Trump Budget Draft Ends Narcan Program and Other Addiction Measures

New York Times

25-04-2025

The opioid overdose reversal medication commercially known as Narcan saves hundreds of thousands of lives a year and is routinely praised by public health experts for contributing to the continuing drop in opioid-related deaths. But the Trump administration plans to terminate a $56 million annual grant program that distributes doses and trains emergency responders in communities across the country to administer them, according to a draft budget proposal.
In the document, which outlines details of the drastic reorganization and shrinking planned for the Department of Health and Human Services, the grant is among many addiction prevention and treatment programs to be zeroed out.
States and local governments have other resources for obtaining doses of Narcan, which is also known by its generic name, naloxone. One of the main sources, a program of block grants for states to use to pay for various measures to combat opioid addiction, does not appear to have been cut.
But addiction specialists are worried about the symbolic as well as practical implications of shutting down a federal grant designated specifically for naloxone training and distribution.
'Reducing the funding for naloxone and overdose prevention sends the message that we would rather people who use drugs die than get the support they need and deserve,' said Dr. Melody Glenn, an addiction medicine physician and assistant professor at the University of Arizona, who monitors such programs along the state's southern border.
Neither the Department of Health and Human Services nor the White House's drug policy office responded to requests for comment.
Although budget decisions are not finalized and could be adjusted, Dr. Glenn and others see the fact that the Trump administration has not even opened applications for new grants as another indication that the programs may be eliminated.
Other addiction-related grants on the chopping block include those offering treatment for pregnant and postpartum women; peer support programs typically run by people who are in recovery; a program called the 'youth prevention and recovery initiative'; and programs that develop pain management protocols for emergency departments in lieu of opioids.
The federal health secretary, Robert F. Kennedy Jr., has long shown a passionate interest in addressing the drug crisis and has been outspoken about his own recovery from heroin addiction. The proposed elimination of addiction programs seems at odds with that goal. Last year, Mr. Kennedy's presidential campaign produced a documentary that outlined federally supported pathways out of addiction.
The grants were awarded through the Substance Abuse and Mental Health Services Administration, an agency within the federal health department that would itself be eliminated under the draft budget proposal, though some of its programs would continue under a new entity, the Administration for a Healthy America.
In 2024, recipients of the naloxone grants, including cities, tribes and nonprofit groups, trained 66,000 police officers, fire fighters and emergency medical responders, and distributed over 282,500 naloxone kits, according to a spokesman for the substance abuse agency.
'Narcan has been kind of a godsend as far as opioid epidemics are concerned, and we are certainly are in the middle of one now with fentanyl,' said Donald McNamara, who oversees naloxone procurement and training for the Los Angeles County Sheriff's Department. 'We need this funding source because it's saving lives every day.'
Matthew Cushman, a fire department paramedic in Raytown, Mo., said that through the naloxone grant program, he had trained thousands of police officers, firefighters and emergency medical responders throughout Kansas City and western rural areas. The program provides trainees with pouches of naloxone to administer in the field plus 'leave behind' kits with information about detox and treatment clinics.
In 2023, federal figures started to show that national opioid deaths were finally declining, progress that many public health experts attribute in some measure to wider availability of the drug, which the Food and Drug Administration approved for over-the-counter sales that year.
Tennessee reports that between 2017 and 2024, 103,000 lives saved were directly attributable to naloxone. In Kentucky, which trains and supplies emergency medical workers in 68 rural communities, a health department spokeswoman noted that in 2023, overdose fatalities dropped by nearly 10 percent.
And though the focus of the Trump administration's Office of National Drug Control Policy is weighted toward border policing and drug prosecutions, its priorities, released in an official statement this month, include the goal of expanding access to 'lifesaving opioid overdose reversal medications like naloxone.'
'They immediately reference how much they want to support first responders and naloxone distribution,' said Rachel Winograd, director of the addiction science team at the University of Missouri-St. Louis, who oversees the state's federally funded naloxone program. 'Juxtaposing those statements of support with the proposed eliminations is extremely confusing.'
Mr. Cushman, the paramedic in Missouri, said that ending the naloxone grant program would not only cut off a source of the medication to emergency responders but would also stop classes that do significantly more than teach how to administer it.
His cited the insights offered by his co-instructor, Ray Rath, who is in recovery from heroin and is a certified peer support counselor. In training sessions, Mr. Rath recounts how, after a nasal spray of Narcan yanked him back from a heroin overdose, he found himself on the ground, looking up at police officers and emergency medical responders. They were snickering.
'Ah this junkie again, he's just going to kill himself; we're out here for no reason,' he recalled them saying.
Mr. Rath said he speaks with trainees about how the individuals they revive are 'people that have an illness.'
'And once we start treating them like people, they feel like people,' he continued. 'They feel cared about, and they want to make a change.'
He estimated that during the years he used opioids, naloxone revived him from overdoses at least 10 times. He has been in recovery for five years, a training instructor for the last three. He also works in homeless encampments in Kansas, offering services to people who use drugs. The back of his T-shirt reads: 'Hope Dealer.'