Drug Deaths Plunged. Trump Wants to Cut Funds Cited for the Drop
Sarah Stone first tried marijuana at 11 years old, and started opioids when she got her wisdom teeth out at 18. She struggled with drug use until she was 34.
“I earned every one of these scars,” Stone said, pointing to her arms.
She spoke as she sat on a covered porch in Charleston, W. Va., where dried garlic hung from the ceiling and an oversized fan hummed behind her trying to ward off the sweltering summer heat.
In 2018, as the opioid abuse epidemic was devastating communities nationwide, Stone and a fellow congregant at the Unitarian Universalist Congregation of Charleston launched an organization to support people struggling with substance use disorders. Their group, Solutions Oriented Addiction Response of West Virginia, started distributing clean syringes and naloxone, the inhalable and injectable medication that reverses drug overdoses, from the church parking lot.
As the nonprofit, now called SOAR WV, worked along with other outreach groups to distribute naloxone, drug overdose deaths fell in West Virginia. The total plunged 39.1% between April 2024 and April 2025, according to the Centers for Disease Control and Prevention. That mirrors a national trend.
Whether the trend will continue depends on what President
SOAR WV gets its naloxone from the West Virginia Department of Human Services, which relies on grants from the Substance Abuse and Mental Health Services Administration, an agency within the US Department of Health and Human Services.
Trump wants Congress to combine SAMHSA with other agencies into a new Administration for a Healthy America, part of his unprecedented and sweeping effort to streamline what he’s called a bloated and wasteful government. How that trickles down to the agency level offers a window into the impact on communities nationwide.
Trump’s budget request would eliminate more than $1.4 billion in mental and behavioral health aid, on top of other program funding cuts this year.
In March, the administration abruptly scrapped nearly 130 SAMHSA grants, worth $1.7 billion, headed to state health agencies to help fight opioid abuse and suicides. Most of the cuts hit Republican-led states, resulting in an unpaid $14 million slashed for substance abuse programs in Florida and over $50 million rescinded in a mental health block grant for Texas.
In the Senate, health appropriators this summer gave an early thumbs-down to much of Trump’s planned HHS reorganization. Their House counterparts advanced their own proposal last week that slashes $298.5 million from SAMHSA, a far smaller cut than Trump seeks, but keeps the door open to Trump’s proposed Administration for a Healthy America.
Both chambers need to reconcile their spending plans this month. Medical associations and providers also worry that the Trump administration will find ways to disrupt funding regardless of what Congress does.
SAMHSA has notified some grant recipients they must attest that their funding will not go to diversity, equity, and inclusion programs. Medical associations suspect other grants opportunities are being withheld or diverted.
The federal aid through SAMHSA had helped West Virginia distribute 100,000 free naloxone kits last year to emergency responders, health professionals and outreach groups like SOAR WV.
The group still holds monthly fairs where Stone, now 45, and others hand out naloxone, hot meals, and outreach materials like a pink pin that sports the image of a tiara above the words “Narcan Queen,” a reference to the dominant brand of naloxone.
Stone says her fear is that SOAR WV’s ability to get naloxone, which researchers have credited with saving lives, will be impacted. Overdose deaths might be dropping, but she also recognizes the reality: Lots of people are still dying.
“We’re going to celebrate at zero,” she said.
Cuts and Coordination
SAMHSA was established in 1992 as a result of reorganizing previous addiction research and service programs, representing a focus on community-based services.
By 2024, the agency had grown to 865 employees and disbursed $6.9 billion in grants and contracts nationwide. Its annual budget had been nearly $5.9 billion in 2020 but rose 25%, to $7.4 billion, during the Biden administration.
A large portion of funding sent to states supports behavioral health services through block grants and state opioid response dollars. There are also discretionary grants for specific purposes, such as training first responders with naloxone and supporting pregnant and postpartum women struggling with substance use disorders.
The scope of the proposed cuts are still evolving, but the administration’s budget request argues they’ll improve government efficiency. “For too long, all these agencies have worked in competition with each other, not in complementary or coordinated ways,” it said.
