Local advocates say the lowering overdose trend may reverse if federal health cuts are passed

ST. LOUIS, Mo. (First Alert 4) -- A west St. Louis County man has dedicated 12 years to advocating for more humane treatment of drug users and better access to medical intervention. He distributed naloxone, the overdose-reversing drug, in Missouri when it was still illegal. He lobbied people in power to change laws. He consulted national organizations on drug policy reform.

Now, the attempted dismantling of that work is happening right before his eyes.

It was to Chad Sabora’s dismay that President Donald Trump’s administration proposed a budget for the Department of Health and Human Services that, if enacted by Congress, would slash billions of dollars to substance use and mental health services across the country. Much of the local substance use and mental health services provided are funded through federal grants.

“We’re seeing all of those efforts that have been positive, that have resulted in that reduction in overdose mortalities about to get wiped away and return to a system that has systemically failed and caused more incarceration, more death, more crime,” Sabora said. He used heroin before becoming an activist in the harm reduction sector of the drug epidemic.

He sat in his kitchen on Thursday with notes by his side outlining the multitude of federal funding items on the chopping block. It’s difficult to keep track of. There’s Medicaid. There’s the Substance Abuse and Mental Health Services Administration (SAMHSA), the CDC, and the Health Resources and Services Administration. There’s an initiative aimed at ending the HIV epidemic.

One grant that might get cut in Missouri, which First Alert 4 reported on last month, is the First Responders-CARA grant. It allows for training first responders in overdose response and equipping them with naloxone. The University of Missouri-St. Louis also has a program to get naloxone to anyone or any organization that needs it. That may not run as smoothly with less funding, according to Rachel Winograd, who heads UMSL’s Addiction Science team.

“We would feel those types of tangible impacts pretty quickly, cause those services would just halt,” she said. “That’s if community grant programs lose their funding.”

The State Opioid Response (SOR) grant that Missouri receives is protected because it was funded by Congress through the CARE Act, Winograd said. But it’s overseen by SAMHSA, and Winograd said she was confused how the grant programs could still exist and run if SAMHSA’s workforce gets cut. SAMHSA staff vet grant proposals and track progress along the way to ensure proper usage of the funds.

Trump’s Office of National Drug Control Policy’s statement of drug policy priorities envisioned a policy that reduces overdose deaths, stops the drug supply chain, prevents drug use, and provides treatment that leads to long-term recovery.

Winograd was confused and surprised as to why the administration would want to cut programs that, in her opinion, implement some of those visions.

“This administration publicly has supported first responders, supported naloxone, overdose prevention work, access to evidence-based treatment,” she said. “They highlighted that in their drug policy priorities they released not even two months ago. And so in theory they support all of these things they are proposing to eliminate.”

These days, Sabora does consulting work. But he said his passion is advocating to lower overdose deaths. And he’s not staying quiet about it.

Sabora compiled a breakdown of public health programs and services in question and sent it on a listserv with experts, including researchers and academics, and people working at nonprofits. His focus used to be on St. Louis, but has shifted to getting attention in Washington to try and protect what he views as life-saving infrastructure.

A few faculty members from colleges and universities then wrote a letter to ranking members of the U.S. House of Representatives and Senate urging them to protect substance use and mental health services. More than 300 academics signed the letter, including Winograd.

“If this funding were to go away and the infrastructure goes away along with it, I certainly think you could tie that directly to people losing their lives,” Winograd said. “So I think we would see overdoses go back up.”

There was a 26% decrease in overdose deaths in the U.S. in 2024, and Missouri has also seen a similar decline. Illinois’ latest data shows an 8.3% decrease from 2022 to 2023.