The Math on Cutting Syringe Funding: Up to 39,600 Extra Deaths

Researchers at the University of Colorado Anschutz Medical Campus built a computer model — technically a “microsimulation,” which just means they created a population of 3.69 million simulated people who inject drugs, gave each one realistic risk factors pulled from real surveillance data, and then ran the tape forward five years under different funding scenarios to see who lived and who didn’t. What they were simulating was the fate of syringe service programs, the community-based sites that trade used needles for clean ones, hand out naloxone, treat wounds, and connect people to methadone or buprenorphine — often the only consistent point of contact many people who inject drugs have with any health system at all.

The plainest finding: if federal funding for these programs is cut 80% and stays cut, the model projects about 39,600 additional deaths among people who inject drugs nationally over five years — roughly 15,600 of them overdoses. That’s the headline number. It is also, notably, the worst case the researchers modeled, not a prediction of what will happen.

The study, published in JAMA Network Open on June 18, 2026, was built in response to a July 2025 executive order that ended discretionary grants to programs the administration judged had “failed to achieve adequate outcomes” — language that swept in harm reduction — and threatened enforcement against organizations distributing syringes and other supplies. The team, led by Dr. Kirk Fetters and Pranav Padmanabhan with senior author Dr. Joshua Barocas, used CDC National HIV Behavioral Surveillance data to calibrate the simulation, then tested two funding-loss scenarios: an 11% cut (representing the roughly one-tenth of typical SSP budgets that comes from federal sources) and an 80% cut (a far more severe disruption), each run three ways — sustained for five years, reversed after one year, or restored by 2029.

The full range matters more than the scariest number in it. Across every scenario tested — as the peer-reviewed record shows — the model found deaths from any cause — what researchers call “all-cause mortality,” meaning not just overdose but the infections, endocarditis, and other complications that untreated injection drug use produces — rose somewhere between 0.1% and 5%. Overdose deaths specifically rose between 0.2% and 6.9%. The 11% cut, sustained five years, was projected to cause about 5,400 additional deaths, 2,200 of them overdoses. Reverse the 80% cut after a single year and the toll drops to roughly 7,900 deaths instead of 39,600 — a reminder that in this model, duration of the cut matters almost as much as its depth. One detail worth sitting with: nonfatal overdoses actually decreased in the cut scenarios, not because people were using less, but because fewer of them had naloxone on hand to survive the overdose they otherwise would have had.

The authors put it bluntly: “In every scenario modeled, eliminating federal funding led to excess deaths compared with maintaining funding at its level prior to August 2025.” Barocas added that the disruptions “are likely to have serious and measurable consequences for public health” that “extend well beyond the immediate funding cuts themselves.”

Here’s the calibration this newsroom owes you: this is a model, not an observed outcome. The researchers are explicit about what it can’t do. They can’t say with confidence how funding losses translate into actual program closures — a syringe service program might absorb a cut through cost-sharing or local backfill long before it shuts its doors, or it might close well before that threshold, since the relationship is likely nonlinear rather than a clean dollar-for-dollar slide. Their comparison of outcomes for people who do and don’t use these programs draws on single-city surveillance data, which may not generalize everywhere. And the model doesn’t account for HIV or hepatitis C transmission at all, or for injection risks the programs address indirectly through screening and referral — which means the real toll, if these programs disappear, plausibly runs higher than what’s modeled here, not lower.

It’s also worth being precise about what this study is not: it isn’t a direct impact assessment of SAMHSA’s April 2026 policy barring federal grant dollars from covering fentanyl and xylazine test strips and sterile syringes, which we covered in detail. That policy came after this study was designed, and the researchers weren’t modeling it specifically — they were modeling the broader executive-order push toward defunding syringe services that the April rule is one concrete expression of. Treat this as the best available math for the shape and scale of that kind of retrenchment, not as a receipt for one specific rule.

Treat this as the best available math for the shape and scale of that kind of retrenchment, not as a receipt for one specific rule.

If you get your syringes, your naloxone, or your wound care from a program that runs partly on federal money, this study is about you, even though it can’t tell you what happens to your specific program. What it can tell you is that the people who run the numbers on this, using real surveillance data and a peer-reviewed model, do not see a scenario where cutting this funding costs zero lives. Every scenario they tested — the mild one and the severe one — moved in the same direction. The debate in Washington over how much to cut is, in this framework, a debate over how many thousands, not whether the number is zero.