People in the United States are in the midst of an ongoing opioid epidemic and a wave of mental health problems.
So funding and staff cuts to a federal agency that supports mental health care, suicide prevention, and addiction treatment, the Substance Abuse and Mental Health Services Administration, or SAMHSA, has worried people who work on substance use disorders and mental health.
“We’ve got some challenges — big ones,” says Keith Humphreys, a psychologist at Stanford University. He has served on the SAMHSA National Advisory Council and as a senior policy adviser at the White House Office of National Drug Control Policy. “It seems like a bad time for the government to say, ‘Well, we’re not doing this anymore.’”
The problems are large. In 2017, President Trump designated opioid overdoses as a public health emergency, a crisis that is still happening. And it’s not just opioids. In 2023, nearly 50 million Americans ages 12 and over were estimated to meet the criteria for a substance use disorder.
And about 1 in 4 adults have a mental health disorder in a given year. Teenagers and young adults in particular are struggling: In 2023, over half of adolescent girls reported long-lasting feelings of sadness and hopelessness, according to the U.S. Centers for Disease Control and Prevention.
In recent months, SAMHSA workers have been fired, its funding has been put in jeopardy and the agency itself has been rolled into a newly created umbrella entity called the Administration for a Healthy America.
This culling and reorganization are “part of ongoing efforts to improve the efficiency and effectiveness of public health programs,” Department of Health and Human Services Deputy Press Secretary Emily Hilliard wrote in a statement.
Here’s a look at some of the ways SAMHSA has helped Americans grappling with substance use disorders and mental health challenges, and those supporting loved ones in these struggles — efforts that could be stopped or altered with recent changes.
Opioid treatment programs depend on SAMHSA
Opioid use disorder contributes to untold suffering in the United States, and SAMHSA officials have provided guidance to states on the most effective treatments for people in the grips of opioid addiction. SAMHSA workers help certify and accredit outpatient opioid treatment programs, which can provide medicines to help recovery, ensuring the programs are safe and effective. More than 1,900 such programs exist nationwide, collectively helping more than 600,000 people each year.
These programs have been evolving, too, in efforts to help the most people in the ways they need. In Washington state, for instance, 15 mobile medication units provide treatment to people who can’t easily reach clinics. The creation of this responsive fleet wouldn’t have been possible without SAMHSA expertise, says Jessica Blose, an addiction expert who serves as the Washington State Opioid Treatment Authority, a role that supports and regulates treatment programs. “We couldn’t have created a regulatory path to establish and support this many sites without their expert guidance and support.”
In recent years, the number of U.S. opioid overdose deaths has decreased. From October 2023 to September 2024, for instance, there were about 87,000 deaths from drug overdoses, provisional CDC data show. That number was about 114,000 in the prior year’s same period. This reduction is welcome, but it may not be the good news it seems to be. The COVID-19 pandemic brought a spike of overdose deaths. Now, overdoses have declined from that extreme peak, but the numbers still aren’t good, Humphreys says. “I’m glad it’s going down, obviously, but we are not on a good curve.”
Beyond overdose deaths, there’s still a lot of suffering that comes with opioid use disorder. “For every person who overdoses, we’ve got 10 people who are addicted,” Humphreys says. “Being addicted is really tough on them, and their families, and their neighbors, and their kids and their employers. So it’s still pretty bad out there.” Any changes to SAMHSA that affect addiction treatment could have severe consequences, he says.
The agency runs a crucial database on drug use and mental health
SAMHSA also oversees the long-running National Survey on Drug Use and Health, which provides a comprehensive snapshot of drug use and mental health in the United States. The survey, which was established in 1971, is “the main way we know things like how many people in the United States are depressed, how many people in the United States have access to psychotherapy, how many want addiction treatment and haven’t been able to get it, how many people smoke, how many people drink too much,” Humphreys says.
On April 1, federal employees responsible for this survey lost their jobs, according to multiple reports. It’s unclear what will happen to the survey going forward — an unsettling prospect for people who rely on those data.
“Simply put, it’s just invaluable information,” says neuroscientist Steven Laviolette of Western University in London, Canada. “We need to have that information. And without that information, it’s almost impossible to develop effective public health policies. It’s impossible to plan your research.”
He and his colleagues use SAMHSA data to guide their experiments on cannabis and tobacco addiction, among other research areas. Cannabis, for instance, can be smoked, vaped or eaten, and “all of these different delivery formats are going to have different impacts on the brain and produce different risk factors for mental health problems,” Laviolette says. Prompted by survey data showing a dramatic rise in edible cannabis use, “we have recently started using edible [cannabis] in our animal research,” Laviolette says.
Back when Laviolette began studying tobacco, the big concern was how people become addicted by smoking cigarettes. “And then e-cigarettes came along, and that changed the whole game, because now we’re talking about a delivery system where nicotine is much more concentrated,” he says. “So we needed to adapt our research. And we wouldn’t have known that if it wasn’t for organizations like SAMHSA telling us what people are doing, how they’re taking the drugs.”
Without the survey data, Humphreys says, “we will have no way to know how serious our substance use and mental health problems are, no way to know if the policies we’re doing have any effect at all.”
The future of a nationwide mental health helpline is unclear
In 2020, President Trump signed legislation creating the national 988 Suicide and Crisis Lifeline, a resource managed and organized by SAMHSA staff. Millions of Americans have called the lifeline and received support in times of crises, including episodes of suicidal thinking. While local funding and call centers support much of the lifeline’s infrastructure, SAMHSA provides some funding, call routing and answers for questions that pop up.
So far, it’s unclear whether the recent cuts to HHS will affect the 988 Lifeline. Some of the people who lost their jobs worked with the helpline, Humphreys says. “What’s going to happen to the line at all? I really have no idea.”
A group of senators sent a letter to HHS Secretary Robert F. Kennedy Jr. on March 27 seeking clarity regarding these changes. “We are also gravely concerned about the impacts of previous dismissals and future staffing cuts to the SAMHSA-administrated 988 Suicide and Crisis Lifeline,” they wrote, adding that they “strongly urge” Kennedy “to reconsider these devastating cuts and instead work to ensure that SAMHSA and the American people have the resources they need to fully address their mental and behavioral health concerns.”
If you or someone you know is facing a suicidal crisis or emotional distress, call or text the 988 Suicide & Crisis Lifeline at 988.
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