Since 2016, the state of Missouri has relied on a federal grant to help purchase and distribute naloxone, often known as Narcan, a life-saving treatment that can reverse potentially fatal overdoses. That grant has expired, leaving treatment providers without a centralized resource to turn to for the medicine.
With no long-term replacement for the same sort of grant money, providers say the loss of some of Missouri’s Narcan resources could worsen the state’s drug overdose crisis. In 1999, the rate of drug overdoses that ended in death was 5%. By 2020, the rate increased to 32.1%.
“We’ve had to – and I’m sad to say – we’ve had to kind of hold back on who we are giving Narcan to, because we don’t want to run out for whenever we need it,” said Mirna Herrera, the special projects coordinator the Mid-America Addiction Technology Transfer Center Network and Truman Medical Center Behavioral Health.
The grant, from the federal Substance Abuse and Mental Health Services Administration, provided $1 million a year and funded the MO-Hope Project.
MO-Hope, which was coordinated by the Missouri Department of Mental Health and the Missouri Institute for Mental Health at the University of Missouri-St. Louis, paid for training and education resources on the use of Narcan. The collaboration was also the hub for groups across Missouri to get free Narcan to distribute in their communities.
End of federal funds leaves Missouri without a reliable cash flow for harm reduction resources
The grant wrapped up in August. Since then, groups across the state have shifted the ways they source Narcan.
“We certainly have felt concerned because MO-Hope had such high name recognition and they really had been the primary driver of naloxone distribution in the state,” said Emily Hage, CEO of First Call Alcohol/Drug Prevention.
From January 2019 to January 2020, 1,597 Missourians died from overdoses. Over the next 12 months, that number increased to 1,952, according to data from the Centers for Disease Control and Prevention.
Hage said the state mental health department and the Missouri Institute of Mental Health still have some Narcan to distribute, but supplies are dwindling.
First Call is looking for ways to “fill the void in Kansas City,” Hage said.
“We’re trying to be proactive, to get funding of our own for people to buy harm reduction supplies, including Naloxone or Narcan, and hire dedicated staff to be out in the community, just making sure that people know it’s a lifesaving drug – that it’s free,” she said.
‘There’s just not enough resources’: Community groups face backlogs and shortages
Smaller grants are filling some of the gaps left by the end of the federal funds. But Missouri is without a “sustainable” way of purchasing Narcan to distribute for free, according to Jenny Armbruster, deputy executive director of PreventEd, formerly NCADA, an organization that partnered with MO-Hope.
That slows down response time, she said. “There’s just not enough resources and the way that the efforts are currently being sourced does not allow us to be as proactive, or as quick to react to trends.”
Herrera said she used to order 250 kits a month from the MO-Hope Project. Now, her team struggles to find kits that aren’t on back order.
“MO-Hope Project, losing that grant, has really affected us and our distribution volume,” Herrera said. “It has been tough not only because there’s no money, but because a lot of Narcan kits are on back order, too. There’s so much back order that it is taking months to get kits.”
Jenny Duncan, director of recovery services at Comprehensive Mental Health Services, said the termination of the grant has forced every agency to fend for itself when it comes to getting Narcan.
“I don’t want to say that we all have our secret ways and we don’t want to share them, but I’d be lying if I didn’t say that might be happening, just because we all are fighting for the same thing,” Duncan said.
Reducing the stigma around drug use and using Narcan is an important part of the equation. Part of that work means finding partners with deep ties to the communities who need care most, Armbruster said.
To her, the end of MO-Hope presents an opportunity for communities to prioritize funding and education on drug use in their own budgets.
“I don’t know that it is solely the responsibility of the legislators in the state of Missouri to be the Narcan providers,” Armbruster said. “These are conversations about how we can get it more ingrained in everyone’s budget…, but we do need some level of safety net and community support to be able to to make sure that there’s ongoing Narcan distribution in the community.”
Missouri is now supported by another $2.5 million grant specifically to support law enforcement and other emergency services in distributing Narcan.
Stimulant-involved overdoses raise additional concerns
Providers aren’t encouraged by new trends in Missouri that show stimulants contributing to overdose deaths, not just opioids.
Data from NoMO Deaths, a part of the state’s targeted opioid response, found that between 2019 and 2020, overdose deaths involving a combination of opioids and stimulants increased by approximately 82% statewide. Statewide increases for opioid-involved and stimulant-involved overdose deaths both rose about 30% from 2019 to 2020.
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In 2020, overdose deaths among Black Missourians increased 37%, compared to 16% among white Missourians, according to NoMO Deaths. Other data shows that Black males in Missouri are three times more likely to die of an opioid overdose than white males.
Education is a massive part of the picture, Duncan said. A national study from 2018 found that 80% of overdose reversals were performed by individuals who also use drugs. But a lack of awareness about overdose signs and stigma related to substance usage can complicate matters.
Missouri is scheduled to receive $458 million from a nationwide opioid settlement with some top pharmaceutical companies. States, cities and counties across the country joined the lawsuit, which will pay out $26 billion over the next 18 years.
Each county in Missouri is getting its own cut of the settlement, as is Kansas City, which is set to receive $15 million. It is still unclear how the state and others receiving the payout will put the money to use.
According to resolutions passed by the Kansas City Council in early March, priorities for its settlement funds will include: increasing behavioral health services for those who are incarcerated, treatment services for incarcerated Missourians, expanding housing access and providing mental health support for young people who may be at risk of opioid misuse.