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First Responders – Comprehensive Addiction and Recovery Act (FR-CARA)


Additional Links

Notice of Funding Opportunity (


Application Deadline: May 14, 2023


Substance Abuse and Mental Health Services Administration (SAMHSA)


Awards funding to support the use of drugs or devices approved or cleared under the Federal Food, Drug, and Cosmetic Act (FD&C Act) for emergency reversal of known or suspected opioid overdose by first responders, including firefighters, law enforcement officers, paramedics, emergency medical technicians, mobile crisis providers, or other legally organized and recognized volunteer organizations that respond to adverse opioid related incidents, and members of other key community sectors. Provides training and resources at the state, tribal, and local levels to first responders on carrying and administering drugs or devices approved for emergency treatment of known or suspected opioid overdose. Offers funding to establish processes and protocols for referral to appropriate treatment and recovery support services (RSS), and for safety around fentanyl, carfentanil, and other synthetic opioids.

The target population includes those disproportionately impacted by opioid use and those with high rates of primary treatment admissions and overdose. Rural communities are a priority.

Required program activities include:

  • Support the purchase and distribution of FD&C Act approved or cleared devices, including naloxone, for emergency reversal of known or suspected opioid overdose by first responders and other key community sectors
  • Train and provide resources for first responders and members of other key community sectors on carrying and administering drugs or devices for emergency reversal of known or suspected opioid overdose and related safety measures, policies, and procedures
  • Establish processes, protocols, and mechanisms for referral to appropriate treatment and recovery services, including the use of outreach coordinators, peer support specialists/teams, or mobile crisis services to connect individuals to follow-up services
  • Develop and submit a Naloxone Education and Distribution Plan the plan within the first 6 months of the award
  • Form or join an established advisory committee to meet requirements of the award
  • Hire staff that represent the population of the community, and translate tools and resources available recipients
  • Develop strategies to increase access to services for people of all racial, ethnic, or marginalized groups in the community
  • Develop culturally and linguistically appropriate conflict and grievance resolutions processes

Amount of Funding

Award ceiling:

  • Up to $800,000 per year for states
  • Up to $500,000 per year for local government entities
  • Up to $250,000 per year for tribes or tribal organizations

Project period: Up to 4 years
Estimated number of awards: 34
Estimated total program funding: $17,200,000

Approximately $6,300,000 of the total funding will be awarded to applicants serving rural communities with high rates of OUD.

Who Can Apply

Applications may be submitted by:

  • State and territorial governments
  • Federally recognized American Indian/Alaska Native (AI/AN) tribes, tribal organizations, Urban Indian Organizations, and consortia of tribes or tribal organizations
  • Local governmental entities including, but not limited to, municipal corporations, counties, cities, boroughs, incorporated towns, and townships

Applicants proposing to serve rural communities must identify a catchment area defined as one of the following:

  • A nonmetropolitan statistical area (MSA)
  • An area designated as a rural area by any law or regulation of a state
  • A rural census tract of a MSA

To determine whether a county or specific address is designated as rural for this funding opportunity, use the 2010 rural-urban commuting area (RUCA) codes. Applicants must also specify if the proposed service area is a community with a high rate of OUD.

Grantees that received a First Responders-Comprehensive Addiction and Recovery Act (FR-CARA) award under announcement numbers SP-19-004 in fiscal year (FY) 2020, TI-21-009 in FY 2021, and TI-22-008 in FY 2022 are not eligible to apply for this funding opportunity. Also, grantees that received a Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths (PDO) award under announcement SP-21-002 in FY 2021 are not eligible to apply.

Geographic Coverage


What This Program Funds

Training Providers

Application Process

Application instructions, requirements, and other information about the online application process can be found in the funding announcement.


For programmatic or technical questions:
Anthony Bethea

For grants management or budget questions:

For grant review process and application status questions:
Stephanie Boyd

Rural Awards

Past awards communities received in FY 2023 can be found on the program website.

One rural community who received funding is the Cherokee County Health Services Council in Tahlequah, Oklahoma for the Opioid Response Initiative that will serve law enforcement and first responder organizations in 4 rural counties in northeastern Oklahoma. The project will provide resources, training, and support to 2,200 first responders for the purchase, distribution, and use of naloxone for the emergency reversal of known or suspected opioid overdoses.

Topics This Program Addresses

Emergency Medical Services • Harm Reduction • Health Education for Community and Patients • Naloxone • Opioids • Overdose Prevention • Recovery • Substance Use Disorder • Treatment