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Tracking FY2019 Federal Funding to Combat the Opioid Crisis

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
WA OR CA ID NV WY WV WI VT VA UT TX TN SD SC RI PA OK OH NM NY NJ NH NE ND NC MT MS MO MN MI ME MD MA LA KY KS IN IL IA HI GA FL DE CT CO AZ AR AL AK DC
Rhode Island

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Alaska

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Alabama

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Arkansas

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Arizona

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California

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Colorado

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Connecticut

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District Of Columbia

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Delaware

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Florida

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Georgia

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Hawaii

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Iowa

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Idaho

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Illinois

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Indiana

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Kansas

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Kentucky

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Louisiana

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Massachusetts

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Maryland

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Maine

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Michigan

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Minnesota

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Missouri

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Mississippi

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Montana

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North Carolina

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North Dakota

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Nebraska

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New Hampshire

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New Jersey

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New Mexico

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Nevada

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New York

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Ohio

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Pennsylvania

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Oregon

State Fact Sheet

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Oklahoma

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South Carolina

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South Dakota

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Tennessee

State Fact Sheet

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Utah

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Texas

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Virginia

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Vermont

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Washington

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West Virginia

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Wisconsin

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Wyoming

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Rhode Island

Opioid Appropriation FY2017
$19,146,633

Opioid Appropriation FY2018
$50,563,765

Opioid Appropriation FY2019
$73,061,882

Alaska

Opioid Appropriation FY2017
