Tracking FY2019 Federal Funding to Combat the Opioid Crisis
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The COVID-19 pandemic has resulted in one of the most significant public health crises of the last century, but there is also increasing concern about the effect of the pandemic on other health issues, including the opioid use disorder epidemic. Reports from states and counties across the country suggest opioid-involved overdose deaths are rising in 2020. This is on top of provisional data suggesting overall drug overdose death rates climbed by 4.9% in 2019, resulting in over 71,000 deaths and erasing the slight decline observed in 2018. Synthetic opioids, such as fentanyl, continue to be the main driver of opioid-involved deaths. The nation is also seeing an increase in methamphetamine and cocaine use. Multiple substances, including methamphetamine and cocaine, are increasingly being found along with opioids in overdose death toxicology reports—commonly referred to as polysubstance-involved deaths.
As drug use patterns shift, so do the demographics of overdose deaths; we continue to see increases in rates of overdose deaths in communities of color. This is especially concerning in Black and Latino communities that have also experienced higher rates of COVID-19 infection and death rates.
While considerable attention has focused on the drivers of the opioid epidemic, less attention has been paid to how the federal government is allocating financial resources to address the issue; the appropriate allocation of responsibility among federal, state, and local entities; where the funding is going; and whether it is being targeted to communities most affected by the epidemic.
In this report, the Bipartisan Policy Center (BPC) tracks spending targeted to address the opioid epidemic across the federal government for fiscal year 2019 and provides insight into how funds are being spent at the state and county-level to address the opioid epidemic. BPC also selected six states—Ohio, Arizona, Tennessee, Louisiana, New Hampshire, Washington—diverse in many aspects and performed case-studies elucidating more detailed state and county-level opioid spending data.
In FY2019, total federal opioid funding was $7.6 billion, up from $7.4 billion in FY2018, an increase of 3.2%. This is a smaller increase than seen in previous years when total federal opioid funding increased 124% between FY2017 and FY2018. Two-thirds ($5.3 billion) of the funding was disbursed by the Department of Health and Human Services, with nearly two-thirds of that funding ($3.7 billion) administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). Similar to FY2018, three-quarters of FY2019 funding went to treatment, recovery, and prevention efforts; the remaining dollars went to research, interdiction, law enforcement, and other criminal justice activities. Notably, total interdiction dollars rose from 5% to 9%, representing a significant increase in funds dedicated to disrupting the trafficking of illicit opioids, particularly illicitly manufactured fentanyl. In addition, while this analysis focused only on annually appropriated (discretionary) funding, Medicaid coverage of medications for opioid use disorder (buprenorphine, naltrexone) and for the opioid overdose antidote naloxone increased by 15% to nearly $1.6 billion in 2019.
Opioid spending in the six states studied totaled nearly $820 million in 2019, or 11% of all federal spending that year. While all federal spending increased 3.3% between 2018 and 2019, spending in the six states studied increased 12.8%. Nationwide federal opioid funding averaged $25 per capita in 2019; for the six states reviewed, per capita spending was similar at $24.
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State Opioid Appropriation Data
- Profiled in report
- Profiled in report
| Rhode Island |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Alaska |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Alabama |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Arkansas |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Arizona |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| California |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Colorado |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Connecticut |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| District Of Columbia |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Delaware |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Florida |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Georgia |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Hawaii |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Iowa |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Idaho |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Illinois |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Indiana |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Kansas |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Kentucky |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Louisiana |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Massachusetts |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Maryland |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Maine |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Michigan |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Minnesota |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Missouri |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Mississippi |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Montana |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| North Carolina |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| North Dakota |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Nebraska |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| New Hampshire |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| New Jersey |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| New Mexico |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Nevada |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| New York |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Ohio |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Pennsylvania |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Oregon |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Oklahoma |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| South Carolina |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| South Dakota |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Tennessee |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Utah |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Texas |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Virginia |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Vermont |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Washington |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| West Virginia |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Wisconsin |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
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| Wyoming |
Opioid Appropriation FY2017 Opioid Appropriation FY2018 Opioid Appropriation FY2019 |
U.S. Territories:
Based on the State Analysis, There Are Several Takeaways:
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With a few exceptions, the geographic distribution of federal opioid funding has remained relatively stable and funds are going to counties with the highest number of overdose deaths. It is difficult to determine within counties whether funds are meeting the needs of those at highest risk of overdose, even though states are required in grants, including in SAMHSA’s State Opioid Response grants to identify at-risk populations and target resources accordingly. In most states, populations most at risk of overdose include justice-involved populations, people experiencing homelessness, and pregnant and parenting women. Rates of polysubstance-involved overdose deaths are increasing, along with rates of methamphetamine and cocaine use. In addition, over the last few years there have been increasing rates of overdose deaths in communities of color.
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Few individuals who are incarcerated receive the standard of care for opioid use disorder, although overdose death is the leading cause of death upon release from jails and prisons. States cited concerns about a lack of sustainable funding sources and access to community-based care upon reentry. States also mentioned shortages in funding for supportive housing, especially for people leaving corrections and in the early stages of recovery.
