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In just a few years, Texas established one of the largest no-cost systems for distributing opioid reversal medications in the United States, thanks to an influx of federal and state funding supporting local community efforts.
The sudden loss of $68 million in federal substance abuse response funding this year due to the end of COVID-19 funding, plus the potential for more federal cuts in the future, is threatening this fragile ecosystem.
“I know in my region, which covers Lubbock and Amarillo, some organizations have closed down that were able to provide free naloxone as well, and we’re kind of trying to fill their shoes right now,” said Alberto Soto-Gonzales, training hub coordinator at the Central Plains Center in Plainview for Naloxone Texas, one of the state’s largest naloxone distributors.
Texas’ naloxone distribution system is composed of various entities, including social service organizations and local public health departments. If one part of the system begins to fail, the rest have to shoulder the demand, and any one of them can become overwhelmed.
The $68 million in COVID-19 money helped pay for medication-assisted treatment, recovery housing, drop-in drug treatment centers, recovery support groups, and overdose response efforts like vending machines with naloxone. Commonly known by its brand name Narcan, naloxone rapidly reverses the effects of an opioid overdose and restores normal breathing within minutes.
The state never had plans to replace that COVID money when it ran out and noted that it was spread across 37 different programs, according to Jennifer Ruffcorn, spokesperson for the state’s health agency.
On top of the expiring COVID-related money, some other federal money in the form of block grants has been delayed because of federal layoffs, and some key regional staff at federal agencies that help Texas land those grants have left or changed jobs.
As a result, local public health agencies will have to either reassign their staff or shift some of their substance use response and prevention responsibilities to nonprofits, as officials focus on other priorities, such as disease containment and vaccinations.
“The situation on the ground is more layered than ‘everything’s gone’ or ‘we’re just fine,’” said Jennifer Potter, executive director of BeWell Texas, an opioid response program at UT Health San Antonio.
Funds are available to counties and local organizations through the Opioid Abatement Fund Council, which distributes the $3 billion recovered through the opioid settlement agreements. However, 15% of that amount is allocated to counties and municipalities to address opioids, and unless the council chooses to give out grants as it did this year, only counties that joined the lawsuit have access to that money.
“The little funding that we have from those settlements is not enough to combat the number one cause of accidental deaths in Travis County, which is overdoses,” said Travis County Judge Andy Brown, whose county helps fund naloxone efforts in the Central Texas region. “We need the federal government.”
Funding for substance abuse services has become even more uncertain after President Donald Trump issued an executive order redirecting federal resources toward addressing homelessness and said the government shouldn’t pay for drug-related “harm reduction” or “safe consumption” efforts that only facilitate illegal drug use.
The National Alliance to End Homelessness called the executive order “a direct attack on life-saving harm reduction services.”
“It’s tough to get people treatment if they’re not alive anymore,” said Tara Karns-Wright, director of Naloxone Texas.
The naloxone distribution system
Soto-Gonzales, the Naloxone Texas coordinator, is a military veteran who said he had his first experience with naloxone when he accidentally doubled the 16 medications he takes for post-traumatic stress disorder, brain injuries, and pain from the multiple surgeries he’s had.
After he overdosed on his prescriptions, naloxone saved his life.
Soto-Gonzales said he wasn’t a drug addict, he just made a mistake, and now he shares his story with anyone who will listen to underscore the importance of making this life-saving drug widely available.
“This is not just for known drug users. This is for everybody. This is why it’s important to remove that stigma around it,” he said. “We are all getting older, and with age comes forgetfulness. This is a life-saving tool everyone will need.”
The federal government’s recent opposition to paying for harm reduction — the term used to describe services like naloxone distribution, syringe or needle exchange programs and drug testing strips — aligns with Texas law.
Texas considers things like syringes and drug testing strips as illegal drug paraphernalia, with anti-drug hardliners fearing such efforts would enable drug use. Multiple attempts at decriminalizing testing strips, specifically for fentanyl, which has ravaged the state, have failed to make it to Gov. Greg Abbott’s desk despite his showing support for it in the past.
