On July 6, the Substance Abuse and Mental Health Services Administration announced approximately $281.25 million in funding for 15 federal grant programs, much of it focused on medications for opioid use disorder (MOUD) and community overdose prevention. In keeping with the agency’s new trajectory under the Trump administration, the notice for each grant states that applications must “align with SAMHSA Strategic Priorities and the application and budget narrative must not support harm reduction.”
Applications are due July 27. Some grants have pre-application webinars scheduled in the coming days.
The largest investment, $68.25 million, will support the “Medication-Assisted Treatment – Prescription Drug and Opioid Addiction” grant. SAMHSA anticipates up to 91 recipients, awarded around $750,000 each.
Among other requirements, recipients would need to “ensure access” to methadone, either by providing it directly or by coordinating with other programs, as well as ensure that “all applicable practitioners” complete the training necessary to prescribe buprenorphine. Recipients are required to offer at least one MOUD, but thankfully no particular mention is made of naltrexone (Vivitrol). They would also be required to create “tobacco cessation programs” for people receiving MOUD, noting that integrating the two treatments “improves overall health outcomes without compromising OUD recovery.”
In addition to harm reduction, the funding notices similarly warn against applications that are supportive of Housing First, or that “promote denial … of the sex binary in humans, or the belief that sex is a chosen or mutable characteristic.”
In September 2025 SAMHSA unveiled new strategic priorities that aligned with President Donald Trump’s executive order targeting street-homeless communities and people who use drugs in public. The agency has redefined harm reduction as a model that promotes or enables drug use, while simultaneously redefining MOUD and naloxone access as issues that are unrelated to harm reduction.
In April, the agency removed fentanyl test strips from funding eligibility, along with overdose hotlines that support people using drugs alone.
Other funding allocations include $34.7 million for First Responders-Comprehensive Addiction and Recovery Act grants. These support naloxone (and nalmefene) trainings for first responders as well as local businesses and organizations that are viewed as “community anchors.” The best examples of these seem to be faith-based organizations, now that syringe service programs can’t apply for these grants or be mentioned in them.
If HHS was putting all this money toward what it viewed as a purely medical problem, you’d think the solution would be viewed the same way.
The funding opportunities are part of the Trump administration’s Great American Recovery Initiative, which since its launch in January has been credited in several similar funding announcements from SAMHSA, though none previously so weighted toward MOUD. The initiative is based in the brain disease model of addiction, a favorite among anyone who wants to say they’re compassionate toward people who use drugs while advancing policies that don’t quite reflect that.
“Addiction is not a moral failure. It is not a character flaw. And it’s not simply a behavioral issue,” Great American Recovery Initiative Co-Chair Kathryn Burgum stated at the Oval Office launch in January. “Addiction is a lifelong, chronic, relapsing medical disease—as real as diabetes, cancer and heart disease.”
If the Department of Health and Human Services was putting all this money toward what it viewed as a purely medical problem, you’d think the solution would be viewed the same way. But as with SAMHSA’s other recent funding opportunities—and funding restrictions—the grant notices specify that MOUD must be provided with other psychosocial services. Methadone and buprenorphine are often enormously effective with or without psychosocial services, ironically for the same reason that “the disease of addiction” is not just a medical issue—it’s a socioeconomic one. To a certain extent this is also true of diabetes and cancer and heart disease, but we don’t usually make the medical treatment of those conditions contingent on counseling and behavioral therapy.
Photograph by Helen Redmond and Marilena Marchetti
