Alabama officials worry about life-saving Narcan program's future as CDC grants stall

The group also gets boxes of naloxone, a drug that can reverse opioid overdoses. They all call it by its more familiar name brand: Narcan. In the uncertainties of an unregulated drug market, Krystal said she overdosed recently and almost died. The naloxone saved her life.

She isn’t alone. Fewer people are dying from overdoses in Alabama. The state saw an 18.24% drop in overdose deaths between 2023 and 2024, according to provisional data from the CDC. In Jefferson County, where Birmingham is the county seat, there’s been a 42% decrease compared to the same time period last year, according to data from the county coroner’s office provided to the Gulf States Newsroom.

State and county health officials and advocates say the drop is due to additional federal funding for harm reduction efforts — public health strategies aimed at minimizing the risks of drug use — like the distribution of overdose-reversal drugs like naloxone.

Suzanne Smith, a harm reduction worker helping Krystal and her friend, said she’s seen firsthand the difference having more of the overdose-reversal drug has made.

“People are staying alive. They’re living,” Smith said. “It has made a huge difference on who lives and dies.”

The naloxone Smith gives out is bought with federal funding through the Centers for Disease Control and Prevention’s Overdose Data to Action program, or OD2A.

That funding has now stalled. Last week, CDC staff told NPR the Trump administration was considering cancelling or delaying up to $140 million in OD2A grants that had already been approved by Congress. Administration officials later stated this is not the case, and the funds would be disbursed in increments.

But for states with fewer resources, like Alabama, any funding changes may make it harder to continue to distribute naloxone at the same rate.

Alabama’s Department of Mental Health (ADMH), one of the subrecipients of the more than $3.6 million in OD2A funds the state received last year, uses the funding to allow peer providers — people like Smith, with lived experience who can connect to the community — to purchase naloxone for distribution.

Nicole Walden, associate commissioner at ADMH, said if OD2A funds are withheld or stalled, they’d have to switch funding sources in order to continue the program — potentially using settlement funds from lawsuits with opioid manufacturers, marketers and distributors.

“Any reduction in funding would hurt, but I think there are ways we can minimize that hurt,” Walden said.

But while statewide agencies may be able to move money around to cover shortfalls from a loss, reduction, or delay of OD2A funding, local health departments don’t have other funding sources.

In addition to the statewide OD2A funding, Jefferson County, where Birmingham is located, also received over $1.7 million last year through OD2A’s Limiting Overdose through Collaborative Actions in Localities (OD2A: LOCAL) program.

Dr. David Hicks, health officer for Jefferson County, said the funding for overdose prevention is irreplaceable. With competing demands for public health initiatives and programs in the community, he said there hadn’t been a sustainable funding source before the OD2A grants.

The money has been "absolutely, 100%” working, Hicks said. The county made naloxone free and easy to access. They started programs like converting old newspaper stands into naloxone vending machines for anyone who needs a kit.

Hicks attributes the “significant decreases in overdoses” in Jefferson County to these collective efforts supported by the grants.

Since 2019 JCDH has purchased over $2 million of naloxone using a combination of grant, opioid settlement and local funding. The Department has distributed more than 20,000 opioid overdose kits to Jefferson County residents since 2024 and over 70,000 opioid overdose kits since the beginning of the initiative.

If the county loses the funding or if it’s delayed, it won’t be able to continue the programs, and Hicks fears the result will be more people overdosing and dying.

“It feels like we’re about to go back into a storm,” Hicks said, “that may not have any end in sight.”

Last year was the first time Jefferson County has ever seen a significant drop in overdose deaths, Hicks said. And the county is on pace this year to have “sustained drops.” He credits the decrease squarely as a result of OD2A funding.

Hicks hasn’t heard any official word from the CDC about the status of the grants. But he said the pattern feels familiar under the Trump administration: he hears about funding cuts in the news, doesn’t hear anything from officials, then receives a notice terminating the funding.

The Jefferson County Board of Health previously received two major federal grants aimed at reducing COVID-19 disparities and improving disease detection — both of which have since been terminated, Hicks said.

The first, awarded in 2021, provided $4 million through the CDC’s National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities.

The second, much larger grant was awarded in 2022 and totaled more than $28 million. It came through the CDC’s ELC Enhancing Detection Expansion & Immunization Cooperative Agreement, a program meant to boost public health infrastructure. The funding helped expand lab capacity, improve disease surveillance and data systems, and build up the local public health workforce.

Combined, the two grants totaled over $32 million in federal support. Both are now gone.

“We had to cease all grant-related activities,” Hicks said. “So when there is any type of chatter about potential funding cuts, I take them very seriously.”

In a written response to the Gulf States Newsroom, the U.S. Department of Health and Human Services said the CDC “remains committed” to supporting the OD2A program, writing that it “directly aligns with administration priorities by advancing data-driven strategies to prevent overdoses and save lives.”

The Department will issue, at a minimum, initial grant awards within the next month, the statement said, but it “may contain less than the full-year of funding in the first incremental award.”

“This incremental funding approach is not specific to OD2A,” the statement added.

The delays to Alabama’s overdose prevention funding are part of a larger, nationwide slowdown in the disbursement of federal public health dollars. Across the country, state and local health departments are reporting late or missing notices of award from the CDC — with no explanation from federal officials.

Other health initiatives dealing with these delays are seeing negative consequences. HIV hotlines are shutting down. Immunization and emergency preparedness programs are paused. Frontline public health workers including disease investigators, contact tracers and program specialists are being laid off.

Even when funding eventually arrives, the damage is done.

Alabama, where more than two-thirds of the public health budget comes from federal sources, is especially vulnerable. Without predictable funding, health departments can’t plan or safely spend on chronic disease prevention, overdose response or emergency preparedness.

Nichole Dawsey, executive director of Addiction Prevention Coalition (APC), a nonprofit that primarily serves Central Alabama, said the “common thread” behind the reduction in deaths is naloxone availability — “naloxone saturation” as she calls it.

She credits OD2A funding with making those efforts possible.

“OD2A sort of weaves that all together and creates a throughline,” she said. “It allows us to coordinate our efforts so that the right hand knows what the left hand is doing.”

Cutting, reducing, or delaying the funding is a “direct attack” on the infrastructure that has been shown to work, Dawsey said.

“I can’t imagine we’re going to be able to continue to see a reduction in deaths without that infrastructure,” she said.

And without support for prevention, treatment and overdose-reversal drugs like naloxone, Dawsey said fewer people may be able to recover from opioid use disorder.

“Dead people don’t recover,” she said.

Reynolds Journalism Institute Fellow Sophia Anderson contributed data visualization for this story.

This story was produced by the Gulf States Newsroom, a collaboration between Mississippi Public Broadcasting, WBHM in Alabama, WWNO and WRKF in Louisiana and NPR. Support for health equity coverage comes from The Commonwealth Fund.