Missouri's fentanyl crisis is worsening, but patients can't get treatment for substance abuse
High school sophomore Ethan Everly died of an overdose last week in Kansas City after taking a pill laced with the potent and dangerous opioid fentanyl.
Everly's death is only the latest warning that the drug epidemic is spreading quickly in Missouri.
A decade ago, the state's opioid crisis was fueled by prescription pills, and largely affected rural, mostly-white communities. But in the last five years, the crisis entered a new phase — one dominated by fentanyl, and focused in urban areas.
When it hit St. Louis, Morris Lockett saw the change first-hand. Lockett used drugs for most of his life, and ended up spending 17 years in prison. When he returned home in 2019, he found the scene had transformed.
“The drugs that was normally on the street wasn’t on the street,” Lockett said. “And the drugs that was on the street was pretty much laced with fentanyl.”
It didn’t matter if someone was looking for heroin or cocaine. Lockett said it was hard to find any drug that didn’t contain the opioid.
Fentanyl’s toll on Missouri has been devastating and immediate. Starting in 2016, the opioid overdose rate among Black men across Missouri began climbing to nearly three times the overdose rate for white men.
After he left prison, Lockett briefly relapsed, but then made up his mind to stop using permanently. He was able to get into an inpatient treatment program with the help of Minister Nathaniel Johnson, a former user who now runs a re-entry program in St. Louis.
St. Louis ranks among the most deadly cities in the country for overdose deaths among African Americans, and to Johnson, the Black community seems caught between organized crime’s fentanyl push and ineffective efforts to stop it.
“I believe it’s promoted and permitted in this country,” Johnson said.
Now Kansas City is seeing fentanyl overdoses increase too — a trend that was exacerbated by the COVID-19 pandemic.
One of the most effective weapons in the fight against opioids is medication assisted treatment, where a patient takes a drug such as buprenorphine every day to prevent cravings. The method has been shown to reduce both withdrawal symptoms and overdoses, and keep people engaged in treatment for longer.
But in Missouri, it’s difficult for people to access that help.
Rachel Winograd of the Missouri Institute of Mental Health says that’s because many treatment programs require patients to do extensive screenings, commit to therapy or lose treatment if they relapse.
“We are making it so hard to get treatment that it is next to impossible for a lot of people out there who are really, really struggling,” Winograd says.
These barriers leave people waiting for treatment, or having it taken away before they're ready.
Winograd has helped guide state efforts that encourage the “medication first” approach, by getting rid of many treatment requirements and providing medications to patients on the same day they start looking.
In one study, researchers found that Missouri programs that adopted this strategy saw the use of medications nearly double. These patients stayed in treatment longer, and the state saved money by preventing the need for additional future treatment.
Winograd explains that some programs have recently expanded their use of medication treatments.
“Utilization of buprenorphine and methadone — the two most efficacious medications for treating opioid use disorder — has broadly increased over the last four years,” Winograd said. “And that has been a net benefit to people who are enrolled in treatment services.”
Despite the evidence, however, most treatment centers haven't followed suit. Often that's because of a difference in philosophies — including an abstinence-based approach.
In Kansas City, though, a lack of access to treatment is already proving deadly. Opioid overdose death climbed to 145 in 2020, an increase of more than 50% from the previous year. Local experts say the number of overdoses is going up still.
There is some movement on the state level. Missouri Department of Mental Health launched a new campaign this year to reduce more barriers to medication assisted treatment, and train more medical professionals in prescribing these drugs.
Dr. Kanika Cunningham, who focuses on recovery for Black residents in St. Louis, say such steps from the state are welcome but overdue.
“Unfortunately, it took for this pandemic on top of this to really exacerbate this, I guess, for some people to see that this has been an urgency for years,” Cunningham said.
Black communities in Missouri are bearing much of the brunt of fentanyl. As of 2019, Missouri had the third highest Black overdose rate in the country, while the rate for white residents dropped below the national average.
Experts says Black communities have been especially vulnerable to fentanyl due to a constellation of factors including targeting by organized crime, disconnection from providers, treatment “deserts” and mistrust of the medical establishment.
The Rev. Burton Barr — associate minister at West Side Missionary Baptist Church in St. Louis — argues that a lack of economic opportunities in many lower income neighborhoods also contributes to the high rates of drug abuse.
A former heroin user, Barr says that many people in his community who use drugs are unable to find a fulfilling alternate lifestyle.
“They see the neighborhoods. All they see is a world of hopelessness,” Barr says. “They see no way out of this. You try to talk to them about getting a job or something like that. They don’t think that’s going to happen.”
The current crisis is further complicated because many people who obtain even non-opioid drugs on the street may not realize they are laced with fentanyl.
Substance abuse experts urge drug users to employ test strips that can determine whether drugs contain fentanyl, and they encourage people who are in contact with users to keep naloxone — an emergency drug that helps reverse an opioid overdose — close at hand.
For Cunningham, fully addressing the fentanyl crisis will require government leaders and health care professionals to better understand users’ life circumstances, and provide prevention strategies and treatment options based on their needs.
“What we’re done in the past historically have not worked — and specifically for the Black community — it has not worked,” Cunningham said. “Because if it did work, and it was working, why are Black overdose deaths increasing so significantly among the Black population?”