The Missouri opioid crisis continues affecting rural communities despite recent drops in overdose deaths. Whilst emergency responders report having Narcan in more homes, significant challenges remain in addressing the underlying rural drug epidemic across the state.

Death Rates Show Mixed Progress

Missouri saw 876 non-heroin opioid overdose deaths in 2024, down from a peak of 1,493 in 2021. However, this figure remains significantly higher than the 360 deaths recorded in 2014. Central Missouri and the St. Louis area saw the largest drops in drug overdose deaths, falling 38% and 35% respectively.

Cooper County Ambulance Chief Brandon Hicks shared a concerning encounter: “I have one gentleman that I have (used Narcan on) three times that’s been in cardiac arrest, and after the third time, he literally told me: ‘See, I can do whatever I want. You’re going to be here to save me.'”

This attitude highlights ongoing challenges in the Missouri opioid crisis where some individuals view overdose-reversing drugs as enabling continued use.

Narcan Distribution Expands Statewide

Missouri distributed nearly 430,000 naloxone kits from 2017 to 2023, with 250,000 handed out in 2023 alone. Cooper County’s Hicks noted: “I do think that Narcan is the reason for those trends statistically dropping. I see Narcan in a lot more homes than I used to.”

However, the rural drug epidemic faces unique obstacles. Derek Wilson from the AIDS Project of the Ozarks explained: “When you get into a more rural area… there’s a ton of stigma. There’s still a lot of shaming, whether it’s self-shaming or from outside sources.”

Hidden Deaths Complicate Statistics

The true scope of the Missouri opioid crisis may be underreported due to classification issues. Hicks explained: “We identified that there’s really not been any opioid deaths in Cooper County for quite some time. The problem is that they’re getting ruled cardiac arrest.”

When someone’s heart stops from an overdose, deaths often get classified as cardiac arrest rather than drug-related fatalities. American Heart Association research found that 8% of cardiac arrests from 2017 to 2021 were caused by drug overdoses.

Funding limitations for autopsies in smaller counties make it difficult to determine whether deaths were drug-related, potentially masking the full extent of the rural drug epidemic.

Emergency Response Challenges

Drug users often fear calling for help due to concerns about police involvement, despite Missouri’s Good Samaritan law providing immunity for possession charges when seeking medical assistance. The law doesn’t protect against other crimes like distribution or outstanding warrants.

Hicks has modified his response approach: “People don’t want law enforcement, they feel like they’ve done something wrong. So we usually encounter somebody who is angry and upset… because they’re scared of getting arrested.”

His team avoids wearing button-up shirts or badges to differentiate themselves from law enforcement during overdose calls.

Treatment Access Barriers Persist

Rural communities face significant obstacles in accessing long-term addiction care. Distance to providers, income, transportation, and childcare are commonly cited barriers for patients seeking treatment in the Missouri opioid crisis.

Wilson emphasises the need for expanded community support: “Access to things like peer support specialists and community resources is an essential piece of the puzzle.”

Kelly Price, a rural addiction researcher in Vermont, noted uncertainty about the causes behind declining death rates: “It’s encouraging, but I don’t think we know exactly why it’s changed. It’ll be interesting to see how it plays out over time.”

Long-term Solutions Needed

Health officials acknowledge that emergency response alone cannot solve the rural drug epidemic. Hicks advocates for better coordination: “The emergency room is just not the place for a lot of people in these situations. More mental health support (is needed), not a physician that tells them to go seek care elsewhere.”

St. Joseph Health Department’s Stephanie Malita noted that peer support specialists report recovery success regardless of overdose frequency: “Some of them overdosed multiple times. But eventually they got to the point in their lives where they were ready and had a support team around them.”

However, the fundamental challenge remains preventing initial drug use and addressing the root causes that drive people toward opioids in the first place.

Prevention Must Be Priority

Whilst naloxone distribution saves lives in emergency situations, the Missouri opioid crisis requires comprehensive prevention strategies. Rural communities need resources focused on stopping first-time use rather than managing ongoing addiction cycles.

Wilson acknowledged the complexity: “It’s just not that simple, not with the way that substances interfere with our brain chemistry. It’s just a human being and things get away from them.”

The data suggests that whilst emergency interventions help reduce immediate deaths, sustainable solutions must address why people begin using opioids initially and how communities can prevent the rural drug epidemic from claiming future victims.

Source: Missouri Independent