What's Real?

Chasing truth in the latest announcement from HHS

On February 2, Robert F. Kennedy Jr. stood at an event and announced a “$100 million investment” for a new STREETS initiative to address homelessness, opioid addiction, and public safety. The pitch was a familiar one: we’ll build a seamless system from street outreach to stabilization to housing to work, and we’ll do it with “evidence-based” credibility. On the surface, there’s a lot to like about this.

The problem is that this administration’s relationship with evidence has been strained, to say the least.

Less than two weeks ago, the administration abruptly terminated nearly $2 billion in mental health and addiction grants and then reversed itself within roughly a day after bipartisan blowback. If you’re on the frontlines, running a treatment program, that’s not the type of “bold leadership” you are looking for. It’s a strange, and disorienting organizational whiplash.

Photo by Michael Carruth on Unsplash

I’m not trying to be political here, just to call out the facts. I know both parties care deeply about mental health and addiction, truly bipartisan issues, but addressing what’s happening in real time, while tiring, feels necessary right now.

Even if you want to ignore the politics and just look at what people are feeling, the on the ground truth is ugly. In KFF’s latest Health Tracking Poll, health care costs now top Americans’ economic worries, with 66 percent saying they’re worried about affording care and 32 percent “very worried,” higher than food, rent, or utilities. Most adults (55 percent) say their health care costs rose in the past year, and 56 percent expect costs to get even less affordable. That anxiety is already turning into electoral pressure: two-thirds of Democratic voters and more than four in ten independents say health care costs will have a “major impact” on their 2026 vote, and 67 percent of the public say Congress did the “wrong thing” by letting the enhanced ACA tax credits expire.

It’s in this context we are being asked to applaud a $100 million announcement. I tried to get into the details, and read the fine print. Basically, HHS describes this as money the Secretary “directed,” not money Congress newly provided. That distinction matters as this is not new money, or a new investment, but rather a re-labeled bucket with a press release. If this is truly new funding, HHS should be able to point to the appropriation, program authority, and the Notice of Funding Opportunity language that makes it so as I couldn’t find it.

The release also leans on heavily on a statistical claim that should also be examined. HHS compares substance use disorder prevalence in 2019 vs. 2024 to declare a dramatic rise. But SAMHSA itself warns that 2019 NSDUH estimates should not be compared with more recent years because of methodological changes. It’s something to at least acknowledge.

Then comes the part that’s hardest to excuse: the release dismisses harm reduction and Housing First as “non-effective” strategies that “enabled future drug use.” This factual claim just doesn’t hold up when you compare it to the evidence.

Harm reduction saves lives. Syringe services programs reduce HIV transmission and reduce injection risk behaviors, without increasing drug use or crime in the ways critics like to imply or politicize. Supervised consumption facilities, across systematic reviews, are associated with fewer fatal overdoses and better linkage to care.

Housing First works on the outcome it was designed to achieve: housing stability. Systematic reviews consistently show Housing First reduces homelessness and improves housing retention for people with high-acuity needs, including people with co-occurring mental illness and substance use disorders. It’s also fair to say Housing First is not a standalone overdose intervention. Housing can reduce exposure deaths and stabilize lives, but overdose risk can remain elevated in supportive housing settings unless they are paired with prevention and treatment. The correct response is not “Housing First doesn’t work,” but rather “Housing is necessary, and we still have to do the clinical and public health work to help.”

Here’s what is evidence-based and deserves support, regardless of party: medications for opioid use disorder. The HHS release touts a move by Administration for Children and Families to allow federal match for buprenorphine, methadone, and naltrexone in specific child welfare prevention contexts. That’s good. This move is aligned with what CDC highlights as core to reducing overdose deaths: naloxone distribution, better access to evidence-based treatment, and sustained prevention investments. More of this, please, and less ideology and rhetoric.

But the announcement also tries to sell Assisted Outpatient Treatment (AOT) in the same breath as addiction policy. The evidence base for AOT is mixed, and its use is controversial for good reasons. Even federal reviews emphasize uneven findings and implementation variability. Treating coercion as a substitute for broader systems capacity and investment isn’t a solution that will lead to healthier communities.

We also shouldn’t ignore the messenger. Secretary Kennedy has repeatedly amplified claims linking antidepressants to violence that experts and fact-checkers have rebutted as unsupported by evidence. And the administration has stepped back from enforcing key requirements of mental health parity. When the nation’s top health official stigmatizes evidence-based treatment and weakens parity oversight, it undercuts any “evidence-based” pitch.

Finally, the administration is trying to claim credit for progress it didn’t create.

Overdose deaths have been falling, and perhaps the most dramatic portion of that decline is clearly visible before this administration had time to enact and implement major policy changes. CDC reported a steep drop in predicted overdose deaths for the 12 months ending September 2024 versus the year prior. CDC also reported that 2024 overdose deaths fell sharply compared with 2023, including large declines in opioid-involved deaths. And CDC’s more recent provisional data show continued declines through the 12 months ending August 2025.

Two realities can be true at once: we should be grateful for fewer deaths, and we should be honest about why and how we got here. Overdose mortality data are provisional and lag because many deaths require investigation and toxicology. And no serious public health professional believes you can flip an overdose curve in a matter of days with a new slogan or renamed grant program. It takes time, intention, and consistency. It also requires a broader strategy.

If the administration wants to lead, it can start with a simple standard: stop calling proven interventions “non-effective,” stop using broken comparisons to sell ideology, and stop yanking funding, even temporarily, from the very infrastructure it claims to be rebuilding.