The number of drug-related deaths increased by 16% last year, as fatal overdoses declined by an estimated 5.1% nationwide, according to the Centers for Disease Control and Prevention.
Missouri is one of 17 states that saw a rise in drug-related deaths last year. In 34 states, the number of deaths declined. Only Delaware had a higher increase over the previous year, at 16.7%.
Addiction treatment advocates point to Missouri’s decision to not expand Medicaid and the state’s belated response to treating the opioid overdose crisis, which according to the CDC killed an estimated 1,635 Missourians in 2018.
“We’re a conservative state that hasn’t invested heavily, because we think these are social issues,” said Dr. Will Ross, chairman of the St. Louis Joint Boards of Health and Hospitals. “We’re not really seeing this as a public health crisis until recently.”
Illinois saw 2,730 deaths in 2018, an estimated decrease of 1.9%.
The federal government gives states grants to help address drug use and addiction.
But Missouri is still leaving money on the table by not expanding Medicaid, which would extend health care coverage to an estimated 200,000 people and free up federal funds for drug treatment and prevention, said Rachel Winograd, director of the Missouri State Opioid Response project.
It helps distribute federal opioid response grants awarded to the state Department of Mental Health. Last year, the state received $29 million.
The state has used federal grants mostly to provide medical treatment to drug users and to distribute the opioid-reversal drug naloxone, she said. Those efforts have saved at least 3,500 people since 2017.
“There are some people who say these crisis grants are an influx, but we don’t have other money to work with,” said Winograd, an associate professor of research at the University of Missouri-St. Louis who specializes in mental health. “Other people say, ‘No, I think we have a decent amount of money, we’re just not targeting it in the right way.’”
For example, some advocates are pushing for primary care doctors to get more money for opioid treatment and prevention, she said.
State officials also didn’t consider how the overdose crisis would affect cities and people of color, Ross said.
“We should have been awaiting this crisis in other parts of the community; we shouldn’t have assumed this was mostly a white, rural plight,” Ross said.
Randall Williams, state Department of Health and Senior Services director, blamed the jump in drug-related deaths in part on the powerful synthetic opioid fentanyl. Fentanyl is often mixed in street drugs in unknowable amounts.
St. Louis is a hub for fentanyl distribution, Randall said. Most of the drug-related deaths in Missouri take place in the city, he said.
“If you look at the numbers, it’s not that we don’t have substance use disorder in other parts of the state; it’s the access to fentanyl that’s driving the deaths,” Williams said.
The state hopes to use federal grant money and help from the CDC to analyze where overdoses are taking place. The health department can use that information to determine where to direct resources, he said.
Gov. Mike Parson has said that when it comes to a Medicaid expansion, “everything is on the table,” Williams said.
But Williams said insurance coverage is useless if there aren’t any doctors to provide treatment.
“We all would acknowledge that nationally, the Achilles heel for the opioid epidemic is treatment, it’s the lack of behavioral health,” Williams said, adding there are only 500 physicians in the state who can legally provide the addiction treatment buprenorphine. “To only have that many to treat is a huge deficit.”
The CDC data is culled from death reports and won’t be finalized until later this year. While the first national decrease in decades could signal a turning point in the opioid addiction crisis, Winograd said she wants to wait to see how the trend plays out in the future.
“I’m not convinced we made the systematic changes both in the perception of addiction and the treatment and prevention that we need to in this country for me to be confident,” she said.
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