Proposed FY 2027 U.S. Budget: Written Testimony for the Hearing Record House Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies

The Overdose Prevention Initiative at the Global Health Advocacy Incubator (GHAI) submits this testimony in support of Fiscal Year (FY) 2027 funding for substance use disorder (SUD) and overdose prevention programs at the Department of Health and Human Services (HHS), specifically: the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant ($2,013,079,000); State Opioid Response (SOR) and Tribal Opioid Response (TOR) grants ($1,595,000,000); Programs of Regional and National Significance (PRNS) ($1,867,531,000); and the Centers for Disease Control and Prevention’s (CDC) Overdose Data to Action (OD2A) program ($505,579,000). GHAI's Overdose Prevention Initiative is a nonpartisan policy and advocacy nonprofit dedicated to advancing federal solutions to the overdose crisis.

Federal investment in overdose prevention is working. Final CDC data confirm 79,384 overdose deaths in 2024, a nearly 27% decline from 2023, the largest single-year decrease on record. This precipitous drop represents a return on years of sustained federal investment in prevention, treatment, and recovery infrastructure.[i] The economic case for continuing these investments is equally clear: the White House Council of Economic Advisers (CEA) estimates the illicit opioid crisis cost the United States $2.7 trillion in 2023 alone, 9.7% percent of the country’s gross domestic product (GDP), while evidence shows treatment reduces economic burden by more than 40%.[ii],[iii] 

Yet the scale and scope of the opioid crisis cannot be measured in dollars alone. Overdose remains the leading cause of death for Americans aged 18-44. A Kaiser Family Foundation poll found that roughly two-thirds of adults have been impacted by a SUD.[iv] While the 2024 decline represents significant progress, the loss of more than 79,000 lives is tragic and unacceptable.[v] Allowing the systems that produced this progress to erode would be a costly setback, in lives and in public dollars required to rebuild.

Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant: Request: $2,013,079,000 (level funding)

The Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant is the backbone of every state’s SUD system. These grants serve three primary purposes: (1) providing flexible funding that allows states to direct resources where their local data indicate need; (2) setting aside a mandated 20% for primary SUD prevention; and (3) supporting a “payer of last resort” function that provides lifesaving services to uninsured and underinsured individuals.

The return on investment is documented. Among individuals admitted to SUPTRS-funded programs in FY 2025, more than 1.5 million people nationwide, outcomes measured in admission versus discharge showed:

• Drug use abstinence increased 11.56% and alcohol use abstinence increased 9.29%;
• Vocational participation increased 6.67% and housing stability increased 4.05%, outcomes consistently associated with sustained recovery and lower overdose risk;
• Arrests decreased 4.08%, reducing criminal justice costs for states and localities; and
• Social support or recovery program attendance increased 52.88%, a key protection against relapse and re-hospitalization.[vi]

These outcomes translate directly to reduced public expenditure. Opioid use disorder (OUD)-related hospital visits cost the U.S. healthcare system an estimated $95 billion annually, with OUD patients averaging 32.5% higher cost per emergency department visit than other patients.[vii] Every person who achieves sustained recovery through SUPTRS- funded services represents averted emergency care, incarceration and lost productivity. 

State Opioid Response (SOR)/Tribal Opioid Response (TOR) Grants:

Request: $1,595,000,000 (level funding)

The State Opioid Response (SOR) and Tribal Opioid Response (TOR) grants are the nation’s most direct federal tool for reducing opioid and stimulant use disorder and preventing overdose death. Unlike formula grants, these funds are targeted to the substances driving the overdose public health emergency, while retaining the flexibility to address co-occurring substance use disorders and adapt to a rapidly shifting drug supply.[viii] A core priority is expanding access to Food and Drug Administration (FDA)-approved medications for opioid use disorder (MOUD), the evidence-based standard of care, and distributing overdose reversal medications in communities where they save lives. 

The results are concrete. From October 2018 to January 2023, SOR and TOR-funded services:

• Provided MOUD to more than 500,000 individuals;
• Distributed over 6.5 million naloxone kits, resulting in 400,000 overdose reversals; and
• Linked more than one million people to recovery services.[ix]

Each naloxone reversal averts costs that would otherwise fall on emergency medical services (EMS) and hospitals. Research consistently finds community naloxone distribution to be cost-effective even under the most conservative assumptions, with savings generated when reversals reduce EMS activations and emergency department visits.[x] At the scale SOR and TOR operate, 400,000 reported reversals results in a substantial amount of health expenditures avoided. 

