Addiction treatment providers in Mass. worry about federal funding cuts

A new federal report showing a dramatic drop in drug overdose deaths across the U.S. is welcome news for many Massachusetts addiction treatment providers, but they're concerned some of the same programs that helped reduce deaths are now jeopardized by proposed federal funding cuts.

The Trump administration's budget plan released this month calls for $1.1 billion in reductions to the Substance Abuse and Mental Health Services Administration. If approved by Congress, the loss would follow nearly $11.4 billion in cancelled or revoked COVID-era grants for addiction treatment, mental health and other programs.

Some addiction treatment providers in Massachusetts told WBUR they are reassessing their budgets and leaving positions vacant as they consider the impact of potential federal cutbacks.

"COVID was a picnic compared to this," said Sarah Porter, president and CEO of Victory Programs, which provides housing, mental health and substance use disorder services to about 5,000 people annually.

Skyrocketing overdose deaths sparked by the COVID-19 pandemic and a deluge of deadly fentanyl in the nation's drug supply led many programs like Porter's to expand with federal support. Now, she said her organization is experiencing "a series of paper cuts" and an uncertain future.

"We all grew really fast because the need grew, and money was there," Porter said. "And now it's not a slow roll down, it's a cliff. And how do you do that without causing people to suffer? Those are the things that anyone who sits in the chair I sit in, that's what keeps us up at night."

Overdose deaths in Massachusetts dropped by more than 30% from November 2023 to November 2024, according to the latest provisional numbers from the Centers for Disease Control and Prevention. The nation's 27% reduction over the same period is the largest single-year decline ever recorded.

Porter and other addiction treatment providers attributed the drop in deaths to several potential reasons, including the availability of the overdose reversal drug naloxone, marketed under the brand name Narcan. The drug is credited with saving tens of thousands of lives. Advocates said they're concerned deep federal cuts could curtail the affordability, or even the availability, of naloxone.

Naloxone is often distributed by groups that offer clean needles and other drug supplies, as part of a "harm reduction" strategy. The goal is to prevent disease and death, and provide health care, substance abuse treatment and other services for people who use drugs. Critics, including the Trump administration, argue the practice enables drug use.

"Unfortunately, under the previous administration, SAMHSA grants were
used to fund dangerous activities billed as 'harm reduction,' which included funding 'safe smoking kits and supplies' and 'syringes' for drug users," President Trump's budget said.

Leaders of organizations that provide services, like Porter, say overdose deaths have dropped, but addiction is still prevalent and drug overdoses still happen.

"People might not be dying, but they may be living on the streets," Porter said. "And our beds are full. We have a waitlist of months and months and months to get a treatment bed."

In addition to cuts for SAMSHA, reductions in other federal funding could affect services related to substance use treatment. After receiving word that a federal Housing and Urban Development grant was cut, Porter canceled a housing program for women that Victory Programs planned to launch this year. She said she had to forfeit the $14,000 she paid to lease a building in Roxbury. She's also making budget cuts for this year.

The picture is different for programs that rely more on private health insurance paymens than federal funding. Spectrum Health Systems, the largest addiction treatment provider in Massachusetts, serves about 5,600 patients a day with 280 treatment beds and 15 outpatient programs. The nonprofit is expanding.

Spectrum just opened new administrative and admissions offices in Westboro and is wrapping up a more than $9 million expansion in Lowell. About 40% of its patients are covered by MassHealth, the state's Medicaid program.

" We're gonna be around, and we have the resources to weather the storm," said Kurt Isaacson, president and CEO of Spectrum Health Systems.

Isaacson does worry about potential cuts to federal Medicaid spending. Congress may cut the budget for the program, which provides health insurance to low-income residents through a combination of federal and state funding.

Porter estimates that 98% of Victory Programs' clients are Medicaid recipients, so cuts to the program would be devastating.

" I don't even know how to get my brain around it," Porter said. "I do not know what will happen. Our entire treatment programs would disappear."

If federal cuts are deep enough, said Isaacson, care might have to be rationed or the state may be asked to step in.

" I worry about the future of health care and especially those who are underserved and poor," he said. "I just don't think that Massachusetts at this point has the wherewithal to be able to supplant any cuts that come from the federal government easily."

State public health officials say they expect federal grants to be level-funded and to maintain current service levels this year.

However they say they're  planning for potential future reductions in federal spending, which accounts for about a third of the budget of the Bureau of Addiction Services at the state Department of Public Health. The agency pays for addiction treatment when a patient doesn't have insurance coverage.

"We're definitely in a planning stage, making sure that our core values and missions are protected and that we can serve the people that we've been serving," said bureau Director Deirdre Calvert.

Most long-term residential treatment programs in Massachusetts have long waitlists, and the state will try to maintain all beds, as well as detox programs and recovery coaching services, according to Calvert. The state licenses more than 500 addiction treatment providers and helps distribute naloxone and drug testing strips that detect fentanyl.

Gov. Maura Healey recently signed legislation that expands access to overdose reversal drugs and licenses recovery coaches.

But Calvert and treatment organization leaders expressed concerns about a Congressional proposal to impose work requirements on Medicaid recipients. Research suggests that such a requirement would cause of millions of people to lose health care coverage. Isaacson said it would hit people with active addictions particularly hard.

"Very few people have just an addiction," Isaacson said. "There's always something underlying it in terms of behavioral health. There's a certain cadre of our clients that just would not be able to work even though probably the federal government would say that they could."

Calvert's agency would be stuck with treatment bills if people lose Medicaid. And because the drug supply is changing, she said, government agencies and organizations that provide services need to be prepared for whatever comes next.

"Right now it's a very chaotic landscape," Calvert said. "We just can't take our foot off the gas."

Correction: The name of the largest provider of substance use disorder treatment in Massachusetts is Spectrum Health Systems, not Spectrum Health Services. We regret the error.