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Workforce shortages continue to limit treatment expansion, with state officials specifically mentioning this as a significant barrier to their efforts. There is a disconnect between where vulnerable populations reside and where physicians have a “data waiver” practice, which stands in the way of providing treatment to at-risk populations. In addition, the majority of “data waived” prescribers do not prescribe to the maximum allowed number of patients. Given well documented addiction treatment workforce
shortages, several states have expanded scope of practice laws for mid-level practitioners, such as physician assistants and nurse practitioners, to allow them to prescribe controlled substances such as buprenorphine. States are also using federal grants to train and fund recovery support services, another key part of the addiction workforce. -
Every state funds naloxone training and distribution. Naloxone is distributed to law enforcement, community-based organizations, and peers. Harm reduction programs such as syringe services programs, typically receive limited federal funding. At the state level, several have passed legislation sanctioning syringe services programs, although BPC found limited coordination between behavioral health and public health agencies in relation to these services. None of the states examined used federal funding for fentanyl test strips.
BPC Makes the Following Recommendations:
- To support sustainable funding and build the necessary infrastructure to reach at-risk populations:
- Increase SAMHSA’s Substance Abuse Prevention and Treatment Block Grant (SABG) funding for evidence-based programs. This block grant has been level funded at $1.85 billion since FY2016 and has not kept pace with inflation over the past decade, despite the startling increase in drug overdose deaths over this 10-year period. BPC recommends increasing the block grant annually, at a minimum, to keep up with inflation. Providing additional funds should also increase culturally competent interventions to eliminate treatment gaps for at-risk populations, including Black and Latino populations who are less likely to receive substance use disorder (SUD) treatment.
- Coordinate federal government harm reduction services: To facilitate enhanced coordination of services at the state and local level and ensure services reach people most at-risk for overdoses, BPC recommends coordination of harm reduction related funding at the federal level. BPC also recommends that Congress remove the restrictions on purchasing syringes currently in federal appropriations language.
- Evaluate programs and provide feedback: Since FY2017, the federal government has invested billions of dollars to curb the opioid epidemic. However, rates of annual overdose death are the sole public measure for the effectiveness of these expenditures. Given the size of this investment, publicly available evidence-based evaluations of each of the streams of federal opioid funding must be conducted. These evaluations should include information on whether the grant is meeting the needs of atrisk populations as well as health equity goals. In addition, evaluations should assess whether federal resources are going to implement evidence-based interventions.
- To address overdose mortality of at-risk populations:
- Remove restrictive funding language: Every state official mentioned increasing rates of polysubstance use and overdose deaths in their state as an area of concern, as well as increasing rates of methamphetamine and cocaine availability and use. To the extent possible, revise federal grants to allow spending on substance use disorders generally, including emerging drug use trends such as methamphetamine and cocaine.
- Reduce the treatment gap in diverse communities: Grant programs should focus on cultural competency to improve treatment access and retention. Evaluations of grant funds as described above must address treatment gaps in communities of color.
- Coordinate criminal justice reform efforts: Reforms that seek to divert people away from arrest and incarceration, as well as efforts to expand access to medications for opioid use disorder in correctional settings and
connect people to services upon reentry are critical. BPC recommends greater coordination between the Justice Department’s Bureau of Justice Assistance and SAMHSA to improve the efficacy of these programs and increase opportunities for funding coordination. In addition, efforts should be made to include housing first responses and increase HUD’s focus on reentry and recovery supportive housing.
- To remove regulatory and legal barriers to treatment:
- Extend regulatory revisions made during COVID-19: The federal government should permanently extend the regulatory flexibilities that have expanded access to treatment via telemedicine. In addition, researchers should examine the effects that changes to other regulations (e.g., increased flexibility around take-home doses) have had on treatment retention and access. Upon completion, the federal government should immediately make permanent the most effective revisions and devise a plan for a comprehensive review of all restrictions on treatment access. The review and recommendations for change should include examining regulatory burdens on opioid treatment programs, or OTPs. The evaluation should include whether the regulatory revisions have made treatment more accessible to at-risk individuals and more equitable.
- Remove the special licensing requirement (data waiver) for health care providers to prescribe buprenorphine: While removing the data waiver requirement requires legislative action, in the interim HHS has administrative discretion to lift the buprenorphine provider patient limit, thereby increasing access. Increasing patient limits and ultimately removing the data waiver requirement can lead to expanded access to buprenorphine, a medication available in physicians’ offices that is too often out of reach for many vulnerable populations, particularly communities of color.
- Expand access through Medicaid: HHS should conduct a thorough review of all Medicaid practices that restrict access to treatment for people with substance use disorder, including people who are incarcerated but have not yet been sentenced. BPC also recommends states increase Medicaid coverage for 12 months post-partum and increase reimbursement rates to encourage additional providers to cover treatment services. In addition, BPC recommends the elimination of prior authorization for MOUDs for opioid use disorder.
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