Proposed federal cuts threaten state and local substance use programs

By Josh Rising, MD

President Trump’s proposed budget for the Department of Health and Human Services, released in May 2025, cuts or eliminates many programs currently funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). 

One of the mechanisms through which SAMHSA funding supports substance use-related services for states, cities, counties, and local organizations is currently facing major cuts. It’s called Programs of Regional and National Significance or PRNS.

PRNSs are focused in specific topic areas, such as providing resources and training to first responders, supporting pregnant and postpartum women, and expanding the capacity of the treatment system. PRNS allow communities to apply for funding to support specific issues, populations, or activities unique to their circumstances. They are competitive in nature, which encourages innovation and enables communities to procure support for programs that address the specific challenges they face.

SAMHSA awards PRNS grants in three areas: mental health, substance use prevention, and substance use treatment. The proposed budget cuts over $1 billion dollars from the PRNS, with the vast majority of the programs completely eliminated. The SAMHSA dashboard provides details on programs currently receiving money from SAMHSA through PRNS; it can be searched by state to understand the scope of the cuts of the program.

What else should I know about PRNS cuts?

• These cuts are not made up elsewhere in the budget. Aside from PRNS, SAMHSA also provides dollars directly to states through the mental health block grant and the substance use block grant. The proposed budget combines these with the State Opioid Response grant to create a single consolidated block grant – the Behavioral Health Innovation Block Grant. However, the budget for this new block grant reduces spending by approximately $500 million compared to what states currently receive through these three distinct programs. 
• PRNS are unique from block grants in that they allow communities to apply for funding to support specific issues, populations, or activities unique to their circumstances rather than being distributed to states via predeterminated formulas. They are competitive in nature, encouraging innovation and enabling communities to procure support for programs that address their specific, unique needs. 
• These cuts will hit particularly hard after the passage of the reconciliation bill that reduces Medicaid funding by $1 trillion. As people lose Medicaid coverage, there may be fewer other services available to them to help them overcome their addiction.

What are examples of PRNS grants that will be eliminated?

First Responder Training–Comprehensive Addiction and Recovery Act (FR-CARA)

• Funding level: $56 million in FY 2024
• Purpose: Provides resources and training to first responders and other frontline workers, including how to use naloxone; focuses on communities with high rates of opioid overdose and rural communities
• Results: In 2023, FR-CARA trained over 70,000 first responders and community members and purchased over 100,000 doses of overdose reversal agents. 

Pregnant and Postpartum Women (PPW)

• Funding level:  $38 million in FY 2024
• Purpose: Funds comprehensive substance use disorder treatment, care management, prevention, and other social support services for pregnant and postpartum women
• Results: In 2023, nearly 1,400 pregnant and postpartum women received services in residential facilities and almost 900 in outpatient settings. 

Children and Families

• Funding level: $30 million in FY 2024
• Purpose: Supports evidence-based, family-friendly treatment programs for youth with substance use disorders
• Results: Over 2,700 people received services from the program in 2023.

Treatment, Recovery and Workforce Support (TRWS) 

• Funding level: $12 million in FY 2024
• Purpose: Supports individuals in substance use disorder treatment and recovery in living independently and working. 
• Results: Over 2,000 people received services in 2023. 

Criminal Justice Activities

• Funding level: $94 million in FY 2024
• Purpose: Supports several programs assisting individuals with carceral system involvement, including diversion or other alternatives to incarceration, drug courts (including drug courts for families), and reentry programming 
• Results: Drug courts funded through this program served over 7,000 people in 2023, while the adult reentry program reached over 2,000 people. 

How much PRNS funding does each state receive?

Below is a table listing all of the money currently coming to each state through PRNS funding; approximately $1 billion would be eliminated should the proposed budget pass.

[1]  Information retrieved from SAMHSA’s dashboard. The amount listed here does not include money going to the state as part of the mental health and substance use block grants, the state and tribal opioid response grants, or for improvements to local 988 capacity.  

Josh Rising, MD, MPH, is a pediatrician with extensive experience, both inside and outside of government, working on strategies to address the opioid epidemic. He operates at the intersection of medicine, health policy, and public health, using his skills and expertise to advocate for evidence-based policies at the federal and state level that improve the health and well-being of communities.