The Federal Response to the Opioid Epidemic

The opioid epidemic has been a major public health crisis since the 1990s but was only declared a federal public health emergency in 2017. Since then, the federal government has increased funding to states for programs to address opioid use and overdose deaths. Despite the increased funding in the past five years, opioid-related overdose deaths continue to rise. The Substance Abuse and Mental Health Administration (SAMHSA) is the major federal agency responsible for allocating federal funds to opioid use disorder prevention, treatment, and personnel training programs. In 2021, SAMHSA allocated funding for opioid use disorder through eleven grant programs with a total of 330 grant awards, amounting to over $150 million. My analysis of 2021 SAMHSA grants aims to identify how funds for opioid use disorder are allocated, examine the relationship between opioid-related overdose deaths and the amount of funding allocated to states, and suggest potential gaps in funding. Ultimately, my research has found that treatment-focused programs were prioritized over prevention and education or training programs by SAMHSA funding. In 2021, treatment programs accounted for 223 of the 330 individual SAMHSA grant awards for opioid use disorder and 100% of grant awards received by nonprofit organizations. Medication-Assisted Treatment is the most commonly funded program among these grant awards. Additionally, states with a higher number of opioid-related overdose deaths are more likely to receive higher funding from SAMHSA grants (p<.001). Conversely, states with higher overdose death crude rates per 100,000 people did not receive adequate funding relative to the size of the population, creating gaps in accessibility to care. Additional gaps in opioid use disorder programs exist due to the downstream focus of funded interventions, neglecting upstream interventions. The data in my research are limited and therefore cannot draw broader conclusions as to how funding influences overdose deaths over time.