May 23, 2022
Opioid Block Grants
Beginning in the late 1990s, the United States experienced a
In 2018, the STR grant program was reauthorized by
significant increase in opioid-related drug overdose deaths,
Section 7181 of the SUPPORT for Patients and
which rose from 8,050 in 1999 to 49,860 in 2019. To
Communities Act (P.L. 115-271). The provision authorized
address the rising rates of opioid use and overdose deaths,
$500 million to be appropriated for each of FY2019
Congress created new opioid-specific block grant programs
through FY2021; however, the STR grant program did not
that provide funding to increase access to substance use
receive funding after FY2018, when it was effectively
disorder (SUD) treatment such as medication-assisted
replaced by the State Opioid Response grant program.
treatment (MAT) for opioid-use disorder.
State Opioid Response (SOR) Grants
State Targeted Response (STR) Grants
Record-level drug overdose deaths continued through the
In 2016, Congress enacted the 21st Century Cures Act (the
2010s, after which Congress provided $1 billion to
Cures Act; P.L. 114-255). Section 1003 of the Cures Act
SAMHSA in FY2018 through a new State Opioid Response
established the “Account for the State Response to the
(SOR) grant program. The appropriation, located in the
Opioid Abuse Crisis” in the Treasury, to which $500
annual Department of Health and Human Services
million was transferred and deposited for each of FY2017
appropriations bill, included a $50 million set-aside for
and FY2018. (Actual program funding was subject to
Indian tribes and an additional 15% set-aside for states with
appropriations.) The resulting grant—the State Targeted
the highest opioid-related mortality rates. Program goals
Response (STR) to the Opioid Crisis grant program—
were similar to the STR grants with an emphasis on
supplemented state activities related to the opioid crisis.
expanding access to MAT. The SOR funding was
The purpose of the grant program was to increase access to
distributed using a formula similar to the STR grant
treatment, decrease unmet treatment need, and reduce
formula but determined entirely by SAMHSA (with a
overdose deaths through prevention, treatment, and
requirement that the formula be submitted to the House and
recovery activities. Administered by the Substance Abuse
Senate Appropriations Committees).
and Mental Health Services Administration (SAMHSA),
the STR grant was distributed to Single State Agencies with
When the STR grant authorization expired in FY2018,
flexibilities to provide sub-awards and contracts to
Congress increased the SOR grant appropriation by $500
substance use treatment and prevention providers, opioid
million—the same amount as the STR grants—for a total of
treatment programs (OTPs), and peer recovery networks,
$1.5 billion for FY2019. The SOR grants received $1.5
among others.
billion in each of FY2020 and FY2021. In FY2022,
Congress increased the SOR grant appropriation by $25
In FY2017 and FY2018, SAMHSA awarded grants to all 50
million, for a total of $1.525 billion.
states, the District of Columbia, and several territories
according to a formula. Formula variables were specified in
The SOR grant program requirements and structure were
statute, but the formula itself was determined by SAMHSA.
similar to those for STR grants but were more explicitly
Grantees received the same funding amount for both years.
focused on increasing access to MAT using the three FDA-
approved medications for the treatment of opioid use
According to the Department of Health and Human
disorder (methadone, buprenorphine, and naltrexone).
Services (HHS) Office of the Inspector General (OIG), 65%
Grants were distributed to states via the Single State
of the total STR funding spent nationwide was devoted to
Agency with state discretion for use or further distribution.
treatment, 17% was devoted to prevention, and 13% was
The FY2020 appropriation language added “stimulants” to
devoted to recovery support during the first 18 months of
the grant purpose, allowing SOR funds to support activities
the two-year grant program. HHS OIG reported wide
related to methamphetamine and cocaine—substances
variation in states’ funding allocations.
increasingly involved in drug-related overdose deaths.
Figure 1. Opioid Block Grant Distribution
To safeguard funding for states with declining drug-related
mortality rates—including those that no longer qualified for
the additional set-aside funding—report language
accompanying FY2021 appropriations directed SAMHSA
to award $3 million in supplemental grants to states whose
year-over-year funding declined by more than 40%.
According to a 2020 SAMHSA report to Congress, SOR
funding substantially increased the number and availability
Source: Congressional Research Service.
of treatment and recovery support systems—especially
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Opioid Block Grants
MAT—for individuals with SUD. SAMHSA reported
partnership with an urban Indian organization. Funds are
positive outcomes related to abstinence from substance use,
distributed noncompetitively based on tribal population.
criminal justice involvement, housing stability, social
Tribes were instructed to use a needs assessment or
connectedness, and employment for participants in SOR-
strategic plan to identify gaps from which to build
funded programs.
substance use disorder prevention, treatment, and recovery
services. Other grant requirements are similar to the SOR
Tribal Opioid Response (TOR) Grants
grant program. Since the TOR program began, SAMHSA
From FY2018 to FY2021, the SOR grant appropriation
has awarded grants to over 100 tribes and tribal
included a $50 million set-aside for Indian tribes and tribal
organizations, with several receiving continuation grants in
organizations—known as the TOR grants. TOR grants are
subsequent years. In FY2022, Congress increased the TOR
not distributed by a formula. Instead, tribes and tribal
set-aside from $50 million to $55 million.
organizations apply individually, as a consortia, or in
Figure 2. Opioid Block Grant Timeline
Authorizing Legislation and Appropriations Levels over Time for the STR, SOR, and TOR Grants
Source: Congressional Research Service.
Notes: For more information about SAMHSA-administered grant programs, see https://www.samhsa.gov/grants and CRS Report R46426,
Substance Abuse and Mental Health Services Administration (SAMHSA): Overview of the Agency and Major Programs.
IF12116
Johnathan H. Duff, Analyst in Health Policy
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Opioid Block Grants
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