SOR Funding: Who Gets State Opioid Response Grants and What They Pay For

State Opioid Response (SOR) grants are the largest federal funding stream aimed at the overdose crisis, distributing more than $1.5 billion a year through the Substance Abuse and Mental Health Services Administration (SAMHSA) to every state and territory for prevention, treatment, recovery support, and overdose reversal.¹ The program was created in 2018, expanded in 2020 to cover stimulant use disorders, and reauthorized in December 2025 with federal funding authority now secured through fiscal year 2030.²

Who Gets the Money and How Much

SOR is a formula grant, not a competitive one. Every state, the District of Columbia, and U.S. territories receive an award SAMHSA calculates for them; they do not apply against each other. By statute, states and DC receive at least $4 million and each territory at least $250,000.³

For FY2024, SAMHSA revised its formula. The base weighs two measures equally: a state’s drug overdose death rate and an “opioid misuse” measure drawn from the National Survey on Drug Use and Health, which replaced a previous “unmet treatment need” metric. Those combine into a “SOR Index” adjusted by a social vulnerability score covering household characteristics, socioeconomic status, and transportation access, meant to reduce the formula’s bias toward states with large populations.³

On top of the base, 15 percent of total funding is set aside for the 25 states with the highest overdose death rates. That threshold was raised from 10 states to prevent sharp funding cliffs when a state moves in or out of the top tier. A separate adjustment caps year-over-year swings, limiting decreases to 5.52 percent and increases to 50 percent relative to the prior award.³

Tribal Opioid Response Grants

Tribal communities are funded through a companion program, Tribal Opioid Response (TOR), rather than through the state grants. TOR totaled nearly $63 million in FY2025 against $1.48 billion for state grants.¹ Awards are tiered by Indian Health Service user population, ranging from a $250,000 base for tribes with 10,000 or fewer users up to $1.75 million for those with more than 40,000. Beginning in FY2024, SAMHSA added a need-based supplement using county-level overdose death data among American Indian and Alaska Native populations, which the agency expected would add about 18 percent to qualifying tribes’ base awards. TOR funding is capped at 5 percent of total opioid response grant dollars.³

What SOR Grants Pay For

Funding covers four broad categories: prevention, treatment, recovery support services, and overdose reversal through naloxone distribution.¹ Treatment includes medications for opioid use disorder such as buprenorphine, methadone, and naltrexone. States have used the money for peer recovery specialists, syringe service programs, mobile health units, telehealth expansion in rural areas, harm reduction vending machines, cognitive behavioral therapy, contingency management, and transitional services for people leaving incarceration.⁴

A 2020 statutory change opened the funds to stimulant use disorders including methamphetamine and cocaine, in recognition that the crisis had shifted toward polysubstance use. Evidence-based pharmaceutical treatments for stimulant disorders remain limited compared to the medications available for opioid use disorder.⁵

Medication-assisted treatment is not just permitted, it is required. Recipients may not fund any provider or sub-awardee that denies services to individuals prescribed FDA-approved medications for opioid use disorder.⁶⁷

Services can only be provided to individuals with a history of or current issues involving opioid or stimulant misuse. The grant is not a general behavioral health fund.

What the Money Cannot Be Used For

SOR dollars must supplement, not replace, existing federal, state, or third-party funding for the same services. Providers are expected to bill Medicaid first for eligible patients.⁶

Prohibited uses include:

Building construction
Inpatient hospital-based detoxification
Housing other than recovery housing
Marijuana-related treatment
Sterile needles or syringes for injection
Direct cash payments to individuals as incentives to enter treatment⁸

Contingency management, meaning small rewards for treatment compliance, is capped at $15 per event and $75 per patient per year.⁷ Salary charged to the grant for any single individual cannot exceed the federal Executive Level II cap, set at $221,900 as of January 2024.⁸

What the Results Look Like

SAMHSA requires grantees to collect client-level data at intake, at a six-month follow-up (with an 80 percent follow-up target), and at discharge, reporting through the agency’s Performance Accountability and Reporting System.⁴

