Naloxone is the standard treatment for reversing opioid overdoses, including those involving illicit fentanyl. While national overdose deaths have declined — from more than 111,000 in 2023 to approximately 68,000 in late 2025 — opioid overdose remains a major public health challenge, especially due to synthetic opioids like fentanyl.

Health care providers and hospitals play a critical role in continuing to expand access to naloxone, educate patients and families, and support community distribution efforts.

Recent updates to the 2026 standing order improve accessibility to naloxone by simplifying eligibility criteria, including individuals under age 18, and allow pharmacists to dispense larger quantities, when appropriate. Enhanced clinical guidance also emphasizes rescue breathing and post-administration monitoring, particularly in response to more potent synthetic opioids.

The standing order continues to see strong utilization statewide. In 2025, Missouri Medicaid processed more than 11,400 naloxone claims through the standing order, reflecting steadily increasing public access to the lifesaving medication. Since 2023, nearly 600 claims have involved children under 18, underscoring the importance of the updated pediatric accessibility language.

State officials noted that Missouri’s overdose prevention efforts are showing measurable impact. Opioid overdose deaths declined by 23% in 2025, while accidental drug poisoning deaths decreased by 17.4%, marking the third consecutive year of statewide improvement.

Hospitals, clinics, pharmacies and community health partners are encouraged to continue promoting naloxone education, prescribing and community access. Missourians can obtain naloxone at participating pharmacies statewide or locate free mail-order and pickup options through GetMissouriNaloxone.com.

The Missouri Hospital Association continues to develop resources for member hospitals regarding naloxone distribution and prevention awareness.

Applications for reimbursement can be submitted between Wednesday, April 1, and Thursday, April 30. DMH’s letter, attestation form and fillable Excel document can be found on the department’s website.

Some nitazenes are five to 10 times stronger than fentanyl and are appearing in counterfeit pills, illicit powders, unregulated cannabis products and vape liquids, often without users realizing it.

DHSS issued a health advisory urging increased awareness, prevention efforts and expanded access to naloxone. DHSS Director Sarah Willson emphasized the importance of having access to naloxone and knowing how to use it. Naloxone is safe, easy to administer and can reverse opioid overdoses.

Applications for reimbursement can be submitted between Wednesday, April 1, and Thursday, April 30. The letter from DMH, attestation form and Excel document to fill out can be found on DMH’s website.

Medetomidine is 100 to 200 times more potent than xylazine and leaves patients experiencing severe, prolonged withdrawal symptoms including tachycardia and hypertension as well as nausea, anxiety and delirium in severe cases.

Naloxone is still an effective antidote to overdose, though patients may not become responsive right away.

Although partial completion is technically possible, it is strongly recommended that teams complete the survey in one session, as returning later may not always work. Printed versions may differ due to question logic built into the online survey.

If teams experience any issues, they can email Ron Frazier or Zach LaForce.

The survey must be completed by Friday, Feb. 13, to meet Office of National Drug Control Policy deadlines. HIDTA appreciates your participation and will share the compiled report once completed.

HRSA calculates “percent of need met” by comparing the mental health providers available in a designated area, population group or facility with the number of providers needed to bring the population-to-provider ratio below the HPSA threshold.

Missouri data show 15.18% of needs are currently met, with an additional 114 practitioners needed to eliminate these shortages.

Find your county ranking on the HPSA Work Shortage page, filter by state and select Mental Health HPSA Discipline.

More information is available in this MO HealthNet provider bulletin.

MHD will host a live webinar about this change for ambulance providers at 1 p.m. Tuesday, Feb. 17.

• clinical providers
• community-based providers
• public health professionals
• child protective services and juvenile court staff
• peer recovery specialists

Stakeholders are encouraged to share this survey with colleagues. Survey results will be shared through the MO PQC in 2026. 

Survey participation will help determine future training and programming efforts for providers who work with mothers experiencing SUD. Participants who provide their email at the end of the survey will be entered into a random drawing for one of five $100 Amazon e-gift cards (delivered directly via email). All responses will be kept confidential and separate from participants’ email addresses.

 Key concerns of 7-OH include the following.

• Isolated 7-OH is up to 13 times more potent than morphine at the opioid receptors and significantly more addictive than natural kratom.
• These products are sold without restriction in Missouri, often in the form of gummies, candies, powders or liquid shots. They are not FDA approved and lack safety data for human use.
• Users have reported serious symptoms including nausea, confusion, insomnia, seizures, respiratory depression and even death. Overdose risk increases when 7-OH is combined with alcohol or other substances.

A suspected overdose should be treated as an opioid emergency. Call 911 and administer naloxone if available. Individuals experiencing dependence on the substance should seek help from a health care provider or call 988 for behavioral health support.