At six-month follow-up, grantees report outcomes that extend the protective effect beyond the acute overdose event: a 2.4% increase in abstinence from alcohol or drug use; 58.42% increase in vocational participation, and 20.55% increase in housing stability, factors strongly associated with sustained recovery and reduced overdose risks; and a 3.6% decrease in arrests, reducing downstream criminal justice costs.[xi]  These outcomes represent cost savings across emergency care, hospitalization, incarceration, and lost productivity, and represent lives stabilized. 

SAMHSA Programs of Regional and National Significance (PRNS): 

Request: $1,867,531,000 (level funding)

SAMHSA Programs of Regional and National Significance (PRNS) are the federal government’s mechanism for closing the gaps that formula grants cannot fill: emerging needs, underserved populations, local community-based providers, and system-wide innovation. In FY 2025, SAMHSA awarded approximately 3,500 PRNS grants, totaling approximately $1.9 billion, to communities nationwide, supporting workforce development, crisis services, youth and family programs, overdose prevention, first responder programs and drug courts, and data infrastructure directly to local providers and community-based organizations, groups closest to the populations they serve and best positioned to identify what interventions work.[xii] For example, in Alabama, PRNS grants provide over $2.6 million to support community-based prevention and services, particularly for vulnerable populations such as children in foster care and their caregivers.

The consequences of disrupting this funding are not theoretical. In January 2026, HHS terminated approximately $2 billion in discretionary SAMHSA grants. Though those funds were subsequently restored, the disruption forced roughly 2,000 grantees, including direct service providers and first responders, to pause operations, cutting people off from care mid-treatment.[xiii] When treatment is interrupted, individuals are at elevated risk of relapse and fatal overdose. The cost of rebuilding disrupted treatment relationships far exceeds the cost of maintaining them.[xiv] These near misses underscore a fundamental principle: in a crisis measured in lives, funding gaps are not administrative inconveniences. Preserving PRNS funding ensures that evidence-based services reach the communities and populations that formula grants alone cannot serve. 

CDC’s Overdose Data to Action (OD2A) Program:

Request: $505,579,000 (level funding)

The record 27% decline in overdose deaths in 2024 did not happen by chance; it happened because public health agencies had the data to know where and why people were dying, and the resources to act on it. CDC’s Overdose Data to Action (OD2A) program is the infrastructure behind that knowledge. It funds state and local health departments to collect timely, circumstance-level overdose data that go far beyond traditional mortality counts, enabling jurisdictions to identify overdose hotspots, risk factors and intervention opportunities in near real-time. This surveillance capacity directly informs the deployment of resources across the SOR, SUPTRS and PRNS programs. Since OD2A’s inception in 2019, the program has supported enhanced overdose surveillance in more than 150 jurisdictions, driving the development of interventions including an overdose prevention hotline, apps that connect individuals to care, overdose reversal training for first responders, awareness campaigns, and rapid response protocols targeting identified overdose hotspots.[xv], [xvi]

The cost of losing this infrastructure became clear in July 2025, when HHS temporarily paused $140 million in OD2A grants. Even a partial, temporary disruption led to the loss of CDC staff overseeing the program and created surveillance gaps that left jurisdictions unable to sustain overdose prevention activities.[xvii] Real-time data is perishable and delays compound, and the ability to identify emerging hotspots and redirect resources is lost. Maintaining OD2A funding at current levels ensures that the data-driven progress of the past two years is not reversed by a gap in the surveillance systems that made it possible. 

Conclusion

The programs described above form an interdependent system: OD2A data informs strategy; SOR and TOR deliver targeted treatment; SUPTRS sustains the broad continuum; PRNS reaches where other programs cannot. Together, they produce measurable, documented returns on federal investments: lives saved and the meaningful reductions in healthcare, criminal justice, and productivity costs that make the overdose crisis one of the most expensive public health failures in American history. The question before this Committee is whether to protect that return on investment or pay far more to rebuild it. The Overdose Prevention Initiative urges the Committee to preserve funding for all four programs at FY 2026 levels in the FY 2027 LHHS appropriations bill.