The 2021 Report to Congress, covering data from May 2020 through March 2021, found that among clients who completed both intake and six-month follow-up, heroin use dropped by 61 percent (from 29.4 percent to 11.4 percent of clients), pain reliever misuse fell by 75 percent, permanent housing increased by 27.5 percent, employment or school attendance rose by 53.8 percent, and emergency department visits for substance abuse declined by 89 percent. During that period, grantees distributed over 1.05 million naloxone kits and reported approximately 90,200 overdose reversals.⁹

By the 2023 reporting cycle, based on 76,583 intake interviews between May 2022 and January 2023, the program continued to show reductions in substance use and improvements in housing, employment, depression, and anxiety. Forty-eight states and territories had naloxone distribution programs, and 49 were running peer recovery support services. The report acknowledged a “slower rate of positive change among ethnic and racial minorities,” and starting in FY2022 SAMHSA required grantees to submit strategic plans addressing historically under-resourced populations.⁴

Is the Program Still Funded

Yes, with some recent volatility worth understanding. FY2025 delivered $1.48 billion in state grants and $63 million in tribal grants, and FY2026 rose to roughly $1.595 billion.¹⁰ The White House’s FY2026 budget request had proposed terminating over $800 million in substance use disorder grants and folding SOR into a new “Behavioral Health Innovation Block Grant,” but Congress rejected the consolidation and kept SOR as a standalone program with a funding increase.¹¹

In January 2026, HHS sent termination notices to more than 2,000 SAMHSA discretionary grant recipients, affecting an estimated $2 billion in funding for programs from youth overdose prevention to the National Child Traumatic Stress Network. The letters cited “non-alignment with SAMHSA priorities.”¹²¹³¹⁴

The administration has also shifted programmatic emphasis. The “Great American Recovery Initiative,” formalized by executive order in January 2026 and co-chaired by Secretary Kennedy, and the $100 million “STREETS Initiative” (Safety Through Recovery, Engagement, and Evidence-based Treatment and Supports) emphasize long-term recovery and sobriety over what the administration describes as a “housing first” and harm reduction approach. In September 2025, SAMHSA awarded $45 million in supplemental SOR funding specifically for sober and recovery housing among young adults.¹⁵

The longer-term legal footing was settled on December 1, 2025, when President Trump signed the SUPPORT for Patients and Communities Reauthorization Act of 2025, extending program authorization through FY2030. The law broadened first responder training eligibility to cover drugs or devices approved, cleared, or otherwise legally marketed by the FDA, mandated a Federal Interagency Work Group on fentanyl contamination, added synthetic opioid and fentanyl awareness requirements to youth prevention strategies, required HHS to publish guidance on at-home safe drug disposal systems, and imposed new cybersecurity requirements for the 988 Suicide and Crisis Lifeline.²

Reauthorization sets the legal framework through 2030. Annual appropriations still get decided year by year, and advocates have flagged FY2027 negotiations as the next likely fight over SAMHSA grant funding levels.¹¹

1
U.S. Department of Health and Human Services. HHS State and Tribal Opioid Response Grants 2025
2
Every CRS Report. SUPPORT for Patients and Communities Reauthorization Act of 2025 (P.L. 119-44)
3
U.S. Government Accountability Office. Opioid Response Grants
4
SAMHSA. 2023 Report to Congress on the State Opioid Response Grants
5
National Academy for State Health Policy. Federal Funding Change That Includes Stimulants Allows States to Expand Their Substance Use Disorder Initiatives
6
National Academy for State Health Policy. Funding Options for States
7
Virginia SOR Support. Notice of Award – State Opioid Response Grants
8
Florida Department of Children and Families. FY 2024 SOR Grant Funding Guidance
9
SAMHSA. 2021 Report to Congress on the State Opioid Response Grants
10
Advocacy Incubator. FY 2026 Appropriations Crosswalk
11
Faces and Voices of Recovery. February 2026 Monthly Policy Update
12
Roll Call. HHS Cuts $2 Billion in Mental Health, Addiction Grants
13
Politico. HHS Terminates Grants for Substance Use, Mental Health
14
NPR. Trump Administration Letter Terminating Addiction, Mental Health Grants
15
U.S. Department of Health and Human Services. Secretary Kennedy Announces $100 Million Investment in Great American Recovery