On September 22, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced the recipients of the 2025 state and Tribal opioid response grants—high-barrier federal funds that for the past several years have covered various overdose-prevention resources, for the harm reduction programs able to access them. The announcement comes on the heels of SAMHSA unveiling new anti-harm reduction “strategic priorities,” and during a time of immense change and uncertainty as to the agency’s future under the Trump administration.
The state opioid response (SOR) grants totaled $1.485 billion, and appear to have gone to the same 58 recipients as in 2024, in the exact same amounts. The largest individual SOR grant was $105,677,209 awarded to the California State Department of Health Care Services. Six grants of $500,000, the smallest amount, were awarded to health departments in four US territories, the Federated States of Micronesia and the Republic of Palau.
The Tribal opioid response (TOR) grants total $63 million and also appear to have gone to the same 139 recipients as in 2024, also in the exact same amounts. The largest TOR grant, by a significant margin, was $9,044,061 to the Northwest Portland Area Indian Health Board; only a small handful of recipients received more than $1 million, and the average grant was for less than $500,000. The smallest was $118,108 awarded to Scotts Valley Band of Pomo Indians.
On September 23, SAMHSA announced that eligible recipients would receive a total of $18 million in supplemental funding through the Substance Use Prevention, Treatment and Recovery Services Block Grant.
SAMHSA “strategic priorities”
Earlier in September, SAMHSA announced new “strategic priorities” that explicitly renounce housing-first and harm reduction models and target drug users who don’t have housing, as the administration has increasingly done since an executive order in July.
“SAMHSA grants will prioritize evidence-based programs and deprioritize programs that fail to achieve adequate outcomes, including so-called ‘harm reduction,’” the agency stated. “Additionally, SAMHSA will not support drug injection sites for illegal drugs, or so called ‘safe consumption sites,’ or the use or distribution of illegal drugs and associated paraphernalia.”
The agency detailed at length its intention to “increase competition among grantees” and ensure that funding went to programs that rejected the “housing first” model, and Community Behavioral Health Clinics that embraced civil commitment. It stated that priority would be given to grantees that met five main criteria: “enforce prohibitions on open illicit drug use”; “enforce prohibitions on urban camping and loitering”; “enforce prohibitions on urban squatting”; civil commitment; and surveilling people on sex offender registries, particularly those with no fixed address.
The strategic priorities also reference a letter to state partners “ending harm reduction,” which the administration published in July days after the executive order. The letter declared that overdose reversal would no longer be conflated with other forms of harm reduction, stating explicitly that no federal funding could be used to purchase syringes, safer smoking pipes, “drug paraphernalia,” sterile water, saline, ascorbic acid or “any other supplies to promote or facilitate drug use.”
The primary effect this will have is creating more confusion and fear around which services are eligible for funding, or legal to offer in the first place. The bans themselves are redundant—syringe service programs (SSP) have never been able to use these funds to purchase syringes. While it’s a misconception that no funds from any federal agency can be spent on syringes, that’s essentially the effect because no federal funds from SAMHSA can be spent on syringes. The ban also already extends to “drug preparation equipment.” Glass pipes for safer smoking were explicitly excluded from the funding in 2022 under the Biden administration.
“SAMHSA will no longer be sidetracked by misguided policies, investments in unsupported clinical interventions, and any unlawful focus on specific populations,” the agency stated in its strategic-priorities announcement, referencing its intent to also defund diversity, equity and inclusion initiatives. “Lasting sobriety and recovery will be tenets of our work to ensure a return to a productive, fulfilling and healthy life for every citizen.”
Top image (cropped) via Madison County, New York. Inset graphic via Substance Abuse and Mental Health Services Administration.