DHSS recommends the following actions.

• Avoid products containing 7-OH.
• Read supplement and candy labels carefully.
• Keep these products away from children and pets.
• Educate youth about the dangers of 7-OH.
• Keep naloxone accessible in case of emergency.
• Seek medical care or call the Poison Help Line at 1-800-222-1222 with concerns.

For treatment resources, visit the Missouri Department of Mental Health’s locating treatment and services page.

According to the 2024 National Survey on Drug Use and Health, more than 58% of Americans ages 12 and older — about 168 million people — reported recent use of tobacco, alcohol or illicit substances.

Hospitals and behavioral health providers are uniquely positioned to lead the charge in the prevention of SUDs in their communities.

The importance of screening

“The most effective way for hospitals to screen patients for SUDs is to have a standardized, evidence-based, universal screening process,” said Shawn Billings, vice president of substance use programming at the Missouri Hospital Association.

Screening and assessment tools can be self-administered or conducted by a clinician and integrated into a patient’s electronic health record. Additionally, a trauma-informed, person-centered approach to conducting screenings with patients ensures the screenings lead to meaningful interventions.

Continued support after discharge

Hospital teams can support patients after they are discharged from their facilities through the following ways.

• facilitate referrals to treatment
• provide bridge prescriptions
• assist with coordinating appointments
• offer financial or transportation aid
• conduct follow-up outreach
• connect patients with peer support or telemedicine services

The American Society of Addiction Medicine released an assessment guide that aims to assist providers with finding the right referral level for the patients in their care.

The Engaging Patients In Care Coordination program, supported by MHA and the Behavioral Health Network of Greater St. Louis, provides 24/7/365 referral and linkage services for patients residing in targeted regions who present to a hospital due to an overdose or other substance use crisis.

“For patients residing in one of our EPICC regions, a referral can be made at the time of hospitalization, and a Certified Peer Specialist will respond to the patient’s bedside, typically within one hour,” Billings said.

Resources available for hospitals

In addition to EPICC, MHA’s substance use programming team offers technical assistance, consultation and training to hospitals across Missouri.

Through Overdose Data to Action in States funding, MHA staff work to support Missouri communities through nonfatal overdose biosurveillance and prevention with targeted training and educational support.

Several resources are available on MHA’s website, including evidence-based guidelines, implementation strategies, and practical tools to help hospitals address substance use and misuse. Hospital staff can learn about the following.

• improving opioid prescribing
• standardizing pain management
• educating patients
• implementing life-saving programs, like hospital-initiated take home naloxone kits

To help implement SUD prevention programs in hospitals, funding is available through grants from the Substance Abuse and Mental Health Services Administration and the U.S. Department of Health and Human Services.

Funding also can come from state programs, sometimes supported by opioid settlement funds, and reimbursement from Medicaid and Medicare. Private foundations offer grants, and federal grant databases like Grants.gov list specific funding opportunities.

Accessing and utilizing data

MHA’s data company, the Hospital Industry Data Institute, provides access to substance use trend information. This information is available through HIDI's Care Optics business intelligence platform, which includes specific dashboards related to substance use.

Hospitals also can elect to participate in nonfatal drug overdose biosurveillance, a public health collaboration between MHA, the Missouri Department of Health and Senior Services, and the Missouri State Public Health Laboratory. Hospitals submitting samples through this initiative will receive monthly reports detailing the substances bringing patients to their emergency departments, Billings said.

Collaborating with community partners

SUDs are not just a challenge for hospitals; substance use and misuse affect entire communities, Billings said. That’s why a community-wide response is necessary.

Billings encourages hospital teams to collaborate with local public health and law enforcement agencies as well as community partners on substance use prevention in the following ways.

• establishing data-sharing networks for real-time information on overdose clusters
• creating co-response teams for behavioral health crises, such as crisis intervention teams
• implementing diversion programs to link individuals with treatment instead of the criminal justice system
• developing joint prevention and education campaigns

Community-wide needs assessments also can be useful to identify nonclinical factors that affect an individual’s health, he said.

How to participate

Hospitals can participate in Substance Use & Misuse Prevention Month by implementing routine screening for substance use, educating staff and patients on the risks of overdoses and prevention tips, and partnering with community organizations to provide resources about substance use.

SAMHSA provides a toolkit that includes social media graphics and messages, flyers and more.

According to the American Addiction Centers, health care professionals are 10% to 15% more likely to develop substance misuse than the general population. This means participation in SUD prevention efforts can benefit members of the health care team. Access to trauma-informed supervision and peer support are steps hospitals can take to lower substance misuse among staff.

To connect with MHA’s substance use programming team, visit MHA’s website.

