As Elon Musk and his Department of Government Efficiency (DOGE) take a chainsaw to federal agencies and funding, critical research—including that related to overdose, harm reduction and other drug issues—is among the targets.
As ordered by President Donald Trump, the National Institutes of Health (NIH) is aiming to reduce spending by capping the “indirect costs” covered for any research it funds at just 15 percent of the total funding for a given project. It’s part of a larger campaign by Musk and DOGE to gut federal public health agencies; already, 5,200 probationary employees of the department of Health and Human Services (HHS), the parent department of NIH, have been fired.
Indirect costs, or overheads, make up a large portion of the funding the NIH provides to universities conducting medical research. Harvard, for example, received $135 million to cover indirect research costs in 2024, according to NPR—69 percent of the total funding the university received from NIH. These taxpayer dollars help pay for items including building and lab maintenance, equipment and supplies, and administrative staff salaries.
On February 21, Judge Kelley extended the restraining order as she weighs a final decision.
The cuts are on hold, for the moment. After the administration’s policy was announced on February 7, 22 states, including California, New York and Illinois, sued the NIH and HHS to prevent the order from taking effect.
On February 10, a federal judge in Massachusetts, Angel Kelley, issued a temporary restraining order for federal agencies to take no action to implement the plan. On February 21, Judge Kelley extended the restraining order as she weighs a final decision. She considered issuing a preliminary injunction, and said she would work “as quickly as I can.”
Another two active lawsuits against the NIH to stop the cuts advancing involve challenges from the Association of American Medical Colleges and from the Association of American Universities.
The administration’s current plan is actually a rehash of something Trump tried during in his first time in office. His first proposed budget for fiscal year 2018 involved a 22 percent cut to NIH funding and targeted indirect costs even more aggressively, limiting them to 10 percent. A former NIH director warned then that this would “disembowel” key medical research nationwide.
The Republican-controlled Congress at the time rejected Trump’s plan, passing legislation on a bipartisan basis to prevent indirect-cost reimbursements to research institutions being capped.
Research on drugs and drug use is an important tool in the nation’s efforts to address the worst overdose crisis in its history. And the NIH, through programs like the “Helping to End Addiction Longterm Initiative” (HEAL), has played a major role. In fiscal year 2019—during Trump’s first term—the NIH HEAL program awarded $945 million in “grants, contracts, and cooperative agreements” to researchers in 41 states, whose work focused on areas like improving treatments for chronic pain, curbing rates of opioid use disorder and achieving long-term recovery.
Under President Biden, the National Institute on Drug Abuse (NIDA, part of the NIH) established a research network to test community-based harm reduction strategies. Launched in 2022, this five-year, $36 million initiative involved nine research centers and a coordinating center. Its projects included looking at how to expand harm reduction through mobile vans, digital services and peer outreach workers.
For Dr. Pho’s harm reduction research, about 50 percent of the NIH funding covers indirect costs.
Dr. Mai Tuyet Pho is an infectious disease researcher at the University of Chicago, currently working on an investigation that’s fully funded by the NIH. Pho works with three harm reduction providers in Illinois, covering 35 predominantly rural counties with less access to harm reduction services and supplies.
She is studying how participants in services like syringe service programs can help get supplies out in their communities—by receiving extra syringes, naloxone or other tools, which they can then share with their friends and families. Pho is also investigating how to innovate in rural harm reduction through vending machines, locker drop-offs and mail order services.
For Pho’s research, about 50 percent of the NIH funding covers “direct” costs—paying participants and research assistants, procuring certain supplies, conducting testing for diseases like HIV and hepatitis C, and working with community partners. The other 50 percent of her funding covers indirect costs.
“The indirect costs, those are the infrastructural costs required to do any of this research,” Pho told Filter. “To keep the lights on at the university in terms of budget administration—getting the funds from NIH and disbursing them. A really important piece is participant and study safety, that includes supporting the institutional review board that reviews all the work we do. Every single survey, instrument, protocol, has to go through intensive review before we would ever expose anyone to that.”
“It’s something that’s so hard to imagine happening, but it’s very real. We would probably have to shut down the study.”
If Trump’s plan goes forward, it would therefore threaten Pho’s harm reduction investigation.
“It would slow everything down, certainly,” she said. “I’m not sure how long we could go. The infrastructure indirect costs support are essential to our day-to-day. If we don’t have a functioning review board, we can’t do our research. If we don’t have the data collection platform, we can’t collect any data … It’s just as essential as the direct costs. It’s something that’s so hard to imagine happening, but it’s very real. We would probably have to shut down the study.”
Pho praised the NIH as an effective partner, and said there is no other institution providing as much funding to harm reduction research. In the event of NIH funding being pulled, she said she wouldn’t want to have to compete with direct harm reduction providers for any independent funding sources.
There’s a climate of fear among many researchers as they wait to see whether their work will be impacted by cuts. While some have spoken out to media about the threat, others reached by Filter didn’t want to speak on the record, worried about the implications of drawing attention to their projects.
The extent to which Trump and Musk may succeed in gutting federal research funding remains to be seen, with lawsuits yet to be resolved. But if the cuts are blocked in the courts, Trump may well find Congress more compliant than he did in his first term.
Photograph via Picryl/Public Domain
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