Last month, the Centers for Disease Control and Prevention announced that, after decades of relentless increases, there is finally evidence that the number of fatal drug overdoses is declining. Averaged across all states, in 2018, there were 4% fewer deaths. Experts from around the country expressed cautious optimism that the money and effort spent to rein in the opioid crisis — the worst drug epidemic in modern history — is finally yielding results.
The story is less hopeful here in Missouri where, despite receiving some $65 million in aid from the federal government since 2015 to address the epidemic, preliminary data shows that we defied the national trend, and our death rate actually increased by about 17%.
The reactions coming from the Missouri leaders who are responsible for these very poor outcomes reveal attitudes that are either gullible or outright dangerous; or, from my perspective, both.
A recent news story about Missouri by a District of Columbia radio station featured several quotes from Rachel Winograd, a University of Missouri-St. Louis researcher and the individual tasked with helping our state decide how and where to allocate these federal dollars. Winograd remarked, “It’s incredibly discouraging to see the increase in Missouri in 2018 that happened at the same time as we really ramped up so many efforts to save lives.”
Winograd indicated that she spent Missouri funds on expanding access to medication-assisted treatment and “saturating our communities with naloxone — the opiate overdose antidote.”
This is true. Missouri poured the majority of its money into naloxone, also known as Narcan, a harm-reduction tool that saves lives but does nothing to address the underlying causes of addiction and does nothing to help bring about lasting recovery. It is the equivalent of throwing a life preserver to someone drowning in the ocean.
Winograd cited other reasons why Missouri is now leading the nation in overdoses: the lack of housing, incarceration rates, a fraying social safety net and no Medicaid expansion.
In a July 26, St. Louis Public Radio story, Randall Williams, the director of Missouri’s Department of Health and Senior Services, blamed the jump in drug-related deaths in part on fentanyl, a powerful synthetic opioid. Williams said 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,” he said.
So excuses abound. But other states have similar challenges, and it is instructive to see how our neighbors managed to spend similar amounts of money in different ways, to far greater effect.
In Kentucky, a bordering state with all same deficits and challenges listed by Missouri’s leaders and the place where the opioid epidemic first took root, overdose deaths decreased by more than 15%, while Missouri’s increased by 17%. That’s a breathtaking difference of 32 percentage points.
Another example of a state that suffers from all of the conditions that our leaders say are the causes for an increase in overdoses is Georgia. That state was also able to decrease its overdose rates by over 10%.
Winograd, who will decide how Missouri’s funds are allocated going forward, closed her interview with these reflections: “I am very proud of what Missouri has done. I don’t think we should have done anything differently.”
This should be extremely concerning for the people of Missouri. The data is in from this $65 million experiment. Refusing to accept the outcomes and stubbornly repudiating any idea of a course correction is both professionally and ethically disgraceful. Our state’s primary focus on harm-reduction activities appears to result in a harm-postponement outcome.
The people of Missouri deserve and should demand immediate change. Change of leadership. Change of plan. And change in attitude.
Although the state leaders don’t believe they should do anything differently, the lost souls who were part of the 17% increase in overdose deaths, their grieving families and those currently struggling with addiction in Missouri have good reason to respectfully disagree.
David Patterson Silver Wolf is an associate professor at Washington University’s Brown School.