The MO HealthNet Division is making this change to comply with the Centers for Medicare & Medicaid Services’ waiver terms and conditions. If the change is not made, Missouri is at risk of losing matching federal funds for services provided in IMDs.

Additional information can be found in the Hospital Manual and on MO HealthNet’s website.

The Addressing Adolescent Substance Use training module uses a patient case model to explore how to identify, assess and address adolescent substance use. Key topics include screening, engaging in a brief intervention, assessing risk factors, diagnosis, treatment planning, talking with family and follow-up care. 

This Addressing Adolescent Substance Use clinician pathway tool is designed to help guide clinical decision-making with adolescent patients from screening through diagnosis and treatment considerations. 

The Missouri Telehealth Network’s Vaping, Tobacco & Nicotine Treatment ECHO will host a series of calls on several adolescent topics. Sessions will take place from noon to 1 p.m.

• Friday, Oct. 10: Combined ECHO session with child psych, presented by Gaurav Kulkarni, M.D. — This session will explore vaping among adolescents and provide strategies for professionals who work with this age group to address challenges.
• Wednesday, Oct. 22: Addressing adolescent addiction and withdrawal, presented by Mandy Olinger, D.O., M.A., FAAP — This session will describe pediatric health clinicians’ role to identify youth who use tobacco and connect with the resources they need to successfully quit.
• Wednesday, Nov. 12 — School-based approaches to prevention and treatment, presented by Jim Brawner, M.Ed., NCTPP — This session will discuss how classroom engagement is essential to education about and prevention of nicotine use by adolescents in schools.

Register at showmeecho.org.

MHA’s Substance Use Programming team recently attended and exhibited at the Second Annual Region 7 Peer Summit held Oct. 1-2 in Kansas City, Mo. The summit convened more than 500 attendees and focused on peer support and community health work across Missouri, Kansas, Iowa and Nebraska.

The event offered opportunities for peer support professionals, community health workers, and recovery advocates to learn from leaders, connect with organizations, and expand their networks through sessions, exhibitor opportunities, and keynotes from recognized figures in the field. 

As an exhibitor, Engaging Patients In Care Coordination highlighted its community-based coordination model, which leverages certified peer specialists to engage community members who present in hospital settings following an overdose or substance use crisis.

Through expedited connections to treatment and access to medication-assisted treatment, the program continues to demonstrate the value of peer-led approaches in improving outcomes and bridging gaps between acute care and community support.

A special thanks to the Missouri Credentialing Board and the planning committee for offering this event.

DHSS is seeking feedback on this new dashboard through a survey. In addition to general feedback, the survey also asks about personal experiences with substance use and overdose.

This survey, which is anonymous and should take about 10 minutes to complete, will close Friday, Aug. 29. Please contact Ashley at aedouglas@health.missouri.edu with questions.

The FDA also is requiring drug manufacturers to discuss medications to reverse opioid overdose such as naloxone.  

Nonfatal overdose surveillance is a key public health practice taking root across the country. In Missouri, six hospitals are leading the charge to better understand what substances are in the local drug supply. 

Through the partnership, the state lab tests specimens from hospitals and provides quarterly reports on drug trends, including demographic and geographic patterns. These insights are shared with hospitals and community organizations, helping emergency departments improve care by informing staff about local substance use trends.

Missouri hospitals interested in learning more about this partnership can contact Hannah Prince, MHA’s clinical director of substance use programming.

Fentanyl is a synthetic opioid up to 50 times stronger than heroin and 100 times stronger than morphine. Even trace amounts can be deadly. Illegally made fentanyl is frequently mixed into heroin, cocaine and methamphetamine or pressed into counterfeit pills designed to resemble legitimate prescription medication. This mixing makes fentanyl extremely dangerous, as many individuals may unknowingly consume fentanyl-laced substances. These practices dramatically increase the risk for unsuspecting users and continue to drive the majority of overdose fatalities in the United States.

Recent preliminary CDC data estimate a 26.5% decline in overdose deaths in the U.S. in the 12 months ending November 2024, compared to the same time frame of the previous year. The U.S. Department of Health and Human Services recently renewed the national public health emergency declaration of the opioid crisis. Despite the downward trend in overdose deaths, fentanyl remains the predominant driver of overdose mortality.

The CDC continues to address this crisis through its Stop Overdose campaign, providing free educational resources and promoting the use of naloxone, a lifesaving overdose-reversal drug. The Overdose Data to Action (OD2A) program also strengthens U.S. overdose surveillance and provides both fatal (SUDORS) and nonfatal (DOSE) data systems. 

To help spread awareness of National Fentanyl Awareness Day, use the CDC NFAD partner toolkit and NFAD toolkit to access key messages, social media templates, email samples and more.