Every day, Dora Dantzler-Wright and her colleagues distribute overdose inverted drugs on the streets of Chicago. They hold training sessions on using them, helping people recover from drug and alcohol addiction to work and family.
They work closely with the federal government through agencies that monitor productivity, connect with other like-minded groups, and distribute important funds to continue their work.
However, over the past few weeks, Wright's phone calls and emails to Washington have not been answered. Federal advisors for her group, the Chicago Recovery Community Coalition, and the local offices of the agency that oversees the six Midwest states and 34 tribe addiction programs are gone.
“We continue to work without any renewals from the federal government,” Wright said. “But we are lost.”
By the end of this week, the Department of Substance Abuse and Mental Health Services staff could be cut by 50%, according to senior Congress staff and congressional aides who attended a briefing by Trump officials.
With just under 900 employees and a $7.2 billion budget for large state grants and individual nonprofits dealing with addiction and mental illness, Samhsa (pronounced Sam-Sah) is relatively small. However, it addresses two of the country's most urgent health issues and generally receives bipartisan support.
The agency's broader duties include oversight of 988, a lifeline of national suicide and crisis. Adjustment of outpatient clinics that distribute opioid medications such as methadone. It directs funds to drug courts (also known as “treatment courts”); and generates a national annual survey of substance use and mental health issues.
It provides best practice training and resources to hundreds of nonprofits and state agencies, helping to establish centers that provide prevention, treatment and social services for opioid addiction. It is also a federal watchdog that closely monitors taxpayer-funded grant spending for mental health and addiction.
President Trump and Robert F. Kennedy Jr. are federal health secretaries in the portfolio, including Samsa, and are frank about dealing with the country's drug crisis. Trump has called for overdose deaths as a rationale for imposing tariffs on Canada, Mexico and China. Kennedy often discussed his continued recovery from heroin addiction. During the presidential election, he produced a documentary on the impact of addiction in the United States, exploring a variety of treatment options as well.
Overdose mortality rates in the US remain high, but have been declining consistently since 2023. Many drug policy experts say Samhsa is a federal agency.
“Given the behavioral health crisis affecting every corner of our country, it is extremely dangerous to cut off Samsa's employees without understanding the impact,” he wrote in a letter to Kennedy signed by Oregon's president Paul D. Tonko and 57 members of the Democratic family.
They argued that a decline in staff could lead to a surge in recurrence rates, a strain on the health care system, and a lower overall health outcome.
Asked about the pending cuts, a Samhsa spokesperson said, “Regardless of personnel changes, significant collaborations promoted by Samhsa's local offices continue to be enthusiastic about partners across the country.”
On Tuesday, the Ministry of Health and Human Services announced that housing agencies, including SamHSA, will reduce their numbers from 10 to 4.
Proposals to reduce staff size across the government sector are scheduled for Thursday. Last month, Samhsa staff was cut by about 10% by layoffs for workers on probation. This is a designation that includes people who have recently been promoted to new positions. Last weekend, employees and other staff at the agency overseen by Kennedy received an email offering $25,000 to those who had left their jobs by this Friday, marked as “voluntary separation.”
In the interview, 12 current and former Samhsa employees, including executives, said the threat posed by layoffs and policy changes is beginning to be felt on the site everywhere, from the troubled city neighbourhood centers to the countryside front posts. Most new Samhsa projects are not at risk to better distribute the life-saving overdose drug naloxone, which maps Chicago housing projects.
They said it is unlikely that funding for centers focused on treating mental health or substance use disorders in certain groups, such as the Black and LGBTQ communities, will be reapproved.
Regina Bell, former acting director of the National Drug Management Policy Office during the Biden administration, called staff “myopia.”
“It may reduce numbers, but it reduces surveillance and accountability,” she said.
During the Biden administration, agency budgets and staff have grown significantly. This is a development described by mental health and addiction experts as an attempt to compensate for the sustained funding shortage. In 2019, just before the start of the pandemic, Samhsa had around 490 full-time staff and a budget of around $5.5 billion. According to the Centers for Disease Control and Prevention, 70,630 people died from overdose that year.
In March 2020, the pandemic collapsed. Over the next three years, annual overdose deaths have skyrocketed well above 100,000. Mental health issues, including suicide deaths, have skyrocketed. There was bipartisan support for Samhsa's budget increase.
There is now a wide range of talks that the Trump administration could fold Samsa into another health agency, or return funds to overdose deaths than in 2019, or funds at 2019 levels.
