Kentucky addiction specialists face uncertain future as federal health cuts loom
Organizations working to reduce Kentucky’s high rate of fatal drug overdoses face uncertain futures as the federal government aims to slash funding for health services.
About $11 billion in federal funding for COVID-19-era health services is in the crosshairs of President Donald Trump’s administration, which announced in March it planned to terminate the funds.
The money, approved during the height of the COVID-19 pandemic, was used to track and immunize against infectious diseases. It was an acknowledgment that public health was underfunded, and the U.S. needed more preventative measures, according to Governor Andy Beshear.
But the money wasn’t just used for those services. It also paid for mental health and substance abuse services.
On April 1, Beshear joined 22 other state officials across the country in a federal lawsuit filed in response to the announcement, claiming it was unlawful.
A judge granted a temporary restraining order that requires the government to continue payments for now.
But the payments aren’t guaranteed to survive the court fight.
If they are cut, Kentucky stands to lose $148.8 million, said Crystal Staley, spokesperson for Beshear’s office.
Kentucky officials argue the money is still critical for harm reduction efforts for Kentuckians with addiction, as overdose mortality rates in the commonwealth remain among the highest in the U.S.
“Less federal funding for addiction services could harm the progress we are making,” Beshear said in an interview with the Herald-Leader. “We have been reducing overdose deaths as the drugs have gotten more powerful — that’s real gains. The idea that they would get turned away, that would push us backwards, harming someone’s child, brother, sister, or parents.”
Almost 2,000 overdose deaths were reported statewide in 2023, according to the state’s Overdose Fatality Report. This was a decrease of 9.8% from 2022.
Despite the overall downward trend, the same report revealed overdose deaths were worsening for Black Kentuckians.
While fatal overdoses have declined for two consecutive years, the state is still among the top five nationally for overdose death rates.
The most recent data from the Center for Disease Control shows Kentucky’s overdose death rate at 53.2 per 100,000. In 2020, the national rate of overdose deaths was 28.3 per 100,000.
In order to reduce overdose deaths, state and local providers contend that funding for services is more necessary than ever.
If the funding is not restored, the lawsuit reads, ongoing public health programs and initiatives will have to be “dissolved or disbanded.”
At the state level
John Bowman, a campaign organizer with Dream.org, a non-profit aimed at ending mass incarceration, said the COVID-19 funding helps operate the Kentucky Harm Reduction Coalition, local health departments and syringe services.
He said these programs “fill the gaps” in state addiction services. Overdose rates in Kentucky lowered because of their partnership, Bowman said.
“We haven’t got through this crisis yet,” Bowman said. “If all the funding gets pulled in these areas, those numbers won’t drop on their own. They will go back up. This is a lot of hard work to see the numbers drop — it’s from a lot of people doing a lot of hard work.”
The Kentucky Harm Reduction Coalition, a nonprofit whose mission is to prevent overdose deaths, lost $100,000 in American Rescue Plan Act funds as a direct result of the federal cuts.
“These reductions, no matter the amount, threaten the very services that have prevented overdose deaths and provided critical support to communities across the Commonwealth,” the group said in a press release.
For people in active use, the group provides a high rate of fentanyl test strips, a testing device that can detect doses of fentanyl in drugs, and naloxone, also known by the brand name Narcan, to treat overdoses in emergency situations. The program was founded in 2011, and since that time, 114,934 doses of naloxone have been distributed in Kentucky.
Nearly 18,000 doses of naloxone were distributed in 2024 alone.
More than 302,000 fentanyl test strips were distributed in 2024, as part of more than 1.2 million test strips since 2021.
“Each naloxone kit and test strip represents a potential life saved, empowering individuals, families, and bystanders to reverse overdoses and make informed decisions,” the press release stated.
In addition to statewide harm reduction programs, the cuts could impact:
- Purple Star Program supporting service members, veterans and their families.
- Staffing to 988 call centers.
- Staffing to support youth drop-in centers.
- Plan of safe care services for pregnant and parenting families with or at risk of addiction impacts.
Apart from the COVID-19 funding initiatives, patients receiving addiction treatment could lose access to their healthcare overall with government budget proposals that could cut Medicaid access.
Kentucky could lose more than $800 million in federal funding that helps address substance use disorders, according to the Kentucky Center for Economic Policy.
Without these funds, Medicaid, harm reduction tools and the Substance Abuse and Mental Health Services Administration — which provides more than $50 million to the state’s addiction efforts alone — could be eliminated.
