SAMSHA Firings Disrupt Nonopioid Education in Emergency, Surgical Settings

The Department of Health and Human Services has cut programs and laid off workers within the Substance Abuse and Mental Health Services Administration (SAMHSA) responsible for educating emergency department physicians and pain doctors about opioids in the surgical setting. The cuts have raised significant concern among healthcare providers, advocates, and policymakers. The recent reduction in force (RIF) actions within SAMHSA have disrupted efforts to promote nonopioid alternatives in emergency and surgical settings, potentially undermining progress made in pain management innovation.

As stakeholders seek to address the opioid crisis, the stability and support of federal programs for emergency departments remain crucial for advancing safe pain treatment options and protecting public health.

Impact on EDAO

The SAMHSA reduction in force strongly affect its Provider Support Branch, charged with managing the Emergency Department Alternatives to Opioids (EDAO) grant program. Rep. Paul Tonko, D-N.Y., the chairman of the Congressional Addiction, Treatment, and Recovery Caucus and ranking member of the House Energy and Commerce Committee, has called out HHS for removing a vital addiction prevention program, adding that the department is “systematically dismantling SAMHSA and its lifesaving mission.”

Physicians agree the gutting of this program may stymie their best efforts at responsible prescribing.

“At Lowell General, we operate with the patient’s best interest in mind, using opioid-sparing modalities that have significantly reduced opioid use in surgical settings,” said Scott A. Sigman, MD, an orthopedic surgeon in Lowell, Mass., who has been an advocate for opioid-sparing surgeries. “Our landmark work on the NOPAIN [Non-Opioids Prevent Addiction in the Nation] Act with coalition partners was instrumental in providing patients with safe and effective alternatives, and these critical SAMHSA funds must be restored.

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“We’re equally encouraged by the FDA approval of suzetrigine [Journavx, Vertex], the first new class of nonopioid, nonaddictive oral sodium channel blocker for acute pain in over 30 years. This innovation represents a major step forward in giving emergency physicians and patients a first-line treatment option that avoids the risks of opioids,” Sigman added.

Tonko continues to demand program funding for emergency care.

“At SAMHSA, we have seen the Provider Support Branch decimated in the latest round of RIFs,” Tonko said. “This branch managed critical grants including the Emergency Department Alternatives to Opioids grant program. These firings fly in the face of years of bipartisan efforts in Congress to address mental health and addiction, and actively endanger the millions of Americans who depend on resources and treatment on their road to recovery. Lives are at stake. If the Trump administration cares at all about addressing our nation’s mental health and substance use disorder crisis, they will reverse these firings at once.”

Opioids Are Introduced in 80% of Surgeries

Approximately 51 million Americans undergo inpatient surgery annually, and opioids remain a primary modality for postoperative acute pain management, according to the National Institutes of Health. More than 80% of patients receive opioids after low-risk surgery, and more than 80% of these prescriptions involve hydrocodone or oxycodone. Thus, surgical patients routinely receive the most commonly prescribed opioids that are also most commonly implicated in drug

Link (pmc.ncbi.nlm.nih.gov/articles/PMC6119469/

Opioid prescribing has quadrupled since 1999, and has risen in parallel with the number of overdoses from the most commonly prescribed opioids. The economic cost of prescription opioid-related overdose, abuse, and dependence exceeds $78.5 billion annually, with the majority of costs related to healthcare, substance abuse treatment, and lost productivity.

CSAT Cuts

At the Center for Substance Abuse Treatment (CSAT), an agency focused on treatment and recovery, at least 26 full-time employees were removed in October. This would leave approximately just 70 employees post-RIFs, according to Tonko’s office.

At the SAMSHA Provider Support Branch, all members of the staff were cut, including the branch chief. The Provider Support Branch includes the Provider’s Clinical Support System-University and Provider’s Clinical Support System-Medications for Opioid Use Disorder.

—Mike Smith