UPDATE: Funding has been restored. Disasters can raise overdose risk, and today’s SAMHSA cuts could make it worse

What happened yesterday

News reports published on January 14, 2026 say HHS sent letters on January 13 ending a large share of SAMHSA grant funding, with more details from STAT and stories about frontline impacts.

That is not only a behavioral health headline. It is also a disaster preparedness headline.

The simple idea

Disasters do not create substance use disorder out of nowhere. But disasters can make things much harder for people who already use drugs or are in recovery.

When a hurricane, wildfire, flood, extreme heat, or a long power outage hits, people can lose access to treatment, harm reduction services, transportation, and safe housing. Stress goes up. People may be alone more often. The drug supply can change quickly and become more dangerous.

What we know, and what we do not

We should be honest about the data. Research on overdoses and treatment access after disasters is still limited. Many studies look at one disaster or one community. At the same time, people working in response, clinics, outreach, and recovery services report similar patterns again and again.

Do overdoses go up after disasters?

A clear pre-post signal comes from a study following Hurricane Maria among people who inject drugs in rural Puerto Rico. In that cohort, self-reported overdose experience increased from 10.6% pre-Maria to 24.2% post-Maria, and the odds of reporting an overdose were about three times higher post-Maria.

The same study also notes something important: the post-Maria period overlapped with wider fentanyl spread. That matters because disasters do not happen in a vacuum. A disaster can hit at the same time the drug supply is getting more unpredictable, and the combined effect can be worse.

Extreme heat is another disaster-like stressor with growing evidence. A national analysis links heat exposure to higher overdose deaths and estimates roughly 150 excess overdose deaths during the hottest months each year, with larger effects in more recent years and in higher social vulnerability counties. See the heat and overdose mortality study.

Do overdose deaths go up after disasters?

They can, especially when disasters interrupt treatment and slow emergency response. But it can be hard to say how much of a change is caused by a single disaster, because other big trends can happen at the same time, like fentanyl changes and people using more than one drug.

National context also matters. CDC reported a big drop in predicted overdose deaths in 2024 compared to 2023 in its May 2025 statement.

That national improvement can still coexist with local spikes after a disaster. It can also hide warning signs if communities wait for slow, yearly death summaries instead of tracking faster signals.

Why disasters can raise overdose risk

Here are the most common reasons.

• Treatment interruptions and medication gaps: Medications for opioid use disorder (MOUD) work best when people can keep taking them without breaks. Disasters can shut down clinics, knock out power, cut phones and internet, and make it hard to travel. Methadone can be especially vulnerable because it is often provided through opioid treatment programs (OTPs). If an OTP closes or people are displaced, access can break fast. After Hurricane Sandy, Bellevue Hospital faced major flooding and disruption, including challenges for people on opioid maintenance treatment, described in the Bellevue Hurricane Sandy case study.

• Harm reduction disruptions: Naloxone distribution, syringe services, outreach, and peer support can be fragile even in normal times. During a disaster, these services may lose staff, space, supplies, or safe ways to reach people.

• A more dangerous drug supply: Disasters can change local drug markets. People may switch sources, switch substances, or take higher risks to avoid withdrawal. If potency changes, the chance of overdose rises.

• More stress and more using alone: Disasters raise stress, grief, and financial strain. People may also be isolated and use alone more often. Using alone increases the chance that no one is there to give naloxone or call for help.

Access to treatment is the biggest predictable problem

For emergency managers, clinics, healthcare coalitions, and public health teams, the main takeaway is simple: disasters often disrupt access to treatment.

SAMHSA has published practical planning guidance, including the Disaster Planning Handbook for Behavioral Health Service Programs.

SAMHSA also maintains methadone take-home guidance that can help reduce risk when travel or clinic operations are disrupted.

Why yesterday’s SAMHSA cuts matter for disaster readiness

When prevention, treatment navigation, recovery supports, and harm reduction programs lose funding, the harm is not limited to normal days. These programs also matter during disasters, when needs rise fast.

News coverage describes large grant terminations and immediate disruptions, as covered by The Guardian, STAT, and public media outlets.

In disaster terms, the risk shows up in a few places:

• Preparedness capacity shrinks: The same groups helping prevent overdose on an average day are often the groups that reconnect people to care after a disaster. If those teams shrink, it is harder to surge.

• MOUD continuity plans get weaker: Mutual aid plans, backup communication, and alternate dosing options take time and staff to build and maintain.

• Naloxone access becomes less reliable: Disasters are exactly when response delays and using alone become more common. Naloxone access matters more, not less.

• Emergency care gets more pressure: When community supports weaken, more people end up in emergency departments and with EMS, on top of all the other disaster health needs.

What to do now

Treat MOUD continuity as essential in ESF-8 and healthcare coalition planning. Keep an up-to-date list of OTPs, buprenorphine prescribers, mobile partners, and recovery community organizations. Put them on call-down lists. Practice the plan.

Build mutual aid and backup operations plans for SUD providers, including cross-site options, rapid patient verification, and redundant communication methods, stress-tested against real disruption like the one described in the Bellevue Hurricane Sandy case study.

Pre-position naloxone and plan distribution like a response supply, with shelter sites, outreach teams, and community hubs.

Write simple shelter and clinic protocols for withdrawal support and rapid connection to MOUD.

Track fast indicators right after impact, not just yearly death data. Watch EMS naloxone use, ED overdose visits, missed dosing, outreach contacts, and shelter incident reports.

The takeaway

Disasters can raise overdose risk by disrupting treatment and harm reduction services and by increasing stress, isolation, and drug supply volatility. The evidence is clear enough to plan for this, even if the data is not perfect, including the Hurricane Maria study, the Hurricane Sandy case study, and the national heat and overdose mortality analysis.

That is why yesterday’s reported SAMHSA grant terminations are not just a budget story. They are a preparedness story, and the impact will be felt most when the next disaster hits a community with fewer resources to keep people connected to lifesaving care.