The Kentucky Center for Economic Policy said Medicaid is the backbone of the state’s health care, but it is also the largest investment in treatment. Kentucky ranks fifth-highest in the country for the rate of Medicaid recipients with addiction.
Without Medicaid coverage, strategies to supply medications for opioid use disorder, such as buprenorphine, naltrexone and methadone, would disrupt treatment for nearly 70% of recipients, according to policy experts.
U.S. Rep. Morgan McGarvey, a Louisville Democrat, said the funding cuts also affect children who receive treatment from Medicaid dollars from prenatal withdrawal or mental health and behavioral issues.
“It’s not just cutting off treatment for adults — which is going to have disastrous consequences —you are also impacting the kids even more,” McGarvey said in an interview with the Herald-Leader. “We know this. We can make the decision to invest in our most vulnerable kids now, or we can pay for it later.”
At the local level
Odell Scott Hager’s job is to provide outreach in the recovery community. Each month, he spends his Friday mornings handing out drawstring bags containing fentanyl test strips, naloxone, sterile gloves, condoms, sunscreen and other items to people on the streets.
“In order to pull themselves up by the bootstraps, they have to have the boots,” Hager said.
Formerly incarcerated himself, Hager said the funding not only affects supplies, but the ability to staff organizations that help with reentry and other addiction services.
He told the Herald-Leader that it is a scary time — not just for the people who work in the field, but for the people who rely on these resources.
“I am not understanding the defunding of things that help our people out,” he said. “Especially in Kentucky, where it is worse than anywhere else.
“We made such strides towards the betterment of re-entry and overdose rates have gone down significantly,” he said. “People are getting back where they need to be. Now it feels like we are going back 20 years.”
Hager’s fears include the prison and jail systems becoming even more overpopulated with the inability to offer services such as job training, education and housing.
The Fayette County Health Department stands to lose $226,000, or 27% of federal funding dollars that supplement its harm reduction programming if the COVID-19 funds are discontinued.
Steve Davis, the department’s interim health commissioner, said public health is already underfunded. With threats of losing nearly a quarter of a million dollars, it’s like “taking a crumb of bread and making it even smaller.”
“We probably spend 10 cents on the dollar that goes into health care costs and prevention initiatives,” Davis said. “We spend 90 cents on the dollar to treat acute and disease and illness. By reducing health funding, the ability to get on the front end of things to prevent injury, disease and illness — it’s even more negatively impacted.”
Without a doubt, any potential loss of funding would increase the risk of seeing higher rates of overdose fatalities in the future, Davis said.
“It’s like the gas tank in a car. You can’t drive the car as far if you don’t have gas,” he said.
In Madison County, the harm reduction programming is primarily funded by tax dollars. However, grants for the 2025 fiscal year totaled $10,000. This included $2,000 for test strips and $8,000 as part of an expansion grant, according to Director Nikita Vundi.
“We do not anticipate that same funding for the next fiscal year, however, we will continue to provide the same level of service,” Vundi said.
She said her department cannot speak to the COVID-19 funding changes until more guidance is provided by the state. However, she predicts the health department can absorb the costs and continue to operate normally.
According to the state’s 2023 overdose fatality report, Madison County recorded 63 fatal overdose deaths. Fifty-six of those deaths were related to fentanyl and 46 included methamphetamine.
Madison County Coroner Jimmy Cornelison reported 13 confirmed overdose deaths and three pending results for the year so far as of April 21.
The lawsuit
The lawsuit to stop health department cuts, filed in Rhode Island District Court, came shortly after Beshear threatened to file suit against the U.S. Department of Health and Human Services if they tried to halt federal funding for state and local health departments.
The 45-page lawsuit says the abrupt termination of the contract for services “immediately triggered chaos for state and local health jurisdictions.”
Robert Kennedy Jr., the department’s secretary, is also listed as a defendant in the lawsuit.
All but two states that filed suit were represented by their respective state attorneys general. Kentucky and fellow Democratic Gov. Josh Shapiro, of Pennsylvania, were the exceptions; both states have a Republican attorney general.
All plaintiffs argue the termination of these funds is unlawful under the Administrative Procedure Act because it exceeds statutory authority and was done without proper notice or the opportunity for a hearing.
The lawsuit aims to vacate the terminations, prevent their enforcement and declare them a violation of the act.
Beshear told the Herald-Leader the federal government’s justifications for the funding pause are “laughable” and “unlawful.”
“These funds were put in place to build the infrastructure up in case we have another pandemic,” Beshear told the Herald-Leader. “The idea of where we are with measles and bird flu in our country — that we would cut to public health and pandemics — is simply unwise.”
A hearing date has not been set in the case.
