FILE – In this Nov. 14, 2019, photo, Jon Combes holds his bottle of buprenorphine, a medicine that prevents withdrawal sickness in people trying to stop using opiates, as he prepares to take a dose in a clinic in Olympia, Wash. The U.S. Department of Justice made clear, Tuesday, April 2, 2022, that barring the use of medication treatment for opioid abuse is a violation of federal law. (AP Photo/Ted S. Warren, File) After a decade of watching the overdose curve climb, we are seeing something we almost stopped expecting: The curve is trending down. Overdose deaths are falling. Treatment is reaching people that it never reached before. Families are coming back together. Communities that were losing neighbors every week are starting to rebuild.
This is the hardest-won good news in public health in years. It was built — block by block, administration by administration, often across bitter political divides — into something resembling a functioning system of care.
Naloxone is in glove compartments and high school nurses’ offices. Medicaid is covering treatment in states that once refused to provide coverage. Buprenorphine prescribers are now in rural counties that had none. Telehealth appointments provide access to people where shame or geography once kept them from care.
The 988 crisis line. Peer recovery coaches. Recovery housing. Syringe services. Fentanyl test strips. Reentry programs. Data monitoring systems.
Stack those blocks of prevention, care, treatment and recovery support together, and you get a Jenga-like tower: tall, interdependent and load bearing in ways that are not obvious until something is pulled out from underneath.
Right now, blocks are being pulled. Not one. Not two. Dozens, in quick succession.
On June 8, the Substance Abuse and Mental Health Services Administration (SAMHSA) took down the national buprenorphine provider locator; the free online database people relied upon to find an addiction treatment provider. Buprenorphine is among the most studied and most effective medications in modern addiction medicine. It cuts overdose risk roughly in half. Yet, the agency says it can no longer staff the locator.
The loss of the locator may sound bureaucratic. It is not. For someone who has finally decided to seek help, often after years of struggle, finding a provider can mean the difference between entering treatment and returning to use. When a person decides that today is the day, the system must be ready to meet them. That is one very concerning block removed.
In January, SAMHSA terminated nearly $2 billion in grants overnight, including awards for addiction treatment, reentry, recovery support and naloxone distribution, before reversing course 24 hours later under bipartisan pressure. The money was restored. The damage was not. Providers froze hiring, paused expansions and pulled back from communities that cannot afford even a day of uncertainty.
The fragile tower wobbled.
An April “Dear Colleague” letter from SAMHSA ended federal support for fentanyl testing strips, despite a growing body of evidence that when people learn fentanyl is in their supply, they change behavior in measurable ways, use less and keep naloxone within arm’s reach. Strips cost pennies. They keep people alive. We have to remember that this is the goal of overdose prevention; it’s not to accept or enable addiction, but to ensure that people survive long enough to recover from it.
That is another block. And the foundational blocks are being threatened, too.
The House’s proposed 2026 appropriation for Health and Human Services cuts the Centers for Disease Control and Prevention by 19 percent, streamlines or eliminates 35 of its programs and zeroes out more than 100 programs across the Department of Health and Human Services, including major reductions to SAMHSA, the Health Resources and Services Administration and the state and local health departments that carry the daily responsibility of this response.
While the proposal ultimately rejected most of the cuts proposed in the president’s budget request and held SAMHSA roughly level at $7.4 billion, the looming threat of funding cuts continues to rattle the substance use treatment system. When the ground moves like that, the tower does not need to fall to do harm. It only has to shake. That is another block, and a heavy one.
None of these decisions, taken alone, will stay in the headlines, and that is the danger. Towers do not topple on the block you notice. They topple on the one after.
And the crisis has not relented. Roughly 196 Americans still die of overdose every day. We are winning and still losing 196 people a day. Both are true, and both should sharpen our resolve.
The right response to progress is to reinvest and commit to securing a stronger foundation through sufficient funding, resources and support. The administration’s own 2026 National Drug Control Strategy lays out much of that path, prioritizing treatment access, recovery support and the data infrastructure that lets us see this crisis clearly.
The gap is not the plan. The gap is the funding and the follow-through to match it.
Reversing the trendline of overdose fatalities is one of the great, quiet victories of this decade, and it belongs to the nurses, peers, recovery specialists, parents, leaders, motivators and policymakers who refused to give up on people the country had written off. But much work remains. And those hard-won gains are exceptionally fragile. And without congressional protection and recommitment, the system producing those gains will break.
The tower is standing. Let’s keep it standing and make it stronger.
Libby Jones is the associate vice president of the Overdose Prevention Initiative at the Global Health Advocacy Incubator. Jones leads the initiative’s advocacy efforts, advancing federal policies to reduce the overdose death rate in the United States by expanding access to treatment and recovery support services.
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