In recent years, Congress passed three laws authorizing the appropriation of $10.6 billion in discretionary spending to combat the opioid epidemic. The Comprehensive Addiction and Recovery Act (CARA), the 21st Century Cures Act, and the SUPPORT for Patients and Communities Act are estimated to increase mandatory opioid response spending by $2.5 billion.
Congress plans to spend these funds from 2017 and 2028. This funding is for programs that reduce the supply of opioids, the demand for them, and the harm they cause. The SUPPORT for Patients and Communities Act represents 85% of this funding, almost $8.99 billion.
Congress determines discretionary spending as part of the annual federal budget process. Programs don’t have to spend all their discretionary funds; they can spend less.
Conversely, mandatory spending is legally required and covers programs including Social Security, Medicare, and Medicaid. Much of the increase in mandatory spending is for Medicaid provisions that require state Medicaid programs to cover all approved medications for treating opioid use disorder.
Provisions in the three new laws affect existing programs that aren’t included in the new appropriations totals. The Congressional Budget Office estimates that sections of these laws would reduce federal revenues by $90 million from 2017 to 2028, noting that it is difficult to fully quantify overall funding numbers because of the complex appropriations process.
Money authorized to be appropriated isn’t always appropriated, and money authorized for spending isn’t always spent. Unspent appropriations are returned to the Treasury, and the overseeing government agency loses the chance to spend that money unless Congress approves a carry-over to the next year.
A March 2020 report from the Department of Health and Human Services (HHS) notes that states were slow to spend money from the $970 million State Targeted Response to the Opioid Crisis grant program for 2018 and 2019 (part of the 21st Century Cures Act). The report found that $300 million — nearly one-third of the program’s total funding — went unspent by the end of the grant period.
Fourteen states had spent less than half of their funding share. All but six requested 12-month extensions to spend the grants.
Much of the money authorized by these federal laws funds grant programs to support states, tribes, local governments, and other organizations. Several federal agencies, including the HHS and the Justice Department, administer the grants.
The Justice Department funded more than 500 projects from 2019 to 2023 through its Comprehensive Opioid, Stimulant, and Substance Use Program. Projects include efforts to support law enforcement in identifying people who use substance misuse treatment services and to work with social services to respond when opioid overdose incidents impact children.
In July 2023, the Department of Health and Human Services distributed $47.8 million via five grant programs that combat substance misuse and overdoses. Those programs funded expanded access to opioid addiction medication, support for hospitals in providing opioids alternatives for pain management, and help adults in the criminal justice system access treatment and reentry services after incarceration.
In 2023, California, Florida, and Ohio each received more than $100 million from the federal State Opioid Response grant program. Pennsylvania and New Jersey rounded out the top five states. Adjusting for population size, Delaware, West Virginia, and New Hampshire were each awarded the most per resident — over $20, compared to $2.84 and $4.71 for California and Florida, respectively.
Total 2023 funding for the State Opioid Response program was about $1.5 billion. It allowed states, territories, and tribal governments to expand substance use disorder treatment, emergency overdose treatments like naloxone, and recovery support programs.
HHS determines funding with a formula that weighs the state’s proportion of drug overdose deaths against the proportion of people who meet criteria for substance abuse but haven’t received treatment. The states with the highest overdose mortality rates also received dedicated allocations.
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