$21,198,561

Opioid Appropriation FY2018
$53,050,465

Opioid Appropriation FY2019
$44,650,497

Alabama

Opioid Appropriation FY2017
$43,860,327

Opioid Appropriation FY2018
$69,912,077

Opioid Appropriation FY2019
$73,578,224

Arkansas

Opioid Appropriation FY2017
$22,399,930

Opioid Appropriation FY2018
$41,996,000

Opioid Appropriation FY2019
$41,845,696

Arizona

Opioid Appropriation FY2017
$75,873,531

Opioid Appropriation FY2018
$117,058,843

Opioid Appropriation FY2019
$139,859,840

California

Opioid Appropriation FY2017
$364,569,789

Opioid Appropriation FY2018
$548,489,519

Opioid Appropriation FY2019
$652,367,089

Colorado

Opioid Appropriation FY2017
$49,927,949

Opioid Appropriation FY2018
$91,696,704

Opioid Appropriation FY2019
$87,215,332

Connecticut

Opioid Appropriation FY2017
$35,303,386

Opioid Appropriation FY2018
$67,348,529

Opioid Appropriation FY2019
$77,150,404

District Of Columbia

Opioid Appropriation FY2017
$14,267,239

Opioid Appropriation FY2018
$44,216,229

Opioid Appropriation FY2019
$74,105,652

Delaware

Opioid Appropriation FY2017
$14,543,097

Opioid Appropriation FY2018
$34,744,577

Opioid Appropriation FY2019
$46,870,377

Florida

Opioid Appropriation FY2017
$185,447,801

Opioid Appropriation FY2018
$316,405,223

Opioid Appropriation FY2019
$316,476,826

Georgia

Opioid Appropriation FY2017
$84,430,130

Opioid Appropriation FY2018
$132,998,291

Opioid Appropriation FY2019
$142,925,918

Hawaii

Opioid Appropriation FY2017
$15,709,404

Opioid Appropriation FY2018
$26,436,867

Opioid Appropriation FY2019
$28,033,928

Iowa

Opioid Appropriation FY2017
$23,346,291

Opioid Appropriation FY2018
$49,997,317

Opioid Appropriation FY2019
$47,604,843

Idaho

Opioid Appropriation FY2017
$12,398,126

Opioid Appropriation FY2018
$27,790,100

Opioid Appropriation FY2019
$25,508,581

Illinois

Opioid Appropriation FY2017
$107,042,293

Opioid Appropriation FY2018
$178,793,497

Opioid Appropriation FY2019
$209,177,680

Indiana

Opioid Appropriation FY2017
$50,024,921

Opioid Appropriation FY2018
$108,772,192

Opioid Appropriation FY2019
$105,098,932

Kansas

Opioid Appropriation FY2017
$21,918,110

Opioid Appropriation FY2018
$40,167,997

Opioid Appropriation FY2019
$34,544,413

Kentucky

Opioid Appropriation FY2017
$66,408,740

Opioid Appropriation FY2018
$120,875,500

Opioid Appropriation FY2019
$150,737,959

Louisiana

Opioid Appropriation FY2017
$48,259,917

Opioid Appropriation FY2018
$81,933,435

Opioid Appropriation FY2019
$75,251,417

Massachusetts

Opioid Appropriation FY2017
$72,960,072

Opioid Appropriation FY2018
$169,441,406

Opioid Appropriation FY2019
$231,151,954

Maryland

Opioid Appropriation FY2017
$53,224,534

Opioid Appropriation FY2018
$130,751,728

Opioid Appropriation FY2019
$181,935,302

Maine

Opioid Appropriation FY2017
$18,884,506

Opioid Appropriation FY2018
$35,122,449

Opioid Appropriation FY2019
$41,375,330

Michigan

Opioid Appropriation FY2017
$91,562,258

Opioid Appropriation FY2018
$164,361,989

Opioid Appropriation FY2019
$174,511,148

Minnesota

Opioid Appropriation FY2017
$46,527,511

Opioid Appropriation FY2018
$70,739,292

Opioid Appropriation FY2019
$83,786,718

Missouri

Opioid Appropriation FY2017
$53,905,666

Opioid Appropriation FY2018
$102,108,271

Opioid Appropriation FY2019
$113,083,826

Mississippi

Opioid Appropriation FY2017
$23,583,817

Opioid Appropriation FY2018
$44,090,772

Opioid Appropriation FY2019
$47,044,700

Montana

Opioid Appropriation FY2017
$15,938,132

Opioid Appropriation FY2018
$37,542,818

Opioid Appropriation FY2019
$34,382,513

North Carolina

Opioid Appropriation FY2017
$72,435,544

Opioid Appropriation FY2018
$135,533,764

Opioid Appropriation FY2019
$294,456,833

North Dakota

