Missouri legislative panel hears recommendations for state substance abuse care

Lawmakers heard suggestions Monday for addressing the behavioral health needs of Missourians struggling with substance abuse.

Missouri’s Substance Abuse Prevention and Treatment Task Force is comprised of state senators and representatives, and the task force chose professor Rachel Winograd to represent its recommendations before the House Health and Mental Health Committee.

Winograd researches addiction science and works to develop solutions to substance abuse at the University of Missouri-St. Louis.

Changes to the state’s drug supply inspired the task force’s recommendations. Winograd said even though opioid deaths are decreasing and deaths from stimulants have plateaued, new street drugs like Xylazine (a veterinary sedative commonly known as “tranq”) complicate efforts to combat substance abuse.

“Across my last two years of sitting with the substance abuse task force, I reviewed our recommendations, which were plentiful,” Winograd said. “I did my best to cluster them in five key domains.”

Funding

Winograd said funding for substance abuse prevention needs to increase or at least stay at its current level.

Medicaid, she said, has been crucial in caring for people with addictions without tapping into state funds.

Most state funding for substance abuse treatment comes from sales tax on cannabis and tobacco, as well as settlement funds received from tobacco companies that compensate for smoking-related medical costs.

Rep. Becky Laubinger, R-Park Hills, pointed out how the state has some of the lowest tobacco sales taxes in the nation. The tax rate per one pack of cigarettes in Missouri is 17 cents.

The task force found that the biggest gaps in funding are basic needs like recovery housing.

Transportation and housing

“I’ve been really humbled,” Winograd said, “by how little it matters if you provide really effective evidence-based treatment service if no one can get there.”

She described transportation as an issue of “equifinality,” or how different experiences can lead to similar outcomes. In rural areas, she said, treatment centers might be too far away. In urban areas, public transportation and infrastructure might be subpar.

Some current solutions to the issue are state-provided bus passes and funds for ride-booking services from care providers, but Winograd said she doubts these solutions are the most efficient way.

Housing is another basic need that effects how those struggling with substances get the help they need.

“What good is fabulous, gold-standard care if then I go back to living on the streets,” Winograd said. “The way we work as humans operating in society is that my first priority is going to be finding housing. Then I’ll deal with my sobriety.”

She recommended flexible strategies as a solution, such as outpatient treatment combined with sober living and recovery housing.

Crisis care

Overdose response makes up a large part of crisis care for substance abuse. Winograd praised the state’s push for behavioral health crisis centers, which she compared to urgent care facilities. However, she also recommended that those centers be required to provide medical treatment for people struggling with opioid addiction.

Another task force proposal was ambulance transport to non-hospital settings, such as behavioral health centers.

“Especially after an opioid overdose or a stimulant overamping event, often the hospital is not necessarily the best place for somebody to go,” Winograd said. “They don’t get the right care, it’s not what they want, it’s not what they need. They kind of get spun and churned back out to the streets.”

Behavioral health care centers can provide more comfortable or personalized care for such cases, she said.

The task force also recommended helping people navigate recovery programs, legalizing needle exchanges and expanding drug-checking services.

Legal programs

Overdoses are a “huge killer” of people who have been formerly incarcerated, Winograd said.

She recommended drug courts and diversion programs in communities to help in lowering incarceration rates. She also suggested increasing resources to treat people with addictions while they are incarcerated.

The task force also recommended judicial treatment courts, which offer care as an alternative to incarceration. Winograd said the task force wants to make sure use of life-saving tools isn’t discouraged.

“There’s a real culture in specific drug courts of success and motivation,” Winograd said. “I’m looking forward to learning more about drug courts and also making sure they are as evidence-based and effective as possible, specifically ensuring that they not only allow, but encourage and support people to stay on medications for addiction treatment.”

Other legal recommendations from the task force include evidence-based treatment for the incarcerated, expanding naloxone distribution and increased funding for public defenders.

Youth prevention

The task force found that community support and infrastructure is crucial for youth prevention of substance abuse.

“All of these things are really about letting a child have a childhood and not be running in the streets unattended and getting into dangerous stuff,” Winograd said.

The task force supported funding for youth mentoring and community service liaisons, school-based supports and youth crisis centers.

After hearing testimony in the task force, Winograd agreed that current prevention programming is not very effective, and can even be harmful.

“There is a difference between any school assembly talking about ‘don’t do drugs’ and efforts that actually work,” she said.

Winograd said targeted messaging to an age-appropriate audience can help adolescents understand what is going on inside their mind so drugs don’t seem like the easiest option.

This story originally appeared in the Columbia Missourian. It can be reprinted in print or online.