Opioid Block Grants

Opioid Block Grants

Updated February 10, 2023
Opioid Block Grants
Beginning in the late 1990s, the United States experienced a
State Opioid Response (SOR) Grants
significant increase in opioid-related drug overdose deaths,
which rose from 8,050 in 1999 to 68,630 in 2020. To
Record-level drug overdose deaths continued through the
address the rising rates of opioid use and overdose deaths,
2010s, after which Congress provided $1 billion to
Congress created new opioid-specific block grant programs
SAMHSA in FY2018 through a new State Opioid Response
that provide funding to increase access to substance use
(SOR) grant program. The appropriation, located in the
disorder (SUD) treatment such as medication-assisted
annual Department of Health and Human Services
treatment (MAT) for opioid-use disorder.
appropriations act, included a $50 million set-aside for
Indian tribes and an additional 15% set-aside for states with
State Targeted Response (STR) Grants
the highest opioid-related mortality rates. Program goals
In 2016, Congress enacted the 21st Century Cures Act (the
were similar to the STR grants with an emphasis on
Cures Act; P.L. 114-255). Section 1003 of the Cures Act
expanding access to MAT. The SOR funding was
established the “Account for the State Response to the
distributed using a formula similar to the STR grant
Opioid Abuse Crisis” in the Treasury, to which $500
formula but determined entirely by SAMHSA (with a
million was transferred and deposited for each of FY2017
requirement that the formula be submitted to the House and
and FY2018. (Actual program funding was subject to
Senate Appropriations Committees).
appropriations.) The resulting grant—the State Targeted
When the STR grant authorization expired in FY2018,
Response (STR) to the Opioid Crisis grant program—
Congress increased the SOR grant appropriation by $500
supplemented state activities related to the opioid crisis.
million—the same amount as the STR grants—for a total of
The purpose of the grant program was to increase access to
$1.5 billion for FY2019. The SOR grants received $1.5
treatment, decrease unmet treatment need, and reduce
billion in each of FY2020 and FY2021. In FY2022,
overdose deaths through prevention, treatment, and
Congress increased the SOR grant appropriation by $25
recovery activities. Administered by the Substance Abuse
million, for a total of $1.525 billion. Congress increased the
and Mental Health Services Administration (SAMHSA),
SOR grant appropriation by $25 million in FY2022 for a
the STR grant was distributed to Single State Agencies with
total of $1.525 billion, and then by another $50 million in
flexibilities to provide sub-awards and contracts to
FY2023 for a total of $1.575 billion.
substance use treatment and prevention providers, opioid
treatment programs (OTPs), and peer recovery networks,
The SOR grant program requirements and structure were
among others.
similar to those for STR grants but were more explicitly
focused on increasing access to MAT using the three FDA-
In FY2017 and FY2018, SAMHSA awarded grants to all 50
approved medications for the treatment of opioid use
states, the District of Columbia, and several territories
disorder (methadone, buprenorphine, and naltrexone).
according to a formula. Formula variables were specified in
Grants were distributed to states via the Single State
statute, but the formula itself was determined by SAMHSA.
Agency with state discretion for use or further distribution.
Grantees received the same funding amount for both years.
The FY2020 appropriation language added “stimulants” to
Figure 1. Opioid Block Grant Distribution
the grant purpose, allowing SOR funds to support activities
related to methamphetamine and cocaine—substances
increasingly involved in drug-related overdose deaths.
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%. Report
Source: Congressional Research Service.
language in subsequent years directed the agency to avoid
funding cliffs among states and between fiscal years.
In 2018, the STR grant program was reauthorized by
Section 7181 of the SUPPORT for Patients and
The Restoring Hope for Mental Health and Well-Being Act
Communities Act (P.L. 115-271). The provision authorized
(Division FF, Title I of P.L. 117-328, the Consolidated
$500 million to be appropriated for each of FY2019
Appropriations Act, 2023) amended Section 1003 of the
through FY2021; however, the STR grant program did not
Cures Act by replacing the STR grant authorization with an
receive funding after FY2018, when it was effectively
authorization for the SOR program. This new SOR
replaced by the State Opioid Response grant program.
statutory authorization codified minimum allocation
amounts for grantees and formula preferences—including
an avoidance of funding cliffs between states. The
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Opioid Block Grants
authorization specified use of grant funds and state
organizations apply individually, as a consortia, or in
reporting requirements. It also included a set-aside of up to
partnership with an urban Indian organization. Funds were
15% for states with the highest drug overdose death rates.
distributed noncompetitively based on tribal population.
The provision authorized to be appropriated $1.575 billion
Tribes were instructed to use a needs assessment or
for each of FY2023 through FY2027.
strategic plan to identify gaps from which to build
Tribal Opioid Response (TOR) Grants
substance use disorder prevention, treatment, and recovery
services. Other grant requirements are similar to the SOR
From FY2018 to FY2021, the SOR grant appropriation
grant program. For each of FY2022 and FY2023, Congress
included a $50 million set-aside for Indian tribes and tribal
specified a TOR set-aside of $55 million. Authorization for
organizations—known as the TOR grants. TOR grants were
the TOR grants was included in the P.L. 117-328 provision
not distributed by a formula. Instead, tribes and tribal
that codified the SOR program.
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.

Johnathan H. Duff, Analyst in Health Policy

IF12116
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Opioid Block Grants

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