The number of drug overdose deaths in Missouri went down for the first time in nearly a decade in 2023, according to the latest data from the state’s Department of Health and Senior Services.
The number of fatal drug-related deaths, mostly from fentanyl and other synthetic opioids, had been going up for years and peaked in 2021 and 2022. The 1,948 overdose deaths recorded among Missourians in 2023 represented a 10% decrease from the year before.
“This remains a really severe epidemic that requires incredible vigilance and attention and multifaceted approaches,” said Heidi Miller, the department's medical director. “But we're so relieved to see that our approaches are working … we have some momentum.”
Overdose rates decreased among men and women and Black and white people. Black men still by far had the highest rates of overdose in Missouri, according to the state.
In 2023, St. Louis had the highest rates of fatal overdoses, followed by Crawford, Phelps and Iron counties.
State health officials attribute much of the decrease to increased availability of naloxone, which can reverse the effects of an opioid overdose. It’s given as an injection or through a single-use nasal spray.
“It is affordable, accessible,” Miller said. “People understand how to use it, and Missouri has worked really hard to improve the accessibility of it.
“There's tremendous evidence for rural counties, urban counties and across the country that naloxone saves lives,” she said.
Missouri in 2017 created a standing order at pharmacies that allowed anyone to get the medicine over the counter. In 2023, the federal Food and Drug Administration allowed naloxone to be distributed over the counter nationwide.
Naloxone costs approximately $40 for a two-dose box, but Miller said insurance will often pay for at least part of the cost.
Medicaid patients in Missouri can get naloxone for free at pharmacies. Miller said that between 30% and 40% of naloxone distributed under the state’s standing order is to those with Medicaid coverage.
It’s also available through local health departments and state-funded efforts such as NoMoDeaths.
Naloxone is still easier to find in urban areas, said Michelle Charbonnier, director of the St. Louis-based addiction treatment and outreach group Mo Network. The organization distributes approximately 1,000 doses of the medicine each month.
“People who use drugs definitely carry it less so in rural communities because they don't have organizations like us where they can go pick it up,” she said.
Charbonnier said that many of the people saving lives are drug users who have made it a practice to carry naloxone.
“People who use drugs and their loved ones … should be the ones credited for the decrease in overdose deaths, because those are the people who are actually reversing overdoses,” she said.
While the latest statistics are heartening, the state also must focus on what to do with patients after they survive an overdose, Miller said. She wants to see more addiction treatment for patients.
She mentioned a state-sponsored pilot program that equips first responders with the addiction treatment medicine buprenorphine as an example of the timely treatment she would like.
She also wants more of the state’s physicians to treat addiction.
“Every primary care doctor should be able to diagnose this and treat this, all psychiatrists, even pediatricians, OB-GYNs,” she said. “Diagnosing and treating opioid use disorder is not difficult. The more of us who fold this into our practice, the better.”
