Federal cuts threaten addiction programs nationwide

More details have continued to emerge about proposed and implemented cuts to addiction-related programs at the federal level.

New DOJ grant cuts: The Department of Justice cancelled hundreds of grants to community organizations and local governments, including funding for efforts to combat opioid addiction.

• The Office of Justice Programs said the cancelled awards did not align with the administration’s priorities. The cancellation notices came midway through the funding cycle, potentially creating massive shortfalls for the programs.

Impact on youth: The series of cuts across the government could profoundly harm youth (which impacts the risk and protective factors that contribute to substance use risk).

• The administration has laid off thousands of workers who supervised education, child care, child support, and child protective services systems, and it has blocked or delayed billions of dollars in funding for things like school meals and school safety. Thousands of state and local agencies serving children nationwide are impacted.
• And next on the chopping block may be Medicaid, which serves children more than any other age group.

Impact of COVID grant cuts: When the administration cut COVID-era funds to states last month, addiction recovery programs were quickly impacted. In many cases, the money funded addiction recovery services, which are not reimbursed by insurance (e.g., transportation to medical appointments and court hearings, job training, housing assistance).

• A federal judge temporarily blocked the cuts, but many of the impacted programs say they cannot easily rehire people they laid off or restart curtailed services. They are unsure they can survive long-term, not knowing when the judge’s ruling might be lifted or another funding source cut.
• Many of the programs employ people in recovery themselves and/or train people for other jobs. The cuts seem to undermine the Administration’s stated goals of getting more people to work, reducing reliance on welfare benefits, and reviving the manufacturing industry.

White House’s proposed HHS budget: While not yet finalized and still requiring adoption by Congress, the administration’s Department of Health and Human Services (HHS) budget proposal would include cuts across HHS that impact substance use disorder (SUD).

• Administration for a Healthy America (AHA): The budgets for the Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA), Agency for Healthcare Research and Quality (AHRQ), Administration for Community Living (ACL), HHS Office of Civil Rights, and a few other offices would be zeroed out. Some of their work would be folded into the new AHA, which would have $14 billion in budget authority.
• Big SUD grants preserved: The substance use block grant, State Opioid Response grants, and Addiction Technology Transfer Centers would continue under AHA’s Mental Health division.
• Prevention: AHA would preserve a number of maternal and child health programs, including the Maternal, Infant, and Early Childhood Home Visiting Program, the Fetal Alcohol Syndrome and Neonatal Abstinence Syndrome programs, and Poison Control Centers. But, many prevention-related programs would be eliminated, including the Strategic Prevention Framework, STOP Act (to prevent underage drinking), Emergency Department Alternatives to Opioids, SBIRT (screening, brief intervention, and referral to treatment), Youth Prevention and Recovery Initiative, Adverse Childhood Experiences program, Head Start, Community Services Block Grants, energy assistance programs, etc.
• Crisis Response: The AHA Mental Health budget would fund the 988 crisis hotline at 2024 enacted levels and maintain funding for specialized services for Spanish speakers, but it would eliminate the set-aside for specialized services for LGBTQ+ youth. Crisis Response Grants would be eliminated.
• Harm Reduction: Grant programs focused on naloxone distribution and training would be eliminated.
• Treatment/Recovery: Several treatment and recovery programs would be eliminated, including initiatives focused on treatment for pregnant and postpartum women, treatment for homeless individuals, Certified Community Behavioral Health Clinics, Peer Support Assistance Center, Comprehensive Opioid Recovery Centers, Building Communities of Recovery, etc. The budget would also eliminate funding for behavioral health centers of excellence focused on various populations.
• Workforce: The SUD Treatment and Recovery Loan Repayment Program would continue under AHA Health Workforce, but the Mental and Behavioral Health Education and Training program and Behavioral Health Workforce Education and Training program would be eliminated.
• Data/Surveillance: AHA Policy, Research, and Evaluation would include some of SAMHSA’s surveillance work and performance and quality information systems. Funding for all National Center for Injury Prevention and Control programs would be discontinued, except for Suicide Prevention, Opioid Overdose Prevention and Surveillance, and the National Violent Death Reporting System, which would be moved to AHA Primary Care.
• Research: At the National Institutes of Health (NIH), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and National Institute of Mental Health (NIMH) would be combined into the National Institute of Behavioral Health. The proposal assumes capping indirect cost rates at 15%.