Local Experts Talk Next Steps To Address Missouri’s Opioid Crisis After Discouraging 2018 Outcomes | St. Louis Public Radio

Local Experts Talk Next Steps To Address Missouri’s Opioid Crisis After Discouraging 2018 Outcomes

Aug 12, 2019

David Patterson Silver Wolf (at left) and Rachel Winograd joined Monday's talk show.
Credit Evie Hemphill | St. Louis Public Radio

A few weeks ago, the Centers for Disease Control and Prevention released some positive statistics related to the ongoing opioid crisis. While drug overdose deaths in the U.S. had reached record levels in 2017, the nation saw an overall 4.2% decline in 2018.

In Missouri, though, the 2018 outcomes were far less hopeful – despite an influx of $65 million in federal funds aimed at addressing the crisis over the past few years. Provisional data for the state indicates a 16% increase in drug overdose deaths over the course of last year.

On Monday’s St. Louis on the Air, host Sarah Fenske talked with two local experts about where Missouri should go from here in light of the discouraging statistics.

Joining the discussion were Rachel Winograd, associate research professor at the University of Missouri-St. Louis’ Missouri Institute of Mental Health, and David Patterson Silver Wolf, associate professor at the Brown School at Washington University.

Winograd, who has recently been tasked with helping the Missouri Department of Mental Health decide where to allocate the federal grant funds, said she continues to think the state’s priorities “were well placed.”

“We’ve been spending money on a whole bunch of things across prevention, treatment, recovery, support and harm-reduction efforts,” she said, “[but] I would say the bulk of our dollars have gone to increasing access to medically focused treatment, using medications like buprenorphine and methadone to help treat opioid use disorder as well as a medication that reverses opioid overdose, which is [called] naloxone, also known as Narcan.”

“If anything … I think we need to scale up and double down on [those] efforts,” Winograd added.

Patterson Silver Wolf has been critical of current efforts to address the opioid epidemic, and recently authored a St. Louis Post-Dispatch column arguing that Missouri “needs a new plan” to tackle the crisis.

He thinks the state needs new leadership in this realm as well as some fresh areas of focus.

“[Medications] have a place in recovery,” he said, “but I think it would be more honest [given current efforts in Missouri] just to say, ‘You’re going to be on opioids the rest of your life. That’s the safest thing we have for you.’”

Patterson Silver Wolf explained that he doesn’t believe there’s enough investment in behavioral health under Missouri’s current strategies with regard to the opioid epidemic.

“In my mind, treatment [means] the combination of medication and behavioral health treatment that happens over a long period of time,” he said, adding that currently “you might get some individual or some peer support, but you don’t get that hard-and-fast, that difficult behavior-change structure that so many people might want and do want.”

Both guests disputed some of each other’s statements at times.

Winograd said there is additional context to consider with regard to the 2018 increase in overdose deaths in Missouri. The huge influx of fentanyl, “which is essentially poisoning our drug supply,” she said, is hitting Missouri harder than many other states.

“I also think we would be remiss not to talk about the disparities in urban black death rates that we’re seeing nationally, and with our deaths focused in St. Louis in Missouri, with a large black urban population, people are really getting decimated,” Winograd said. “In fact, in St. Louis we saw a 5% decrease in deaths [among] white males and yet a 50% increase among black males in St. Louis city.

“So yes, these are the statistics that keep me up at night and the ones that I think are worthy of discussion. But I also don’t want to say that a year-to-year increase of 16% is an indictment on the way that single opioid grant money was spent,” she said. “Remembering that only 1 in 8 people who need treatment get access to treatment, if we have money that goes specifically to prevention and treatment, we may very well have very little impact in the overall state mortality rates year to year. But we do have a moral obligation to provide them with the things that we know save lives.”

Listen to the full conversation:

Related Event
What: Project O (Opioid) Awareness Walk
When: 9 a.m. Saturday, Aug. 31, 2019
Where: Forest Park’s Upper Muny Parking Lot (1 Theatre Drive, St. Louis, MO 63112)

St. Louis on the Air” brings you the stories of St. Louis and the people who live, work and create in our region. The show is hosted by Sarah Fenske and produced by Alex Heuer, Emily Woodbury, Evie Hemphill, Lara Hamdan and Alexis Moore. The engineer is Aaron Doerr, and production assistance is provided by Charlie McDonald.

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