Maryland’s opioid fight is moving into a harder stretch as new federal rules put pressure on groups working close to the street. In Baltimore, where overdose prevention already feels urgent, even a funding change can ripple through the small tools people rely on.
That tension is the real starting point here. The policy debate can sound technical from far away, but on the ground it becomes simpler and more uncomfortable: who gets support, which supplies remain available, and how quickly workers can respond when danger changes.
Penn North became central to Maryland’s warning because Baltimore saw 3 mass overdose incidents there in 3 months last year. Dozens of people were left on the street after overdosing on drugs they believed were opioids, while Narcan boxes and test strips were visible nearby.
Testing from the National Institute of Standards and Technology later found N-Methylclonazepam, a benzodiazepine that acts somewhat like Xanax or Valium, in the drugs. That changed the lesson from the overdoses because the danger was not just opioids alone at all.
Dr. Gentry Wilkerson, an emergency medicine physician at the University of Maryland Medical Center, said the drug can lower consciousness and reduce breathing. When the drug is mixed with an opioid, he said, the effect can be more profound, and opioid reversal drugs may not work.
The new SAMHSA policy moves federal funding away from some harm reduction work, especially tools the Trump administration says “facilitate illicit drug use and are incompatible with federal laws.” For Maryland groups, that means the fight is now partly about what money can cover.
The letter blocks Department of Health and Human Services funds for clean syringes, pipes, and overdose hotlines that stay on the phone with people using drugs. It also bars public test strip distribution for fentanyl, xylazine, medetomidine, and similar adulterants.
An HHS spokesperson said the goal is to put taxpayer money toward proven lifesaving tools that move people toward recovery, including naloxone. The policy still allows test strip funding for law enforcement, EMTs, public health officials, and other health professionals.
Candy Kerr of the Baltimore Harm Reduction Coalition said the Penn North overdoses taught workers they needed strips for that substance. Her point was blunt: people buying street drugs often do not know what is inside, so testing can help them “move slower.”
Dr. Yngvild Olsen, who oversaw SAMHSA’s Center for Substance Abuse Treatment under both the Biden and Trump administrations, said evidence shows strips can change behavior. Some people decide not to use, use less, keep naloxone nearby, or make sure another person can help.
Kerr also pointed to Baltimore’s overdose death rate, which has fallen more than 40%, while warning that adulterants still kill. If groups must fund strips elsewhere, she said they may cut hygiene and wound care kits, a tradeoff that weakens street-level care.
Debate around Maryland’s response now sits between caution and control. Federal officials want taxpayer money steered toward naloxone and recovery-focused tools, while Baltimore workers argue street testing catches dangers people cannot see before they use a substance from an unsafe supply.
The next chapters may be less about policy language and more about budgets. Nonprofits can still buy strips with other money, but Kerr said that may mean fewer hygiene and wound care kits, a hard tradeoff if Baltimore faces another mass overdose.