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States' Use of Grant Funding for a Targeted Response to the Opioid Crisis


To address the increased need for treatment services, the 21st Century Cures Act established the State Targeted Response to the Opioid Crisis grant program (STR grant program). Through this program, SAMHSA awarded almost $1 billion in grants to States over a 2-year grant period (May 2017 through April 2019). States were required to use these funds to expand access to evidence-based treatment for opioid use disorder (OUD), especially medication-assisted treatment (MAT); reduce unmet treatment needs; and reduce opioid overdose-related deaths through the provision of prevention, treatment, and recovery support services.


For 56 States and territories that received STR grants, we examined how much of each State's award remained unspent at the end of the first and second years of the grant period. We also reviewed State progress reports to determine how States used STR grant funds to expand access to OUD prevention, evidence-based treatment, and recovery support services. We also reviewed the number of patients who received OUD treatment and recovery services.


More than $300 million-almost a third of the total nationwide grant funding for the STR grant program-remained unspent after 2 years. Among individual States, 14 spent less than half of their respective grant allocations. In total, all but six States requested extensions-known as no cost extensions-that will allow them up to an additional 12 months to use their STR funding. States primarily attributed spending delays to challenges related to State procurement processes. Additionally, several States are in danger of exceeding the legislatively mandated 5-percent cap on administrative costs.

Across all States, 65 percent of spending was devoted to improving access to treatment in general for OUD, and as a result, States reported that the number of patients receiving any type of OUD treatment increased substantially during the grant period. However, although SAMHSA required States to use STR grant funds to implement or expand access specifically to evidence-based OUD treatment-particularly, MAT-the agency did not collect data on how many patients specifically received MAT versus other types of treatment (i.e., detoxification or abstinence-based treatment).

Given the lack of data, it is unclear how successful the STR grant program was at achieving its goal of expanded access to MAT. Without such data, SAMHSA has limited means to monitor whether the money spent through the STR grant program, or other future grant programs, is helping patients obtain effective, evidence-based treatment for OUD.


We recommend that SAMHSA work closely with States and territories during the no-cost extension period to address barriers to timely spending and to ensure that administrative cost caps are not exceeded. Additionally, we recommend that SAMHSA require States that receive grants for OUD treatment to specifically report how many patients are receiving MAT. SAMHSA concurred with our recommendations.