Opioid Initiative

student with pills 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

 Policy Brief Neonatal Abstinence Syndrome

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.

News Release

Policy Brief


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.

News Release

Fact Sheet

Presentation: Video | PDF

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 MVA vs. Opioid

  • Research
  • Policy
  • Practice
  • Videos

MHA Board-Approved Policy | Opioid Use in Missouri: Strategy for Reduced Misuse and Abuse

Prescribing Guidelines | Opioid Policy Recommendations

MHA News Release | Opioid Prescribing Recommendations Endorsed by Six Health Care Provider Organizations

CDC Recommendations | The Centers for Disease Control and Prevention issued 12 recommendations for prescribing opioid medications for chronic pain, excluding cancer, palliative and end-of-life care. The CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016, will help primary care providers ensure safe and effective treatment for their patients with chronic pain.

Opioid Initiative Videos

Evan Schwarz, MD

Best Practices for Treating Opioid Overdoses in the Emergency Department:
Dr. Evan Schwarz, Washington University emergency medicine physician at
Barnes-Jewish Hospital




The Opioid Epidemic’s Impact on Expectant Mothers & Babies:
Dr. Randy Tobler, Scotland County Hospital



Randall Williams
Opioid Overuse Reduction Strategies:
Dr. Randall Williams, Director, Missouri Department of Health & Senior Services



Darin HaugEmergency Department Opioid-Prescribing Guidelines Implementation:
Dr. Darin Haug



Sam PageThe Value Of A Prescription Drug Monitoring Program For Physicians:
Dr. Sam Page