Opioid Appropriation FY2017
$11,145,255

Opioid Appropriation FY2018
$22,959,895

Opioid Appropriation FY2019
$18,845,026

Nebraska

Opioid Appropriation FY2017
$15,532,200

Opioid Appropriation FY2018
$26,529,616

Opioid Appropriation FY2019
$25,383,660

New Hampshire

Opioid Appropriation FY2017
$16,019,880

Opioid Appropriation FY2018
$59,505,426

Opioid Appropriation FY2019
$66,128,282

New Jersey

Opioid Appropriation FY2017
$74,481,778

Opioid Appropriation FY2018
$117,544,570

Opioid Appropriation FY2019
$124,532,970

New Mexico

Opioid Appropriation FY2017
$32,566,825

Opioid Appropriation FY2018
$57,500,191

Opioid Appropriation FY2019
$62,763,225

Nevada

Opioid Appropriation FY2017
$34,400,983

Opioid Appropriation FY2018
$55,597,023

Opioid Appropriation FY2019
$53,226,389

New York

Opioid Appropriation FY2017
$198,909,499

Opioid Appropriation FY2018
$297,262,882

Opioid Appropriation FY2019
$387,987,985

Ohio

Opioid Appropriation FY2017
$119,030,865

Opioid Appropriation FY2018
$224,921,519

Opioid Appropriation FY2019
$271,552,490

Pennsylvania

Opioid Appropriation FY2017
$120,813,117

Opioid Appropriation FY2018
$225,826,998

Opioid Appropriation FY2019
$284,658,674

Oregon

Opioid Appropriation FY2017
$41,331,972

Opioid Appropriation FY2018
$76,925,678

Opioid Appropriation FY2019
$65,802,751

Oklahoma

Opioid Appropriation FY2017
$35,088,042

Opioid Appropriation FY2018
$84,599,594

Opioid Appropriation FY2019
$77,528,184

South Carolina

Opioid Appropriation FY2017
$36,414,618

Opioid Appropriation FY2018
$66,384,911

Opioid Appropriation FY2019
$72,016,561

South Dakota

Opioid Appropriation FY2017
$11,152,429

Opioid Appropriation FY2018
$27,498,547

Opioid Appropriation FY2019
$26,637,638

Tennessee

Opioid Appropriation FY2017
$63,402,093

Opioid Appropriation FY2018
$114,604,103

Opioid Appropriation FY2019
$114,602,320

Utah

Opioid Appropriation FY2017
$32,212,320

Opioid Appropriation FY2018
$54,103,659

Opioid Appropriation FY2019
$62,975,339

Texas

Opioid Appropriation FY2017
$217,687,949

Opioid Appropriation FY2018
$315,550,335

Opioid Appropriation FY2019
$335,938,680

Virginia

Opioid Appropriation FY2017
$59,194,571

Opioid Appropriation FY2018
$126,695,918

Opioid Appropriation FY2019
$134,461,429

Vermont

Opioid Appropriation FY2017
$14,231,681

Opioid Appropriation FY2018
$27,791,831

Opioid Appropriation FY2019
$36,663,960

Washington

Opioid Appropriation FY2017
$71,006,955

Opioid Appropriation FY2018
$129,210,979

Opioid Appropriation FY2019
$156,021,509

West Virginia

Opioid Appropriation FY2017
$24,130,543

Opioid Appropriation FY2018
$72,425,625

Opioid Appropriation FY2019
$87,387,034

Wisconsin

Opioid Appropriation FY2017
$57,307,167

Opioid Appropriation FY2018
$95,405,776

Opioid Appropriation FY2019
$98,754,977

Wyoming

Opioid Appropriation FY2017
$9,576,451

Opioid Appropriation FY2018
$15,986,485

Opioid Appropriation FY2019
$15,566,273

  • Profiled in report
Rhode Island

State Fact Sheet

Opioid Appropriation FY2017
$19,146,633

Opioid Appropriation FY2018
$50,563,765

Opioid Appropriation FY2019
$73,061,882

Alaska

State Fact Sheet

Opioid Appropriation FY2017
$21,198,561

Opioid Appropriation FY2018
$53,050,465

Opioid Appropriation FY2019
$44,650,497

Alabama

State Fact Sheet

Opioid Appropriation FY2017
$43,860,327

Opioid Appropriation FY2018
$69,912,077

Opioid Appropriation FY2019
$73,578,224

Arkansas

State Fact Sheet

Opioid Appropriation FY2017
$22,399,930

Opioid Appropriation FY2018
$41,996,000

Opioid Appropriation FY2019
$41,845,696

Arizona

State Fact Sheet

Opioid Appropriation FY2017
$75,873,531

Opioid Appropriation FY2018
$117,058,843

Opioid Appropriation FY2019
$139,859,840

California

State Fact Sheet

Opioid Appropriation FY2017
