1. A State Targeted Response to the Opioid Crisis:
Tim Rudder, MSW
The Missouri Department of Mental Health, Division of Behavioral Health

2. Why?

3. 35% 908 Why? increase from 2015 to 2016 Total Number of Opioid-Related
Overdose Deaths in 2016
35%
increase
from
2015 to
2016
908
Source: DHSS, 2017

4. State Targeted Response to the Opioid Crisis Grants (Opioid STR)
Missouri: $10,015,898 x 2 years = $20,031,796
Service grant; at least 76% for treatment & recovery support

5. “Combined with coordinated collaboration and sophisticated evaluation,
Missouri’s
Plan
“Combined with coordinated collaboration and sophisticated evaluation,
The Opioid STR project aims to transform the system of care for OUD in Missouri.”

6. Prevention
Implement evidence-based primary prevention school programming GenerationRx in two high need areas in the state
Provide professional telehealth education through Project ECHO and case consultation on chronic pain management in primary care settings
Expand implementation of Overdose Education and Naloxone Distribution (OEND) – Mo’ Heroes & Community Pharmacy Naloxone Expansion

7. Prevention Overdose Education & Naloxone Distribution (OEND)
10-15 minutes with patient & family
Non judgmental, eliciting, MI style
Review:
Risk factors for an overdose
Signs of an overdose
Overview of naloxone – what it is and how to use it
Full rescue response
Preventing a future overdose – harm reduction strategies
The ONLY thing naloxone enables is BREATHING!

8. Treatment
Primary goal: Increase access to medical treatment for uninsured individuals with opioid use disorder (OUD) through provider training, direct service delivery, healthcare integration, and improved transitions of care.
Recruit, train, and support providers for medication delivery
Supply hospital-based screening, treatment induction, and connection with community care in the St. Louis area, with statewide expansion
Increase access to telemedicine for OUD treatment

9. Prior Approach to OUD Treatment
Detoxification model of treatment for Opioid Use Disorders (OUD)
Overreliance on residential and group therapy as treatment
Approached OUD as acute care rather than chronic care
Use of agonist/partial-agonist medication such as Buprenorphine and Methadone as last resort

10. Medication First Model
Treatment
Medication First Model
Fairly immediate relief from distress caused by withdrawal symptoms
Stabilizes the client
Decreases craving
Creates mental ability for patient to engage and benefit from psychosocial treatments
Increased retention in treatment
Decreased deaths from overdose

11. Treatment
The medical management of OUD should be ongoing, not subject to arbitrary time limits or tapering requirements. Evidence suggests the longer patients receive medical treatment, the better their functional outcomes.

12. Sustainability & Community Impact
Reduce the barriers to the provision of medications and naloxone by changing DMH billing and service policies
Provide education, training, and infrastructure support to ensure continuation of effective treatment and recovery services following the conclusion of the Opioid STR grant period
Promote policy changes to reduce barriers and expand access to medication for individuals on Medicaid

13. Recovery

14. Recovery Peer Support Trainings Recovery Community Centers:
help to reduce stigma and provide information, engagement, and support for long-term recovery
NARR Housing Accreditation: Allows for safe recovery housing for individuals with an SUD/OUD that are accepting of evidence based treatment
Peer Support Trainings

15. Recovery Support safe and effective recovery housing
Build the workforce of certified peer specialists to help individuals meet their recovery goals
Promote wellness and recovery through recovery community centers in high-need areas.
Recovery Community Centers help to reduce stigma and provide information, engagement, and support for long-term recovery

16. Implementation Guide for the Medical Treatment of OUD
Resources
Health Literate Patient Brochure
MissouriOpioidSTR.org
Join the Opioid STR listserv
PCSS Waiver Trainings
Opioid Crisis Management Trainings, Follow-Up Consultations & TA
Clinic-Provider “Matcher”
MO-HOPE naloxone training
Rx assistance programs
Implementation Guide for the Medical Treatment of OUD

17. YOU?! Partners Missouri Coalition for Community Behavioral Healthcare
Behavioral Health Network of Greater St. Louis
Missouri Hospital Association
Missouri Network for Opiate Reform & Recovery
St. Louis County Department of Public Health
Community Academic Partnership on Addiction (CAPA), Washington University
St. Louis College of Pharmacy
Southern Illinois University- Edwardsville
University of Kansas Medical Center
Missouri Telehealth Network – ShowME ECHO
Missouri Primary Care Association
NCADA, Community Partnership of the Ozarks
Missouri Recovery Network
Missouri Coalition of Recovery Support Providers
MO HealthNet
YOU?!

18. Questions and Discussion
Visit to learn more and sign up for our statewide listserv!