Keep Politics Out Of Addiction Science—Evidence-Based Care Depends On It

August 13, 2026

Diana Fishbein, Thomas F. Babor, Elizabeth Ginexi, Elliot A. Stein, and Anna Lee; Health Affairs

This commentary can also be found at:

https://www.healthaffairs.org/content/forefront/keep-politics-out-addiction-science-evidence-based-care-depends

The article reads:

Addiction science has produced practical, life-saving knowledge because federal research has been guided by rigorous peer review and content expertise.

The Office of Management and Budget has proposed sweeping changes to the federal grant rules that determine how research is awarded, managed, and terminated. For addiction science, this is not a bureaucratic adjustment. The proposal would weaken peer review, broaden mid-award termination authority, and restrict the travel, publishing, and professional engagement that allow research findings to reach clinicians, communities, and policy makers. It is a direct threat to the evidence base that guides prevention of teen use, substance use treatment, recovery support, and care for families affected by addiction.

Federal grantmaking is a core public policy lever that shapes which substance use problems are studied, which interventions are tested, and which findings reach treatment programs, recovery organizations, public health departments, and communities. In addiction science, that lever affects progress on medications, overdose prevention, contingency management, harm reduction, adolescent prevention, polysubstance use, and treatment delivery in real-world settings. Moving funding decisions away from scientific merit would weaken the research infrastructure that underpins effective responses to substance use.

Addiction science has produced practical, life-saving knowledge because federal research has been guided by rigorous peer review and content expertise. It has clarified how repeated drug exposure changes brain circuits involved in reward, stress, learning, memory, and decision making; why substance use disorders often co-occur with pain, trauma, HIV, hepatitis C, and mental illness; and which prevention, treatment, and recovery strategies reduce harm. Consistent with other clinical research, addiction science has helped establish the safety and effectiveness of medications for opioid use disorder, expand overdose reversal strategies, improve screening and brief intervention, and test community-based approaches in emergency departments, primary care, jails and prisons, schools, and recovery settings. These advances emerged because scientific judgment—not ideology—identified projects with the greatest promise for saving lives.

The proposed revision to 2 CFR Section 200.205 would weaken that framework by making peer review explicitly nonbinding. Under current practice, expert review is the primary basis for assessing scientific merit. Under the proposed rule, that judgment could be overridden by officials who are not selected for expertise in addiction neuroscience, medications development, epidemiology, implementation science, behavioral treatment, recovery research, or the ethical conduct of studies involving people who use drugs. In a field in which methodological details can determine whether an intervention reduces overdose risk, improves retention in care, or unintentionally increases harm, sidelining the peer review would be dangerous, even if it occurs in a minority of cases.

That concern is especially acute in addiction science, in which questions about prevention, treatment, recovery, and risk often depend on population-specific differences that are both scientifically established and clinically important. Substance use patterns, overdose risk, medication access, treatment retention, pregnancy-related care, pain management, criminal legal involvement, and recovery supports vary by age, sex, gender, race, geography, disability, housing status, and exposure to trauma. Research on these differences is not a political add-on to addiction science; it is how the field determines what works, for whom, and under what conditions. For example, alcohol consumption guidelines differ for women and men because biological differences affect metabolism and risk. Limiting the ability to study such differences in all National Institutes of Health-supported research would not eliminate them. It would simply make prevention and treatment less precise, less equitable, and less effective.

The proposed revisions to Section 200.300 also raise concern because they would add language prohibiting federal funds from supporting diversity, equity, and inclusion or diversity, equity, inclusion, and accessibility policies or practices; “gender ideology” as defined in executive order 14168; and the so-called “transition” of a child younger than age 19. Whatever one thinks of these policy choices, embedding them in a grants regulation aimed at preventing discrimination would alter the function of the rule. In addiction science, it could chill research on groups facing elevated overdose risk, barriers to medication, trauma, homelessness, infectious disease, or untreated mental health conditions. A provision meant to prevent discrimination could instead restrict the very research needed to understand and address disparities in substance use outcomes.

The same concern applies to the proposed changes to Section 200.340. Current policy allows agencies to end grants for noncompliance or mutual agreement. The proposed revision would permit termination of active awards mid-project whenever a grant is deemed inconsistent with the current administration’s goals, agency priorities, or the national interest as defined at the time of termination. That would be a major change for addiction research, which often depends on long-term relationships with treatment programs, harm reduction organizations, justice settings, tribal and rural communities, and people with lived experience. Grant cancellation for shifting administrative priorities would destabilize ongoing studies, waste prior federal investment, jeopardize participant protections, and discourage urgent research on substance use on toxicity, safety, and efficacy for medications.

