The Trump administration has made deep cuts to the principle federal company targeted on combating opioid dependancy, probably jeopardizing the nation’s latest progress on lowering overdose deaths, some public well being officers and suppliers say.
Created in 1992, the Substance Abuse and Psychological Well being Providers Administration, referred to as SAMHSA, arms out billions in grants for psychological well being and dependancy companies. The company, which is a part of the U.S. Division of Well being and Human Providers, had a finances of about $7.5 billion final 12 months.
Since January, the Trump administration has lowered the company’s employees by greater than half, scrapped $1.7 billion in block grants for state well being departments and eradicated roughly $350 million in dependancy and overdose prevention funding, based on a latest evaluation by STAT, a well being information web site. The company is at the moment with out an administrator and is lacking 12 of its 17 senior leaders.
Dr. Yngvild Olsen, the previous director of the Middle for Substance Abuse Remedy at SAMHSA, stated virtually all of SAMHSA’s substance misuse funding flows to state and native well being departments, nonprofits and behavioral well being suppliers on the entrance strains of the struggle towards dependancy. She famous that the company has labored with state and native companions to ensure naloxone, the overdose-reversal medicine, is “within the arms of each one that wants it.”
“I’m undecided {that a} very lowered SAMHSA goes to essentially be capable to proceed that focus,” stated Olsen, now an adviser to the consulting agency Manatt.
However Andrew Nixon, communications director for the Well being and Human Providers Division, stated the Trump administration is “dedicated to tackling dependancy with compassion and accountability, guaranteeing taxpayer {dollars} fund packages that result in actual restoration.”
“SAMHSA is prioritizing therapy, prevention and long-term restoration whereas guaranteeing all federally funded packages adjust to the regulation,” Nixon stated in an e mail.
In March, the administration introduced that as a part of a serious restructuring of the Division of Well being and Human Providers, it deliberate to fold SAMHSA and 4 different businesses into a brand new Administration for a Wholesome America. HHS Secretary Robert F. Kennedy Jr., stated the reorganization would scale back “bureaucratic sprawl.”
“We’re realigning the group with its core mission and our new priorities in reversing the persistent illness epidemic,” Kennedy stated in a press release.
In July, a federal decide in Rhode Island issued a preliminary injunction briefly blocking the deliberate reorganization.
The cuts come at a time of regular progress within the struggle towards opioid dependancy.
Overdose deaths have fallen persistently since 2023. As of April, the most recent figures obtainable, there have been 76,500 deaths over the earlier 12 months — the bottom year-over-year tally since March 2020. The pandemic drove the quantity as excessive as almost 113,000 in the summertime of 2023, based on federal statistics.
A extra well timed indicator of overdoses — nonfatal suspected overdose sufferers in hospital emergency departments — was down 7% this 12 months by way of August in contrast with 2024, based on a latest Stateline evaluation of statistics from the federal Facilities for Illness Management and Prevention.
Just a few states and the District of Columbia noticed an increase in nonfatal overdoses for the 12 months. The most important will increase had been 17% within the district, 16% in Rhode Island, 15% in Delaware, 11% in Connecticut and 10% in New Mexico, with smaller will increase in Colorado, Pennsylvania, Wyoming, South Dakota, Utah, New Jersey and Minnesota.
Sara Goldsby, director of the South Carolina Division of Behavioral Well being and Developmental Disabilities, stated the SAMHSA cuts come at a time when her state is making “good progress, like different states are, to get a deal with on the drug disaster.” However Goldsby cautioned that “fixed surveillance of the developments” is important.
In New York, the employees cuts at SAMHSA have created uncertainty, based on Jihoon Kim, president and CEO of the Albany-based InUnity Alliance, which advocates for psychological well being and substance use organizations throughout the state. Federal grants account for about half of his members’ funding, he stated.
“Because the Trump administration has been dismantling SAMHSA and different businesses, the factors of contact for lots of my members have simply vanished,” Kim stated in an interview.
“Now we have plenty of suppliers who haven’t any data — they only have no idea what’s occurring with their contract renewals. They proceed to ship companies, and sooner or later they are going to be delivering companies with out the sources to take action from the federal authorities.”