[i] Centers for Disease Control and Prevention (CDC). (2025). U.S. Overdose Deaths Decrease Almost 27% in 2024. National Center for Health Statistics (NCHS) Public Affairs. https://www.cdc.gov/nchs/pressroom/releases/20250514.html

[ii] White House. (2025). The Staggering Cost of the Illicit Opioid Epidemic in the United States. https://www.whitehouse.gov/releases/2025/03/the-staggering-cost-of-the-illicit-opioid-epidemic-in-the-united-states/

[iii] Goldman, M. (2025). Exclusive: Opioid use disorder costs almost $700K per case. Axios. https://www.axios.com/2025/05/20/opioid-use-disorder-costs

[iv] Kaiser Family Foundation (2023). KFF Tracking Poll July 2023: Substance Use Crisis And Accessing Treatment. KFF. https://www.kff.org/tag/treatment/page/2/ 

[v] Centers for Disease Control and Prevention (CDC). (2025). Statement fom CDC’s National Center for Injury Prevention and Control on Provisional 2024 Overdose Death Data. CDC Media Relations. https://www.cdc.gov/media/releases/2025/2025-statement-from-cdcs-national-center-for-injury-prevention-and-control-on-provisional-2024.html

[vi] Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.) TEDS Performance Measures – State Level. Web Block Grant Application System (WebBGAS). https://bgas.samhsa.gov/Module/BGAS/Users/ApplicationIntroduction

[vii] Alkire, M. J., Juliano, D., & Rosenthal, N. (2023). Premier Data: Opioid Use Disorders Cost U.S. Hospitals More than $95 Billion Annually. Premier. https://premierinc.com/newsroom/blog/pinc-ai-data-opioid-use-disorders-cost-u-s-hospitals-more-than-95-billion-annually

[viii] Department of Health and Human Services (HHS). (2026). Renewal of Determination That a Public Health Emergency Exists. Administration for Strategic Preparedness and Response (ASPR). https://aspr.hhs.gov/legal/PHE/Pages/Opioid-Renewal-16Mar2026.aspx

[ix] National Association of State Alcohol and Drug Agency Directors (NASADAD). (2023). State Opioid Response Grants Impact Brief. https://nasadad.org/wp-content/uploads/2023/10/FINAL-State-Opioid-Response-Grants-Impact-Brief-Final-2023.pdf

[x] Cherrier, N., Garasia, S., Guindon, E., Kearon, J., & Tetreault, R. (2021). Community Distribution of Naloxone: A Systematic Review of Economic Evaluations. PharmacoEconomics – Open, 6(3): 329-342. https://doi.org/10.1007/s41669-021-00309-z

[xi] Byrd, C. D. J., Delphin-Rittmon, M. E., Olsen, Y., & Searcy, T. (2023). 2023 Report to Congress on the State Opioid Response Grants (SOR). Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/sites/default/files/fy23-sor-grants-rtc.pdf

[xii] Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.). SAMHSA Grants Dashboard. https://www.samhsa.gov/grants/grants-dashboard

[xiii] Raman, S. (2026). White House reverses $2 billion cut to mental health, addiction grants. Roll Call. https://rollcall.com/2026/01/14/hhs-cuts-2-billion-in-mental-health-addiction-grants/

[xiv] Crystal, S., Olson, M., Samples, H., & Williams, A. R. (2019). Acute Care, Prescription Opioid Use, and Overdose Following Discontinuation of Long-Term Buprenorphine Treatment for Opioid Use Disorder. American Journal of Psychiatry, 177(2): 117-124. https://doi.org/10.1176/appi.ajp.2019.19060612

[xv] Centers for Disease Control and Prevention (CDC). (2024). About Overdose Data to Action. Overdose Prevention. https://www.cdc.gov/overdose-prevention/php/od2a/about.html

[xvi] Centers for Disease Control and Prevention (CDC). (2026). Overdose Data to Action Stories. Overdose Prevention. https://www.cdc.gov/overdose-prevention/php/od2a/stories.html

[xvii] Mann, B., & Simmons-Duffin, S. (2025). CDC to disburse delayed funds for fighting fentanyl and more, staffers say. NPR. https://www.npr.org/sections/shots-health-news/2025/08/05/nx-s1-5493279/cdc-funding-freeze-overdose-omb