A relatively obscure federal agency that plays a crucial role in supporting services like the 988 crisis helpline, distribution of the lifesaving drug naloxone, and addiction treatment across the United States may face reduction or even elimination under a proposed restructuring of the U.S. Department of Health and Human Services.
As part of Health Secretary Robert F. Kennedy Jr.’s plan, the Substance Abuse and Mental Health Services Administration (SAMHSA), which has a budget of $8 billion, would be integrated into a new office alongside other agencies concerned with chemical exposures and workplace injuries. This consolidation would lead to the formation of the Administration for a Healthy America (AHA), aligning with Kennedy’s slogan “Make America Healthy Again.”
According to a statement from the HHS, merging SAMHSA into this larger entity aims to “increase operational efficiency and ensure that programs are executed by dismantling artificial barriers between similar initiatives.”
Brendan Saloner, an addiction researcher at Johns Hopkins Bloomberg School of Public Health, remarked, “Many Americans depend on SAMHSA for mental health and substance use services, even if they are unaware of the agency’s name.”
During his confirmation process, Kennedy shared his personal battle with heroin addiction, with 14 years of addiction and 42 years of recovery. He acknowledged the importance of medication-assisted treatments like Suboxone and methadone but emphasized the value of 12-step programs such as Alcoholics Anonymous for a comprehensive recovery approach. Kennedy also proposed developing “healing farms” during his presidential campaign, where individuals could engage in work while recovering.
SAMHSA’s establishment by Congress in 1992 suggests that its closure might be unlawful, raising questions about Kennedy’s dedication to addressing addiction and mental health issues, noted Keith Humphreys, a Stanford University addiction specialist. “Burying the agency within a sprawling administrative body without a clear purpose detracts from the focus on the problem or organizing a response,” stated Humphreys.
Experts warn that undermining SAMHSA could impede progress against overdose fatalities. The agency is pivotal for regulating methadone clinics and supporting addiction prevention programs nationwide. “SAMHSA’s effective work is a key reason behind the decline in overdose rates,” asserted Dr. Ruth Potee, overseeing multiple methadone clinics in Massachusetts. “I’m stunned by this development.”
Commenting on a 24% decrease in drug overdose deaths over the past year, former White House drug policy director Dr. Rahul Gupta expressed concerns that the bureaucratic changes might hinder this progress. “An escalating overdose crisis is the last thing our nation needs,” warned Gupta, who served under President Joe Biden.
The announcement comes on the heels of staff reductions and grant cancellations, which have stirred unease and apprehension among government-backed researchers and federal health workers. Saloner warned that reorganizing a large entity could potentially lead to improved services, but voiced concerns over the absence of a careful process, which appears to be creating upheaval and driving skilled professionals away from federal roles.
The challenges facing the restructuring of SAMHSA, alongside the broader implications of the proposed departmental consolidation, remain a point of contention amid ongoing discussions about the best path forward for addressing addiction and mental health services in the nation.