Opioid use disorder, a form of substance use disorder, is classified as a chronic, relapsing brain disease. OUD is associated with increased morbidity and death resulting in a decreased life expectancy.

With effective and ongoing treatment, individuals suffering from OUD can reach long-term remission. However, the Substance Abuse and Mental Health Services Administration estimates that nearly 80% of individuals experiencing OUD do not receive treatment. This is largely due to the stigma attached to substance use, the nation’s fragmented care systems, and limited access to effective, evidence-based treatments.

Limited access to health and behavioral health care services, inaccessible OUD treatment, prescribing practices, and social determinants of health — including homelessness, unemployment, and poverty — are contributing factors to Missouri’s opioid epidemic.

There is an immediate need to implement a multifaceted, collaborative public health, and safe approach to the OUD crisis. Addressing OUD requires expanded community resources, and timely and comprehensive surveillance data to inform decisions.

Several Missouri initiatives expand access to integrated prevention, treatment, and recovery support services for individuals with OUD. These initiatives include multidisciplinary provider and layperson training on opioid overdose education and naloxone distribution; increased patient access to pharmacotherapies, including buprenorphine, through clinician education; SUD treatment engagement; and patient care navigation designed to promote the safe and timely transfer of patients between levels and settings of care.

Practice

Opioid Prescribing Guidance

Opioid prescribing recommendations designed to guide hospital-based physicians’ use have been adopted and released by a coalition of health care policy and advocacy organizations. The revised guidance reflects evolving best practices in the use of opioids for pain management and changes in the law designed to reduce the opioid addiction crisis. The guidance was updated in November 2018.

Hospital and Hospital ED Prescribing Guidelines for Reduced Opioid Misuse and Abuse

CDC Recommendations

The Centers for Disease Control and Prevention issued recommendations for prescribing opioid medications for chronic pain, excluding cancer, palliative, and end-of-life care. The CDC resources available will help providers ensure safe and effective treatment for their patients with chronic pain.

Resources

Advancing ED-Initiated Overdose Education and Naloxone Distribution: Key Considerations

Advancing Emergency Department-Initiated Overdose Education and Naloxone Distribution: Key Considerations

In response to the high prevalence of unmet SUD needs and the increasing frequency of drug-related ED visits, MHA published a guide, “Advancing Emergency Department-Initiated Overdose Education and Naloxone Distribution: Key Considerations,” which helps hospitals explore opportunities to integrate OEND programming into their EDs and beyond.

OEND programming is a simple and cost-effective way to provide a lifesaving harm reduction intervention to community members who are at risk for an opioid overdose. Several key considerations and implementation strategies should be considered for successful integration and deployment.

A special thanks to DMH, DHSS and MIMH for endorsing and supporting this effort.

access the guide

EPICC Statewide Status Report

MHA is honored to provide the EPICC Statewide Status Report on behalf of all the local and state partners that work to connect patients from hospitals to evidence-based substance use treatment and grassroot recovery supports.

Collectively, there are 118 unique Missouri agencies (80 active and 38 planning) that are participating in EPICC programming and/or infrastructure development. This broad base of EPICC stakeholders are supported actively by a technical assistance team comprised of an additional 10 agencies — with representation from local and state institutions.

Read the report

Opioid Prescribing and Pain Management Toolbox

The opioid overdose crisis has focused attention on evolving best practices for treating patients who use prescribed opioids for pain management, patients who develop complications from opioid use and patients who have been diagnosed with opioid use disorder. Health care providers who prescribe opioids or serve patients experiencing pain can satisfy a patient’s clinical needs and review opioid prescriptions. The Opioid Prescribing and Pain Management Toolbox highlights evidence-based practices and guidelines to help health care providers deliver compassionate, clinically appropriate pain management and opioid use disorder treatment.

The Toolbox has been designed by members of the Opioid Community of Practice, a multijurisdictional, multisector collaborative coordinated by the Saint Louis County Department of Public Health. OCP members include the following.

Local public health agencies across Missouri
Missouri Department of Health and Senior Services
University of Missouri, St. Louis – Missouri Institute of Mental Health (UMSL-MIMH)
Missouri Hospital Association
Missouri Primary Care Association
Behavioral Health Network of Greater St. Louis
St. Louis Regional Health Commission

The Toolbox has been thoroughly reviewed by practicing health care providers who work within primary care, pain management, emergency department and behavioral health specialties. While this Toolbox is intended to be a resource for health care providers, it is not intended to provide medical advice.

View the Toolbox

Hospital Flyers

SAMHSA: Rx Pain Medications: Know the Options, Get the Facts