It wants to combine three large grants at SAMHSA — now separately funding programs for mental health, substance use disorder, and state opioid initiatives — into a single Behavioral Health Initiative Block Grant. Funding for those three areas would shrink from a combined $4.5 billion to $4.1 billion, according to a Brookings Institution analysis.
The administration also wants to eliminate 40 other SAMHSA grant programs that focus on mental health, substance use treatment and prevention.
“U.S. Department of Health and Human Services Secretary Robert F. Kennedy’s vision for a healthy America is founded on a steadfast commitment to address chronic disease and streamline public health policy and action that most effectively serve Americans,” HHS spokesperson Andrew Nixon said in a statement.
The White House did not respond to a list of questions sent by email.
Bloomberg Government identified at least 1,419 SAMHSA grants across the country that could prematurely lose some or all of their underlying funds if the administration’s recommendations are implemented.
A coalition of health associations wrote to health and congressional leaders last week to express concern that Trump’s Office of Management and Budget is directing the withholding or diversion of funds Congress had approved for grants in the current fiscal year. The money includes grants to help divert youths with mental illnesses from the justice system and provide outpatient treatment for adults with mental illnesses.
“Such a move would be unprecedented and introduce more uncertainty into an already fragile behavioral health care system,” said the letter from groups including the American Academy of Pediatrics and the National Alliance on Mental Illness.
Nixon said that all programs funds that have been approved will be released by the end of the month.
The department also acknowledged that it wants certain current grant recipients to pledge the funding won’t be used to support diversity, equity, and inclusion activities. “We believe opportunities should be based on character, effort, and ability, not race or other group identity,” the agency’s website states.
Only grantees identified as having potential compliance concerns were receiving notices, according to SAMHSA.
WestCare Foundation, a group that gets federal aid and provides prevention and treatment services in 17 states, said the government asked it to send letters stating its compliance with the DEI and harm-reduction directives.
“We’re not serving a minority population because we want to give them preferential treatment,” said Peggy Quigg, member of the President’s Senior Service Advisors at WestCare. “We’re serving minority communities because that’s where the greatest risk often shows up.”
Dreading Fridays
Back east, West Virginia Prevention Solutions relies on $1.3 million in SAMHSA funds to cover salaries for eight employees, as well as the training they provide and the outreach materials they share with schools, children and community members in 13 counties.
Elizabeth Shahan runs the nonprofit from a office in Clarksburg, a town of about 16,000 people two hours north of Charleston. Wedged between a karate dojo and a defunct cannabis dispensary, its back room is stacked floor-to-ceiling with lesson plans, games, and substance use prevention workbooks to distribute at schools.
Shahan’s team also distributes naloxone kits marked with stickers of mythical West Virginia creatures, such as Sheepsquatch and Mothman. It’s not just for art’s sake: Marking the kits helps them track when and where their supplies are used.
Shahan’s group has already felt the sting from the new administration’s revamped mission. In the spring, it abruptly cut a $66,421 grant that funded a staffer to focus on adult suicide prevention. In total, the state lost more than $1 million in behavioral health program funding as the administration cut Covid-19 era dollars.
She still largely relies on funding from SAMHSA grants, but the uncertainty over their future has her on edge.
“Every Friday, you either avoid your email, so you don’t have to get the bad news, or you are intentionally here until five o’clock so that you can get the email,” Shahan said.
If the federal funding dries up, the state could consider tapping into opioid settlement funds to buy and distribute naloxone, said Lindsay Acree, an assistant professor of pharmacy practice at the University of Charleston who works with the state’s human services department to distribute naloxone.
Another $19.2 million is expected to be released this month from the West Virginia First Foundation, which oversees most of the settlement money from companies that fueled the opioid crisis.
Hoping that insurance companies might cover naloxone purchases at pharmacies is also an option, Acree said. But free distribution helps get the naloxone into people’s hands instead of convincing individuals to go to a pharmacy and buy medication they know they may never use, she said.
“If you were to come across somebody that was experiencing an overdose, you would have to then find a pharmacy, like if you didn’t have it on hand, right?” she said. “In a lot of rural areas, that pharmacy could be 30 or 45 minutes away.”
Key Votes Loom
The fate of SAMHSA — and the programs it supports — rests with Congress. So far, lawmakers have not greenlit Trump’s extensive overhaul, but have kept the door open to create a new Administration for a Healthy America.