$364,569,789

Opioid Appropriation FY2018
$548,489,519

Opioid Appropriation FY2019
$652,367,089

Colorado

State Fact Sheet

Opioid Appropriation FY2017
$49,927,949

Opioid Appropriation FY2018
$91,696,704

Opioid Appropriation FY2019
$87,215,332

Connecticut

State Fact Sheet

Opioid Appropriation FY2017
$35,303,386

Opioid Appropriation FY2018
$67,348,529

Opioid Appropriation FY2019
$77,150,404

District Of Columbia

State Fact Sheet

Opioid Appropriation FY2017
$14,267,239

Opioid Appropriation FY2018
$44,216,229

Opioid Appropriation FY2019
$74,105,652

Delaware

State Fact Sheet

Opioid Appropriation FY2017
$14,543,097

Opioid Appropriation FY2018
$34,744,577

Opioid Appropriation FY2019
$46,870,377

Florida

State Fact Sheet

Opioid Appropriation FY2017
$185,447,801

Opioid Appropriation FY2018
$316,405,223

Opioid Appropriation FY2019
$316,476,826

Georgia

State Fact Sheet

Opioid Appropriation FY2017
$84,430,130

Opioid Appropriation FY2018
$132,998,291

Opioid Appropriation FY2019
$142,925,918

Hawaii

State Fact Sheet

Opioid Appropriation FY2017
$15,709,404

Opioid Appropriation FY2018
$26,436,867

Opioid Appropriation FY2019
$28,033,928

Iowa

State Fact Sheet

Opioid Appropriation FY2017
$23,346,291

Opioid Appropriation FY2018
$49,997,317

Opioid Appropriation FY2019
$47,604,843

Idaho

State Fact Sheet

Opioid Appropriation FY2017
$12,398,126

Opioid Appropriation FY2018
$27,790,100

Opioid Appropriation FY2019
$25,508,581

Illinois

State Fact Sheet

Opioid Appropriation FY2017
$107,042,293

Opioid Appropriation FY2018
$178,793,497

Opioid Appropriation FY2019
$209,177,680

Indiana

State Fact Sheet

Opioid Appropriation FY2017
$50,024,921

Opioid Appropriation FY2018
$108,772,192

Opioid Appropriation FY2019
$105,098,932

Kansas

State Fact Sheet

Opioid Appropriation FY2017
$21,918,110

Opioid Appropriation FY2018
$40,167,997

Opioid Appropriation FY2019
$34,544,413

Kentucky

State Fact Sheet

Opioid Appropriation FY2017
$66,408,740

Opioid Appropriation FY2018
$120,875,500

Opioid Appropriation FY2019
$150,737,959

Louisiana

State Fact Sheet

Opioid Appropriation FY2017
$48,259,917

Opioid Appropriation FY2018
$81,933,435

Opioid Appropriation FY2019
$75,251,417

Massachusetts

State Fact Sheet

Opioid Appropriation FY2017
$72,960,072

Opioid Appropriation FY2018
$169,441,406

Opioid Appropriation FY2019
$231,151,954

Maryland

State Fact Sheet

Opioid Appropriation FY2017
$53,224,534

Opioid Appropriation FY2018
$130,751,728

Opioid Appropriation FY2019
$181,935,302

Maine

State Fact Sheet

Opioid Appropriation FY2017
$18,884,506

Opioid Appropriation FY2018
$35,122,449

Opioid Appropriation FY2019
$41,375,330

Michigan

State Fact Sheet

Opioid Appropriation FY2017
$91,562,258

Opioid Appropriation FY2018
$164,361,989

Opioid Appropriation FY2019
$174,511,148

Minnesota

State Fact Sheet

Opioid Appropriation FY2017
$46,527,511

Opioid Appropriation FY2018
$70,739,292

Opioid Appropriation FY2019
$83,786,718

Missouri

State Fact Sheet

Opioid Appropriation FY2017
$53,905,666

Opioid Appropriation FY2018
$102,108,271

Opioid Appropriation FY2019
$113,083,826

Mississippi

State Fact Sheet

Opioid Appropriation FY2017
$23,583,817

Opioid Appropriation FY2018
$44,090,772

Opioid Appropriation FY2019
$47,044,700

Montana

State Fact Sheet

Opioid Appropriation FY2017
$15,938,132

Opioid Appropriation FY2018
$37,542,818

Opioid Appropriation FY2019
$34,382,513

North Carolina

State Fact Sheet

Opioid Appropriation FY2017
$72,435,544

Opioid Appropriation FY2018
$135,533,764

Opioid Appropriation FY2019
$294,456,833

North Dakota

State Fact Sheet

Opioid Appropriation FY2017
$11,145,255

Opioid Appropriation FY2018
$22,959,895

Opioid Appropriation FY2019