However, the state has made a significant funding push to widely distribute naloxone around the state, and Texas is starting to see the results as overdose deaths are beginning to drop. Drug overdose deaths decreased by 18% in Texas, from approximately 5,640 deaths reported in 12 months ending in April of 2024 to 4,609 during a similar time period, according to provisional data from the US Centers for Disease Control and Prevention.
The same trend is playing out nationwide, and experts attribute it to the widespread distribution of free naloxone. A study conducted by RAND, a nonprofit research organization, found that over-the counter sales of naloxone have declined after an initial surge, most likely due to the $40 to $50 price point, with most Americans getting the drug through no-cost programs.
But Texas’ naloxone distribution system is composed of various parts — from social service organizations to nonprofits to public health centers. If one part of the system begins to fail, the rest have to shoulder the demand, and some parts bear the extra load worse than others.
Public health directors say the current environment is chaotic, as federal funding — the foundation of their work beyond just drug response and prevention — has become unstable in the span of a year.
“It creates an unsolvable problem among a lot of these local entities that are dealing with this and other public health needs,” Brown said.
Vaccine programs that have been planned for months have been suddenly canceled. Staff have been furloughed or reassigned to new positions in rural areas of the state, and federal grants and organizations have undergone name changes or consolidations.
Substance use services are often the first to be cut when it comes to public health, as more pressing needs, such as containing measles outbreaks and vaccinating children, take priority.
“The unknown with the budgets is really the scariest part,” said Katherine Wells, director of the Lubbock Health Department, which helped respond to the measles outbreak earlier this year. “The hard part this time has been with kind of more abrupt stops, where you don’t have the runway for planning, and local health departments don’t have lots of reserve funds to keep things going that we can fall back on.”
Philip Huang, director of Dallas Health and Human Services, said his center is already dealing with various programs being canceled due to uncertainty around federal funding for public health.
“We are all juggling and moving things around just to try and maintain services the best we can,” he said.
Local nonprofits involved in naloxone distribution are usually run by small volunteer groups that lack the time to search for grants or the funding to pursue them independently.
The Substance Abuse and Mental Health Services Administration’s regional offices and other federal health offices have been a key component in helping secure grant funds for smaller organizations. But now that the federal government has closed many of them, that knowledge and expertise have disappeared with them.
“Not many of these organizations can pay someone to scan the environment constantly,” Potter, executive director of Be Well Texas, said.
Are partnerships the future?
Naloxone Texas, which is part of BeWell Texas’ network, is the one piece of the state distribution system that has the most reliable source of funding at $18 million — its money comes from the state through the opioid abatement fund and a university — and has continued expanding its training programs to college and university campuses. The group has also expanded its distribution efforts by partnering with local community groups and nonprofits to provide training and, in some cases, funding.
“We have been pretty fortunate in that … the state of Texas has really supported us, and so we have additional funds for the next two years, so that has really helped us fill in those gaps,” said Karns-Wright, the director of Naloxone Texas.
“With all that is going on, it’s reassuring to know how committed BeWell Texas is to the naloxone distribution in our state because they are pretty much managing all these hubs,” said Erika Borrego, president of Corazon San Antonio, an organization that provides services to the homeless and marginalized and has been one of Naloxone Texas’ funded hubs.
Potter said Naloxone Texas has no urge to become the leader of the distribution system because history has shown that no one organization can do it alone. However, they are willing to help any organizations that need it, whether through technical assistance, naloxone supply, help with grant writing, or more.
“We always work with these programs because the systems are fragile and we want to make sure we are all working collaboratively,” Potter said.
However, Huang cautioned that even the best partnerships won’t replace federal funding if the government follows through on ending support for harm reduction.
“I looked at our budget at Dallas County Health and Services, and over 90% of it is federal funds,” Huang said. “To say with all these federal cuts, we’re going to be able to piece it together by working with university partners and with philanthropic support is a short-term solution, but that’s not going to be long-term and sustainable.”
Texans seeking help for substance use can call the Substance Abuse and Mental Health Services Administration’s free help line at 800-662-4357. They can also access services in their region through the Texas Health and Human Services website.
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