JEFFERSON CITY, Mo. – As Missouri continues to struggle with an epidemic of drug overdoses, the state is set to receive hundreds of millions of dollars in opioid settlement payouts.

More than 2,100 Missourians died of an overdose last year, and nearly 70% of those deaths involved opioids. As settlement money continues to flow into the state, this funding will provide Missouri with desperately needed drug treatment and prevention programs.

“It’s absolutely fair to say that we are in a crisis,” said Rachel Winograd, director of the University of Missouri St. Louis’ Missouri Institute for Mental Health. “We are in a crisis of a preventable death.”

According to the Missouri Department of Health and Senior Services (DHSS), it’s the number one leading cause of death among adults ages 18 to 44 in Missouri.

“It took years and years and tons of failed backward policies to get us into this, and it’s going to take years and years and a lot of course corrections to get us out,” Winograd said. “Transportation, housing, access to insurance, access to nutrition, and access to peers and community health workers who have lived this – until we make that type of care easier to get than the potent drugs itself, we’re still going to find ourselves in the midst of a crisis.”

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In recent years, every state in the country has sued companies that made, sold, or distributed opioid painkillers. Over the next two decades, Missouri is set to receive nearly a billion dollars in payouts.

“I think these pharmaceutical companies should absolutely be paying into this, and that shouldn’t be the end of it,” Winograd said. “We also have an obligation [and] a set of responsibilities to spend this money wisely to really try and invest in healing and evidence-based strategies to reduce death.”

Over the past 20 years, more than 23,000 Missourians have lost their lives due to an overdose. Many counties and local governments also joined in the lawsuits, helping the state receive more money. The state portion of the settlement will be deposited directly into the Opioid Addiction Treatment and Recovery Fund. Those funds then have to be appropriated by the General Assembly.

Now that it’s a stable funding source, the Department of Mental Health Director Valerie Huhn expects it to be a popular topic for lawmakers in the upcoming session.

“I do expect that we will spend a lot of time talking about the best ways to fund alternatives [and] substance use disorder programs around opioid use disorders and how we can use those dollars to help prevent substance use disorders and support those individuals that are currently utilizing substances,” Huhn said.

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So far this year, five state agencies have received a total of $19 million. Those departments include mental health, health and senior services, social services, corrections, and the office of administration.

The local portion of the payouts is paid directly to the cities, counties, and municipalities. Currently, there are 93 counties, 50 cities, and three political subdivisions that are receiving settlement funds. Already, more than $28 million has been paid out to local governments across the state.

Winograd, an associate professor in psychological sciences at UMSL, has been researching substance use disorders for years. She said fentanyl has become the leading player in overdose deaths.

“Which is an incredibly potent, very strong synthetic opioid—not the kind you might get prescribed from a hospital, but the kind that’s made in underground laboratories and sold through normal drug trafficking routes,” Winograd said.

With this crisis happening in urban, suburban, and rural parts of the state, Winograd said it’s important to focus on populations with the highest rates of overdose deaths.

“Put equality at the forefront when we’re making funding decisions about which communities are getting access to which resources and not just doing a uniform approach but really making it needs-based,” Winograd said. “We have huge racial inequalities in overdose deaths. Specifically, Black men in Missouri are more than three times as likely to die of an overdose than the rest of the population. We have absolutely left Black Missourians behind when it comes to our investments in prevention treatments.”

Winograd said over the last decade, physicians have overcorrected when it comes to opioid prescribing, leading to people looking for medication on the elicit market, like fentanyl.

“We did have a big problem of overprescribing opioid painkillers, but then, what happened around 2010, we saw physicians and other providers reduce or eliminate the number of opioids being prescribed because they were scared. They were contributing to this addiction and death epidemic,” Winograd said. “Now, what happens when you cut back a supply of opioid painkillers? People are seeking that relief in other ways. You can’t just snap your fingers and say you don’t have a substance use disorder. Now you’re not physically or emotionally dependent.”

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Besides drug treatment and prevention programs, Winograd said the state should also legalize expanding an access syringe program, giving people a place where they can get sterile supplies, reducing the rate of infectious disease transmissions, and also giving people an easier place to access services.

DMH said the state has settled with 10 companies, and additional deals are still being negotiated and finalized.

In March, the state will launch a website to show how it’s spending the settlement funds.

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