$18,845,026

Nebraska

State Fact Sheet

Opioid Appropriation FY2017
$15,532,200

Opioid Appropriation FY2018
$26,529,616

Opioid Appropriation FY2019
$25,383,660

New Hampshire

State Fact Sheet

Opioid Appropriation FY2017
$16,019,880

Opioid Appropriation FY2018
$59,505,426

Opioid Appropriation FY2019
$66,128,282

New Jersey

State Fact Sheet

Opioid Appropriation FY2017
$74,481,778

Opioid Appropriation FY2018
$117,544,570

Opioid Appropriation FY2019
$124,532,970

New Mexico

State Fact Sheet

Opioid Appropriation FY2017
$32,566,825

Opioid Appropriation FY2018
$57,500,191

Opioid Appropriation FY2019
$62,763,225

Nevada

State Fact Sheet

Opioid Appropriation FY2017
$34,400,983

Opioid Appropriation FY2018
$55,597,023

Opioid Appropriation FY2019
$53,226,389

New York

State Fact Sheet

Opioid Appropriation FY2017
$198,909,499

Opioid Appropriation FY2018
$297,262,882

Opioid Appropriation FY2019
$387,987,985

Ohio

State Fact Sheet

Opioid Appropriation FY2017
$119,030,865

Opioid Appropriation FY2018
$224,921,519

Opioid Appropriation FY2019
$271,552,490

Pennsylvania

State Fact Sheet

Opioid Appropriation FY2017
$120,813,117

Opioid Appropriation FY2018
$225,826,998

Opioid Appropriation FY2019
$284,658,674

Oregon

State Fact Sheet

Opioid Appropriation FY2017
$41,331,972

Opioid Appropriation FY2018
$76,925,678

Opioid Appropriation FY2019
$65,802,751

Oklahoma

State Fact Sheet

Opioid Appropriation FY2017
$35,088,042

Opioid Appropriation FY2018
$84,599,594

Opioid Appropriation FY2019
$77,528,184

South Carolina

State Fact Sheet

Opioid Appropriation FY2017
$36,414,618

Opioid Appropriation FY2018
$66,384,911

Opioid Appropriation FY2019
$72,016,561

South Dakota

State Fact Sheet

Opioid Appropriation FY2017
$11,152,429

Opioid Appropriation FY2018
$27,498,547

Opioid Appropriation FY2019
$26,637,638

Tennessee

State Fact Sheet

Opioid Appropriation FY2017
$63,402,093

Opioid Appropriation FY2018
$114,604,103

Opioid Appropriation FY2019
$114,602,320

Utah

State Fact Sheet

Opioid Appropriation FY2017
$32,212,320

Opioid Appropriation FY2018
$54,103,659

Opioid Appropriation FY2019
$62,975,339

Texas

State Fact Sheet

Opioid Appropriation FY2017
$217,687,949

Opioid Appropriation FY2018
$315,550,335

Opioid Appropriation FY2019
$335,938,680

Virginia

State Fact Sheet

Opioid Appropriation FY2017
$59,194,571

Opioid Appropriation FY2018
$126,695,918

Opioid Appropriation FY2019
$134,461,429

Vermont

State Fact Sheet

Opioid Appropriation FY2017
$14,231,681

Opioid Appropriation FY2018
$27,791,831

Opioid Appropriation FY2019
$36,663,960

Washington

State Fact Sheet

Opioid Appropriation FY2017
$71,006,955

Opioid Appropriation FY2018
$129,210,979

Opioid Appropriation FY2019
$156,021,509

West Virginia

State Fact Sheet

Opioid Appropriation FY2017
$24,130,543

Opioid Appropriation FY2018
$72,425,625

Opioid Appropriation FY2019
$87,387,034

Wisconsin

State Fact Sheet

Opioid Appropriation FY2017
$57,307,167

Opioid Appropriation FY2018
$95,405,776

Opioid Appropriation FY2019
$98,754,977

Wyoming

State Fact Sheet

Opioid Appropriation FY2017
$9,576,451

Opioid Appropriation FY2018
$15,986,485

Opioid Appropriation FY2019
$15,566,273

U.S. Territories:

Based on the State Analysis, There Are Several Takeaways:

  1. 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.

  2. 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.

  3. 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.

  4. 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:

  1. 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.
  2. 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.
  3. 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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