The Trump administration has delayed and may cancel roughly $140 million in grants to fund fentanyl overdose response efforts, according to four staff members with close knowledge of the process at the Centers for Disease Control and Prevention.
The staffers shared detailed information with NPR about the funding disruption and potential cuts on the condition of anonymity, saying they don't have permission to speak publicly about their concerns and feared retribution from the Trump administration if identified.
"These are lives at stake," said one CDC staffer, who has a role administering the addiction grant program, known as the Overdose Data To Action program, often referred to as OD2A. "The announcement [of delays] alone could trigger layoffs and program shutdowns. It could really start a chain reaction that's hard to come back from," the CDC staffer said.
State and local public health departments fighting to lower overdose deaths from fentanyl, methamphetamines and other drugs across the U.S. describe the funds as crucial to their efforts.
The last time a major national interruption of addiction care occurred, during the COVID-19 pandemic, drug deaths soared.
"[OD2A funding has] been a critical piece of the decreases we've seen in overdose deaths," said Chrissie Juliano, executive director of the Big Cities Health Coalition, an organization that includes 35 urban public health departments.
"Any changes to funding levels would be catastrophic and would really send us backwards," she said.
The money currently being withheld accounts for roughly half of the funds allocated by Congress for the OD2A program, which supports fentanyl response efforts in 49 states, the District of Columbia, as well as dozens of city, county and territorial public health departments.
NPR sent requests for comment about the potential OD2A cuts to the CDC, the U.S. Department of Health and Human Services and the White House Office of National Drug Policy. Trump administration officials haven't responded.
The CDC staffers said it appears the funding interruption is being caused by bureaucratic confusion involving the Trump administration's Department of Government Efficiency (DOGE) cost-cutting effort and the Office of Management and Budget, which are both scrutinizing OD2A grants before money is issued.
"This is what happens when you start doing these things slash and burn," said the CDC employee interviewed by NPR.
A second CDC staffer shared detailed notes taken during a meeting on July 10 where CDC leadership voiced uncertainty about future funding for OD2A.
"We can't promise all the funds will come," CDC leaders said, according to the contemporaneous notes. "It's a procedural issue creating a real problem for jurisdictions to be able to implement the program."
Two other CDC staffers who also spoke on condition of anonymity confirmed the funding delay to NPR and echoed alarm that the grant review process could lead to the funds being withheld altogether.
"We're cutting into muscle and bone"
According to public health officials around the U.S., many addiction and drug overdose programs will reach the end of their current OD2A funding cycle by Sept. 1.
Without the promise of new funding, many public health departments grappling with the deadly opioid-fentanyl crisis say they've already paused new spending.
With the deadline looming, Vermont's Department of Health said there was still "a lot of uncertainty" surrounding the funding in a statement shared with NPR.
The statement said Vermont officials have been warned by the CDC that OD2A funds will be delayed and may be cut. Vermont has paused spending "until we have more clarity about the future of this funding."
Under the Biden administration, Congress and the federal government responded to escalating fentanyl deaths by ramping up spending on drug treatment and addiction health, including an expansion of the OD2A program. Most experts believe that bipartisan effort contributed to a dramatic decline in overdose deaths that began in 2023.
The latest provisional data from the CDC found roughly 82,000 drug deaths in the 12-month period ending in January. In August 2023, at the peak of the fentanyl crisis, the 12-month report found more than 114,000 fatal overdoses.
Many public health experts told NPR that they worry the Trump administration's actions could unravel the nation's newly expanded drug treatment safety net at a moment when it was helping bring the fentanyl toll down.
Three of the four CDC sources who spoke with NPR said the grant disruption could also cripple federally funded state and local surveillance systems created to detect new toxic and highly addictive substances turning up in the illicit street drug supply.
Keith Humphreys, a drug policy researcher at Stanford University, said defunding street drug monitoring programs around the country would put the public at risk.
"We're just increasingly putting ourselves in the dark," Humphreys said. "The drug supply is always changing. If public health officials don't know what's in the drugs, they can't warn the public."
Humphreys noted that the Trump team already laid off a team of researchers who had tracked drug use by Americans for 50 years, collecting data that many front-line addiction care providers viewed as vital.
According to Humphreys, the Trump administration has made a series of moves that threaten the broader addiction care system, including mass layoffs of federal addiction researchers and the pending dissolution of the Substance Abuse and Mental Health Services Administration.
"We're cutting into muscle and bone," Humphreys said. "The question on the front lines is how do I get naloxone out there? How do I get people into treatment? We're getting increasingly desperate as each additional program is axed."
Naloxone, also known as Narcan, is a medication that reverses opioid overdoses. It became more widely available following regulatory and funding changes implemented by the Biden administration.
The interruption of OD2A funding also follows passage earlier this month of President Trump's spending plan that includes deep cuts to Medicaid, the government insurance program that funds most alcohol and drug addiction treatment in the U.S.
Research published in early July estimated that as many as 156,000 people in the U.S. addicted to fentanyl and other opioids could lose access to highly effective medical treatments such as methadone and suboxone.
"What the simulation projected out is based on the loss of [insurance] coverage we would see approximately 1,000 extra [fatal overdoses per year] amongst the folks who lose access to care," said Dr. Benjamin Linas, a physician and addiction researcher at Boston University who co-authored the study.
"It just feels like we're throwing in the towel exactly when we were beginning to make progress," he said.
Some public health departments signaled hope the OD2A dollars will arrive in time.
"CDC leadership warned [us] of potential cuts or delays to OD2A funding in a grant recipient meeting last week," Dr. Bisola Ojikutu, Boston's commissioner of public health, said in a statement to NPR. "We have not received formal notice but are assessing potential impact."
DOGE intervenes while the CDC waits
All the CDC staffers interviewed by NPR said the Trump administration and Republican lawmakers have signaled broad policy support for overdose prevention programs funded through the OD2A grant program.
But they said an increasingly opaque budget review process involving the CDC, HHS, OMB and DOGE has bogged down the grant-making process.
Notes shared from the July 10 meeting show CDC leadership voicing confusion over the "criteria" used by DOGE to review the grants and over the broader role played by DOGE staffers.
"We have no idea what it is they are looking for," one of the CDC staffers told NPR. Asked whether there is confidence within the CDC that the DOGE team has the medical knowledge and expertise needed to evaluate these grant programs in a timely fashion, the CDC staffer said, "Absolutely not."
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