The FY 2027 President’s Budget Request: What’s at Stake for Federal Overdose Prevention Funding

By Overdose Prevention Initiative, Global Health Advocacy Incubator (an initiative of the Campaign for Tobacco-Free Kids)

On April 3, 2026, the White House released the Fiscal Year (FY) 2027 President’s Budget Request. It proposes deep cuts to federal substance use disorder (SUD) and overdose prevention programs. The Budget Request is not law, as Congress writes and passes the appropriations bills. But the Budget Request does highlight the Administration’s priorities and may foreshadow where cuts will occur.

The Budget Request proposes major changes to federal spending.

The Budget Request asks Congress for $1.5 trillion in defense spending — a 42% increase over last year — paired with a $73 billion (10%) cut to non-defense spending. The Department of Health and Human Services (HHS) would absorb one of the largest cuts, $15.8 billion (12.5%) less than last year’s budget.

ONDCP’s role in federal policy would be significantly reduced.

Among the largest structural shifts within the request is the White House Office of National Drug Control Policy (ONDCP). The request would strip ONDCP down to a budget of $21.785 million— a 95% cut from FY 2026 — and eliminate or transfer its federal drug control programs elsewhere.

The Administration frames this as letting ONDCP “focus on coordination.” However, when the central coordinating office for federal drug policy shrinks and its programs scatter, alignment becomes harder.

Several agencies within HHS would be consolidated into a new agency, with less total funding for behavioral health programs.

For the second time in as many years, the Budget Request proposes to consolidate many federal agencies and programs into a new Administration for a Healthy America (AHA). If adopted, this would eliminate more than 100 programs across HHS and the Substance Abuse and Mental Health Services Administration (SAMHSA) would cease to exist. Congress rejected this same proposal last year.

The total program funding level in the Budget Request for AHA’s Mental and Behavioral Health division is $6.8 billion for all transferred programs, which is $576.2 million below the current funding for the same programs.

As part of HHS’ consolidation, the Budget Request proposes to eliminate more than 25 of SAMHSA’s Programs of Regional and National Significance (PRNS)—the competitive grants that fund specific initiatives targeting priority populations or areas of concern. These grants supplement SAMHSA’s broader behavioral health grants by delivering dedicated funding for a range of programs, including prevention coalitions, workforce development, crisis response and culturally specific care.

Combined, the PRNS cuts alone would result in $591.4 million less in prevention, treatment and recovery grants going to providers and communities. Overall cuts to SAMHSA’s discretionary budget authority would amount to $752.9 million (10.1%), with prevention programs proposed to be hit the hardest— $222.2 million decrease (92.2%).

SAMHSA’s three main grants would be merged into one program.

Another notable proposal for overdose prevention within the AHA consolidation is the Behavioral Health Innovation (BHI) Block Grant, which would combine SAMHSA’s three main behavioral health grants¹, including the State Opioid Response grant, into a single program. The total amount of funding is level.

Unfortunately, the need for these grants is anticipated to be even higher as 1.6 million Medicaid enrollees with a substance use disorder are estimated to lose coverage with the impending changes to Medicaid from the One Big Beautiful Bill Act. Additionally, once those dollars disappear into a single grant, tracking whether they actually are used for overdose programming may become more difficult.

NIH would be restructured, with reduced funding for substance use disorder research.

The request also seeks to restructure the National Institutes of Health (NIH), consolidating the National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism and cutting $160.7 million (7%) from existing funding to the two agencies. Additionally, NIH’s overall discretionary budget would be cut by $3.5 billion.

NIH-funded research is one reason we know what works – from naloxone to medication treatment to behavioral approaches. Less research will mean less information to inform clinicians and communities about how to address the crisis.

OD2A would be moved from the CDC to the new AHA.

CDC’s National Center for Injury Prevention and Control runs Overdose Data to Action (OD2A), the surveillance program that 90 state and local health departments use to rapidly track and respond to changes in fatal and nonfatal overdose trends. The Administration tried to eliminate the Injury Center last year, though Congress restored it. The Budget Request proposes moving CDC’s overdose portfolio under the AHA umbrella. Moving OD2A to a new agency risks destabilizing the early-warning system that catches drug-supply changes and prompts robust community responses.

What happens next?

The President’s Budget Request is the start of the appropriations conversation, not the end of it. The FY 2026 process is the recent precedent: the Administration proposed eliminating SAMHSA and the CDC Injury Center, and Congress — on a bipartisan basis — kept both intact and rejected the AHA consolidation. The conversation will play out over the coming months for FY 2027, through committee markups, floor votes and conference negotiations.

More information on the FY 2027 President’s Budget Request, including detailed tables tracking funding levels for key SUD and overdose prevention programs, can be found on GHAI’s webpage, here and here.

For advocates who want to engage the federal budget process directly, the Overdose Prevention Initiative’s U.S. Federal Advocacy Action Guide, available free on the Health Advocacy Training and Collaboration Hub (HATCH), walks through how the cycle works and how community-level evidence can inform it.

Footnotes: [1] These three grants are the State Opioid Response grant, the Substance Use Prevention, Treatment, and Recovery Services Block Grant and the Community Mental Health Services Block Grant.