House appropriators last week advanced a bill to slash the Health and Human Services Department by $7 billion, including a nearly $300 million cut to SAMHSA. Their proposals include cutting grants for programs that focus on minority populations at risk of or are living with HIV, and people experiencing homelessness.
In a late-night bill markup, Rep.
“Now is not the time for us to take our foot off the gas and decrease funding to SAMHSA,” said Dean, who has publicly shared her own son’s struggle and recovery from opioid abuse.
The Senate bill goes in the other direction. It would provide $7.4 billion for SAMHSA’s budget and includes a $20 million increase to the substance use prevention and treatment block grant as well as a $20 million increase to the state opioid response grants, according to a summary from Sen.
The fate of government spending bills remains uncertain, with lawmakers currently negotiating stopgap legislation to avert a shutdown.
The subcommittee is led by a West Virginia Republican, Sen.
She has been criticized for her support of another bill likely to reduce aid for those in need of substance use disorder treatment: the Republican tax law that would cut $911 billion from Medicaid over 10 years, according to an analysis by the health research group KFF.
“There are just going to be a lot more folks we miss downstream,” said Joe Solomon, a Charleston city councilman who also is a co-director at SOAR WV.
Capito did not respond to questions from Bloomberg Government about Trump’s budget request and her Medicaid vote. In a statement, she asserted she has been a long-standing supporter of SAMHSA, and said that won’t change.
“I will continue to advocate for policies and resources that make a real difference in combating substance use and mental health challenges in West Virginia,” she said.
But even pushback in Congress might not be enough to stop the White House from delaying or diverting the funding.
Andrew Kessler, a principal for the consulting group Slingshot Solutions LLC, noted Trump’s Aug. 7 executive order requiring each agency head to designate a senior appointee to implement a grant review process. Its stated goal, like many similar orders, is “to ensure that they are consistent with agency priorities and the national interest.”
At this point, SAMHSA doesn’t have a Senate-confirmed leader.
“What does that mean for the grant-making process?” Kessler said. “Does it mean it can’t go forward? Does it mean the person who is running things takes up this process? We don’t know, so that adds to the layer of confusion.”
A Matter of Investment
On a Saturday evening in early August, people milled about a park in Buckhannon, W. Va.
The event in Jawbone Park mirrored many community fairs, with food vendors, a kids bounce house, booths selling shirts, even a stage for performances. But it had a unique purpose.
Called Recover Out Loud, it aimed to celebrate successes over substance abuse disorders and offer support for those looking for help. The stage hosted not just music, but speakers who shared their recovery stories.
Scott Baker played a few songs on his guitar for the crowd, then walked to a table where Shahan, from West Virginia Prevention Solutions, passed out pamphlets and a rubber ducky that says “Stop the Stigma.”
Behind the table, parents and kids wandered through a 12-foot high inflated blowup that resembled a human brain. Panels on its walls described the impact of drugs and concussions on the brain.
Baker has worked for West Virginia Prevention Solutions for three years, focusing on at-risk youth ages 9 to 20. He reaches out to key stakeholders in each county — places like schools and mental health providers — to network and find opportunities to share information and support that might help them deal with the alcohol, marijuana and opioids use.
Sometimes that means giving classroom presentations; other times, it’s taking the stage or mingling at events like Recover Out Loud.
His position and work throughout 13 counties is funded through a $153,305 SAMSHA grant called Strategic Prevention Framework-Partnerships for Success Grant.
The Strategic Prevention Framework grants focus on reducing substance use disorders in communities; they are among the biggest programs in Trump’s crosshairs. If eliminated, 171 grant recipients across every state and US territory — and over 300 sub-awardees — would lose nearly $80 million that Congress previously approved.
Baker’s grant was supposed to last five years; he’s bracing for it to end early.
“It’s a shame because we have generational poverty, generational risk factors, we have to really provide a lot of protective factors for our youth to get away from that and break that cycle,” he said. “If they take that funding away, and I’m not allowed to go in there, or able to go in there and work with them to help develop coping skills and conflict resolution skills and things, then all the work that’s been done is going to become undone again.”
To contact the reporters on this story:
To contact the editors responsible for this story: