Strategy 3: Prioritize communities at highest risk of overdose and poor outcomes in programs and grants
Understanding which communities are experiencing higher than average overdose deaths and other poor outcomes is a critical step when targeting resources. Leveraging available data on outcomes and access to services can help inform where services are needed most. Prioritizing communities at highest risk of overdose in grant development, review, and scoring — and ensuring that community voices are part of the grant review process — can further help direct funding toward effective interventions.
Policy levers include:
Implement programs offered specifically to CBOs serving communities experiencing higher levels of overdose:
States can offer grant opportunities that are open exclusively to organizations serving target populations or areas with disproportionately high rates of overdose.
Strategy in action: Funded with settlement dollars, Pennsylvania’s Services to Black, Indigenous, and People of Color (BIPOC) Communities grant program, which concluded in June 2025, supported organizations that provide services, outreach, and/or education to BIPOC communities that promote access to harm reduction services, low-barrier substance use disorder and medication-assisted treatment, recovery and peer supports, and/or reentry supports.
Additional example: Oregon’s PHOCUS (Promoting Health Outcomes with Culturally Unique Solutions)grant program
Additional example: Kentucky’s SHIFT (Shaping a Healthy and Inclusive Future Together) grant program
Additional example: Virginia’s STOP (Specifically Targeted Overdose Prevention) grant program
Within existing grant programs, adapt scoring to prioritize organizations that serve communities with higher levels of overdose:
Informed by data and community input, states can prioritize funding for organizations with high community impact or that serve communities with higher than average overdoses. Additionally, some states have specifically targeted smaller grassroots organizations by prioritizing applicants that have not been previously funded or that have relatively low operating budgets.
Strategy in action: The Kansas Fights Addiction Grant Program, responsible for distributing a share of the state’s settlement funding, uses a county’s “vulnerability index,” which measures county vulnerability to opioid overdose, as a priority element for scoring of grant applications. The organization also prioritizes organizations with an operating budget of less than $500,000.
Additional example: Rhode Island’s Opioid Settlement Advisory Committee (OSAC), which advises the state Executive Office of Health and Human Services on settlement allocations, developed a list of equity expectations. Funded grantees must also ensure compliance with National Standards for Culturally and Linguistically Appropriate Services and the Americans with Disabilities Act, as well as actively work to reduce disparities in outcomes throughout their funded project life.
Include people with lived/living experience in grant review and scoring:
Grant reviewers may lack awareness of the specific strengths and challenges of those who have been most affected by the opioid crisis. Staff can be educated and trained on these principles to enforce fair application scoring practices. Putting together an application review team that reflects the demographics or experiences of those impacted by the opioid crisis can also ensure that funded services and organizations are focused on community priority and needs.
Strategy in action: The Mosaic Opioid Recovery Partnership, a public-private collaboration funded by the Massachusetts Opioid Recovery and Remediation Fund (within the Massachusetts Department of Public Health) and operated by RIZE Massachusetts Foundation, uses a community grant review process in which all reviewers receive anti-bias training and are compensated $250 for their time. Grants are also further prioritized based on geographic overdose burden and gaps in the continuum of care.
Considerations for Implementation
- Providing compensation for people with lived/living experience for participation in advisory bodies or grant-making processes can help support broader engagement.
See NASHP’s blog post “Engaging with People with Lived Experience in Opioid Settlement Decision-Making” for more on state strategies to address stigma, empower people with lived/living experience in leadership positions, and tackle practical barriers to participation.
Offering grant opportunities catered to individual communities, such as those run by and/or serving American Indian and Alaska Native communities, limits competition between communities facing disparate outcomes.
Considering adding a layer of discretion for final determinations on grant awards — balancing grant scores with discussion or allowing opportunities to address unintended factors that might have affected scoring. Transparency about the process and outcomes of grant decisions is essential to maintaining trust with communities.