug supply, naloxone remains one of the most important tools available for suspected opioid overdose.

SAMHSA recommends immediately activating emergency medical services and administering an opioid overdose reversal medication when an opioid overdose is suspected.

Federal funding continues to support opioid overdose reversal medications such as naloxone and nalmefene, as well as overdose reversal education and training.

In July 2026, SAMHSA also announced its First Responders-Comprehensive Addiction and Recovery Act program, with $34.7 million in anticipated funding. The program is designed to train first responders and communities in administering and distributing opioid overdose reversal medications.

Naloxone Does Not Reverse Every Substance

The increasing presence of non-opioid sedatives is particularly important for prehospital clinicians.

Xylazine is one example.

According to the CDC, naloxone does not reverse the effects of xylazine because xylazine is not an opioid.

However, naloxone should still be administered when an opioid overdose is suspected because xylazine is frequently found in combination with opioids such as fentanyl.

This can create a challenging clinical presentation. Naloxone may reverse the opioid component of an overdose while sedation or respiratory compromise caused by another substance continues.

Similarly, opioid overdose reversal medications do not reverse the effects of benzodiazepines, cocaine, amphetamines, or other non-opioid substances.

What This Means in the Field

For EMS professionals, one of the most important lessons is that response to naloxone should never replace a complete patient assessment.

A patient who remains unconscious or hypoventilating after naloxone may have received an inadequate dose, may require additional time to respond, or may have been exposed to additional substances that naloxone cannot reverse.

Prehospital priorities remain centered on the patient's airway, breathing, circulation, oxygenation, ventilation, mental status, and overall clinical condition.

EMS clinicians should follow their local protocols and medical direction regarding naloxone administration, airway management, ventilation, monitoring, vascular access, transport, and additional supportive treatment.

The CDC specifically advises considering xylazine as a possible contributor when naloxone does not produce the expected response and emphasizes the importance of respiratory support when needed.

EMS Agencies Should Pay Attention to Local Drug Trends

The drugs circulating in one community may be substantially different from those found in another.

Maryland's surveillance data, for example, showed geographic differences in the prevalence of xylazine, medetomidine, and benzodiazepines.

This makes partnerships between EMS, emergency departments, public health agencies, toxicology programs, law enforcement laboratories, and local overdose prevention organizations increasingly valuable.

When emerging substances are identified locally, EMS agencies can use that information to prepare personnel for changes in overdose presentation and treatment.

Agencies may also want to incorporate emerging drug trends into continuing education, quality improvement reviews, medical director updates, and overdose response protocols.

Federal Policy May Affect Community Partners

Although the 2026 funding change primarily affects how federal money can be spent, EMS agencies may experience indirect effects.

Organizations that previously used federal funding to distribute fentanyl or other drug test strips may have to replace that funding or modify their programs. Some organizations may shift resources toward naloxone distribution, treatment referrals, recovery services, wound care, or other federally supported activities.

EMS leaders involved in community overdose initiatives should remain aware of those changes, particularly when working with public health departments and nonprofit organizations.

The federal policy also makes understanding individual grant requirements increasingly important. Agencies should not assume that every overdose prevention activity is either universally permitted or universally prohibited simply because federal guidance has changed.

The EMS Role Continues to Evolve

The decline in overdose deaths across the United States is encouraging, but the opioid crisis has not disappeared. Instead, it is evolving.

The modern overdose patient may have been exposed to fentanyl along with benzodiazepines, xylazine, medetomidine, stimulants, or other substances. Those combinations can complicate traditional overdose presentations and may help explain why some patients do not respond to naloxone as expected.

At the same time, changes in federal policy are altering how communities fund different overdose prevention strategies.

For EMS professionals, the fundamental mission remains the same: recognize life-threatening overdose, support ventilation and circulation, administer opioid reversal medication when indicated, consider polysubstance exposure, monitor the patient's response, and provide appropriate transport and follow-up care.

Staying informed about both emerging drug threats and changes in public health policy can help EMS professionals better understand the environment in which today's overdoses occur.