HHS Opens Public Comment on Addiction Policy, Asking What Actually Works

The Department of Health and Human Services wants to hear from the public about addiction treatment — and it is working on a tight clock. A Request for Information published in the Federal Register on June 10 invites patients, people in recovery, healthcare providers, community organizations, and researchers to identify which programs and policies have produced rigorous, measurable results in preventing and treating substance use disorders. Comments are due by July 5, giving respondents barely three and a half weeks to weigh in on the future shape of federal addiction policy.

The notice, signed by HHS Secretary Robert F. Kennedy Jr., frames the request as part of implementing Executive Order 14379, signed in January, which established the administration's Great American Recovery Initiative. The stated goal is to identify successful research, programs, and policies — and to surface novel ideas that could be implemented "using existing funding," a phrase that appears early in the notice and signals that respondents should not expect new appropriations to follow their suggestions.

For treatment providers, advocates, and researchers who have spent years arguing about what the evidence supports, the RFI is both an invitation and a test. The department says it wants citations: commenters are explicitly encouraged to include supporting facts, research, and linked data sets. Responses may be reflected in future solicitations or policies, though HHS is careful to note the notice creates no obligation on the government's part.

Five Questions, One Worth Reading Twice

The RFI poses five structured questions. The first two are broad: which programs have empirical evidence of effectiveness across prevention, treatment, and recovery, and which changes to federal programs could improve outcomes without new money. The third asks how federal policy can reduce the stigma that keeps Americans from seeking treatment — language drawn directly from the executive order's call to "foster a culture that celebrates recovery."

The fourth question contains the document's most striking admission. Citing its own workforce data, HHS acknowledges a national shortfall of roughly 77,050 addiction counselors and 99,780 mental health counselors. The department asks how federal programs can address a practitioner supply problem that leaves Americans — especially in rural and underserved areas — unable to find affordable, insurance-covered care anywhere near where they live. That gap has been documented for years by researchers and bemoaned by providers struggling to hire; seeing it quantified in a federal solicitation gives advocates a number to organize around.

The fifth question looks forward, asking how HHS can evaluate program effectiveness in something closer to real time, including through data modernization and artificial intelligence. Anyone who has waited two years for overdose mortality data to be finalized will recognize the problem the department is trying to solve.

A Policy Inventory With a Clear Direction

Before it gets to the questions, the RFI spends most of its length cataloguing what the administration has already done — and the inventory reads as a roadmap of where federal addiction policy is heading.

Some items will be welcomed across much of the treatment field. The notice highlights a new option allowing states to use Title IV-E foster care prevention funding as a payer of last resort for FDA-approved medications for opioid use disorder, an arrangement designed to keep families intact when a parent's untreated addiction puts children at risk of foster placement. It points to FDA guidance on developing non-opioid pain medications, joint CMS-SAMHSA-ACF guidance on coordinating state agencies around youth mental health, and a $145 million investment by the Health Resources and Services Administration's Rural Communities Opioid Response Program, which now reaches more than 200 grant recipients across 2,000 rural counties in 47 states.

Other items mark a sharper break with the previous decade of public health practice. The notice describes — in the department's own words — guidance issued "to end support for counterproductive harm reduction efforts that facilitate illegal drug use." Syringes and other supplies for safer drug use are no longer allowable expenses under SAMHSA funding, a change whose consequences are already visible in places like Ohio, where public health agencies recently lost federal support for fentanyl test strips. The RFI's framing makes clear this is not an accounting technicality but a philosophical position: the administration distinguishes between overdose reversal medications and medications for opioid use disorder, which it supports, and supply-side harm reduction, which it has moved to defund.

The document also describes the $100 million STREETS Initiative, which will fund eight localities to restructure homelessness services away from housing-first models and toward mandated engagement with addiction and mental health treatment, and a forthcoming $10 million Assisted Outpatient Treatment opportunity to expand civil commitment pathways and step-down services. SAMHSA, the notice says, will direct future Certified Community Behavioral Health Clinic expansion grants toward the 100 counties hardest hit by overdose deaths.

The Money Arriving Alongside the Questions

The day after the RFI published, SAMHSA announced $40 million in funding opportunities across eight grant programs, also under the Great American Recovery banner, aimed at preventing addiction, strengthening the behavioral health workforce, addressing child trauma, and preventing suicide. Among the components: $8 million for the National Center for Child Traumatic Stress, the coordinating hub of the National Child Traumatic Stress Initiative network, with companion categories funding treatment and service centers at up to $600,000 per year.

Taken together, the week's announcements sketch the administration's intended architecture. Money is flowing toward child trauma services, rural treatment infrastructure, hepatitis C elimination among people with substance use disorders, recovery housing, and court-supervised outpatient treatment. It is flowing away from syringe services and other harm reduction programs that operated with federal support as recently as last year.

What a Comment Can and Cannot Do

Seasoned observers of federal rulemaking will note that an RFI is the softest instrument in the regulatory toolkit. It binds no one, funds nothing, and can be filed away without response. But RFIs shape the record agencies cite when they write the next grant solicitation, and this one arrives at a genuinely unsettled moment. Overdose deaths have fallen dramatically from their 2023 peak, and researchers are still arguing about how much credit belongs to treatment expansion, naloxone saturation, shifts in the illicit drug supply, or forces nobody fully understands. The answers commenters provide — and the evidence they attach — will land in that argument.

Submissions go to the department by email with the subject line "Great American Recovery." For treatment providers watching federal priorities shift around them, the most consequential thing about this RFI may simply be that the questions are real: the workforce shortage is named, the evaluation gaps are acknowledged, and the comment window, however brief, is open. It closes July 5.