Opioid use disorder is complex and requires multifaceted solutions with two goals: identify and help individuals who are currently facing opioid use disorder; and implement prevention strategies to reverse the alarming trends. Both the downstream turbulence and upstream opportunities must be addressed. There is no single action or policy change that will suddenly halt and reverse this crisis. Research and changes to both practice and policy are important strategies currently being implemented by Missouri hospitals, providers and other key partners.
An Ounce of Prevention for Mothers and Newborns: Reducing In-Utero Opioid Exposure in Missouri
This policy brief is aimed at quantifying the incidence of Neonatal Abstinence Syndrome in Missouri using both conventional and novel surveillance techniques, and proposing a Medicaid policy-centered interventional approach aimed at reducing the number of infants born with opioid withdrawal in Missouri through a 1115 waiver that would expand coverage for substance use disorder treatment to low-income women of child-bearing age.
The brief evaluates rates of NAS in Missouri using traditional diagnostic coding methods, linkages of new and expectant mothers to hospital visits for opioid misuse, and a survey that was administered to Missouri’s 70 hospitals with labor and delivery services to generate first-hand data on the severity of NAS. The brief also provides a cost-effectiveness analysis of the proposed policy intervention for both state and federal Medicaid outlays.
Opioid Prescriber-Accountability Initiative
Beginning March 1, 2018, the Department of Social Services, the Department of Mental Health, and the Department of Health and Senior Services will begin enforcing national standards for prescribing opioids to chronic pain patients. The departments are working to bring MO HealthNet providers who aren't following Centers for Disease Control and prevention guidelines into compliance when it comes to opioid prescriptions. Providers will need to respond to the Missouri Medicaid Audit and Compliance Unit with clinical data justifying the prescription history or a plan for modification to comply with the MO HealthNet standard.
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A Dangerous Intersection
Since 2001, the rate of opioid-related overdose deaths in Missouri has steadily increased. In 2010, drug overdose deaths surpassed motor vehicle-related deaths in Missouri, and between 2014 and 2016, there were 29 Missouri counties with more drug overdose than MVA deaths. This list accounts for 70 percent of the population and includes nine out of our 10 most populous counties. New research from MHA is available below.
Presentation: Video | PDF