COVID-era grants
Among the SAMHSA grants the administration terminated earlier this 12 months had been COVID-era expenditures scheduled to run out in September. Because the pandemic is over, HHS argued, there was no want for cash to proceed to move.
Some state well being officers Stateline contacted, together with in California, Idaho, Maryland, Missouri and West Virginia, stated the early cutoff hadn’t had a lot of an influence, both as a result of that they had already spent the cash they had been promised or resisted spending it on ongoing companies.
However well being officers and suppliers in different states informed a unique story.
Texas was relying on SAMHSA to supply about 77% of the company’s annual finances for substance use packages, Thomas Vazquez, assistant press officer on the Texas Well being and Human Providers Fee, wrote in an e mail. The early cancellation of the COVID-era cash disadvantaged the state of greater than $24.7 million it deliberate to make use of to fight substance misuse.
In South Carolina, Wendy Hughes, president and CEO of the Lexington/Richland Alcohol and Drug Abuse Council, stated her group didn’t have the funds for earlier than the pandemic. So the lack of the additional cash, mixed with inflation, “appears like a serious reduce.”
“The cuts had a really important influence on my group specifically, in addition to the others all through the state,” Hughes stated. “What it meant was a reasonably important reduce to plenty of our outpatient companies. We additionally bought a reduce to our inpatient companies, or detox. And for us, what that meant was we ended up eliminating a few of our positions.”
Hughes stated her group secured some further state funding to mitigate a number of the losses and has tried to protect what it views as essentially the most important companies, reminiscent of drug therapy for pregnant ladies and new moms.
Unsure future
Some public well being officers and suppliers of dependancy companies fear this 12 months’s SAMHSA grant cuts are solely the start.
The Biden administration strongly supported efforts to make drug use much less harmful, reminiscent of rising the provision of naloxone kits and coaching on tips on how to use them. However President Donald Trump in July signed an govt order stating that SAMHSA grants will not “fund packages that fail to realize ample outcomes, together with so-called ‘hurt discount’ or ‘protected consumption’ efforts that solely facilitate drug use and its attendant hurt.”
Along with making naloxone extra extensively obtainable, hurt discount measures embody needle exchanges, overdose prevention websites, fentanyl checks and wound care. Olsen, the previous director of the Middle for Substance Abuse Remedy at SAMHSA, stated Trump’s order has created widespread confusion.
“States have now change into very anxious and nervous about the usage of any federal funds for any a part of their hurt discount group, together with employees which will have been concerned in handing out naloxone,” Olsen stated. “Due to the wording of a number of the messages and a number of the steering from SAMHSA, it’s simply very unclear as to what it’s that they’re actually allowed to do versus not allowed to do, with respect to hurt discount.”
In the meantime, the Medicaid adjustments included within the One Huge Lovely Invoice Act that Trump signed in July, together with new work necessities and greater than $900 billion in spending cuts over the subsequent decade, will end in many individuals with substance use dysfunction shedding their well being care protection and, probably, their entry to therapy.
The Medicaid adjustments within the regulation will lower the variety of individuals with medical health insurance by about 7.5 million individuals by 2034, based on the Congressional Funds Workplace. Medicaid, which is funded collectively by the federal authorities and the states, pays for a good portion of psychological well being and substance use care in the USA.
“States had been already struggling to fulfill the demand for therapy,” stated Hanna Sharif-Kazemi, a coverage supervisor at the nonprofit Drug Coverage Alliance, which advocates for well being care as an alternative of punishment for drug customers.
“Whereas the Trump administration says that they’re making an attempt to do these federal funding cuts as a approach to eliminate duplicate funding streams, what they’re truly doing is eradicating … instruments in our instrument belt. And this isn’t the time for us to be eliminating instruments. We truly wanted extra instruments and extra funding in our instrument belt to start with. So it’s actually disappointing.”
Stateline reporter Shalina Chatlani will be reached at schatlani@stateline.org.
Stateline is a part of States Newsroom, a nationwide nonprofit information group targeted on state coverage.
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