The proposal would also impose new barriers to undermine public return on federal investment. Conferences, journals, and open-access publication are how findings are tested, improved, replicated, and translated into practice. Conference participation would require more preapproval, professional society membership and journal access would become more difficult, and publication costs and open-access fees would be presumptively unallowable. These are not minor details. Addiction science must move quickly because the drug supply changes quickly; community needs evolve; and emerging risks such as fentanyl adulteration, stimulant-involved overdose, xylazine exposure, and polysubstance use require rapid exchange among researchers, clinicians, public health officials, and community partners. Science delivers value only when findings are validated, disseminated, and translated into care. A study that identifies an effective medication strategy, overdose prevention approach, or recovery support model but cannot be readily shared or implemented provides less value to the public than one that supports the full scientific process from discovery to community uptake.

These barriers would also undermine public return on federal investment. Addiction science delivers value only when findings are validated, disseminated, and translated into care. A study that identifies an effective medication strategy, overdose prevention approach, or recovery support model but cannot be readily shared or implemented provides less value to the public than one that supports the full scientific process from discovery to community uptake.

The practical effects would not be limited to universities or investigators. Communities across the country rely on federally supported research to guide prevention, treatment, education, and policy. Emergency departments rely on evidence for initiating medication after overdose. Primary care clinics rely on evidence for screening and referral. Treatment programs rely on research about retention, dosing, counseling, contingency management, and co-occurring psychiatric conditions. Families and schools rely on prevention science that distinguishes effective programs from well-intentioned but ineffective messages about mental health. Local governments rely on implementation research to distribute naloxone, support recovery housing, and connect people leaving jail or prison to care. Less stable funding would slow the development of effective interventions and widen inequities in addiction care.

The chilling effect would be real. Addiction science already operates in a politically charged environment because its findings intersect with stigma, drug policy, criminalization, pain treatment, harm reduction, adolescent health, pregnancy, and public spending. Investigators may hesitate to study naloxone distribution, syringe services, medications for people in jail, drug checking, pregnancy-related substance use care, or disparities in treatment access if those topics could later be deemed misaligned with agency priorities. Early-career scientists and community-based researchers would be especially vulnerable. Over time, the field would ask fewer hard questions, produce a narrower evidence base, and lose public trust.

The proposed rules also misunderstand addiction research by treating grants more like contracts than investments in discovery and public health practice. A research grant supports an iterative process that depends on continuity, expertise, and trust. In addiction science, that may mean following participants over years of relapse and remission, maintaining relationships with communities that have been overpoliced or undertreated, and adapting protocols as the drug supply and treatment landscape change. Midstream termination would strand participants, disrupt multiyear protocols, damage community partnerships, and waste investments in staff, infrastructure, clinical workflows, and data generation. In substance use research, where evidence accumulates across complex real-world systems, that instability can be especially damaging.

Addiction policy needs a research system that is independent, credible, and able to follow evidence wherever it leads. When funding rules narrow which questions may be asked or which findings may be supported, the result is a weaker response to the issues that continue to plague us, such as overdose, alcohol-related harm, stimulant use, co-occurring mental illness, and infectious disease, as well as the ongoing needs of those who are working toward recovery. The history of addiction policy shows the staggering cost of letting stigma and ideology outrun evidence. Progress depends on researchers being able to ask hard questions about drug use, test interventions in real-world settings, report results transparently, and translate findings into care.

Health systems that serve individuals with substance use disorders (SUDs) rely on federally supported research to improve care delivery; identify effective interventions; and guide prevention, treatment, recovery support, and quality improvement. The consequences would be felt most directly by people and families affected by SUDs. Less predictable funding would mean slower translation of evidence into practice, less reliable guidance for clinicians and health administrators, and poorer care for patients.

Given this litany of concerns, Congress and federal agencies should reject regulatory changes that allow political appointees to override peer review, narrow legitimate research on health disparities and population health, or terminate grants based on shifting priorities. Federal research funding should advance knowledge, improve prevention and treatment, support recovery, and serve the public interest.