Funding and political action fall short as fentanyl crisis in St. Louis region explodes
ST. LOUIS (KMOV) - Nichole Dawsey was worried she would be late for a Zoom meeting on the morning of St. Patrick’s Day. A man needing help walked into her office, high on something and looking like he hadn’t slept in days.
“As much as I love being able to help those individuals who just came and said ‘please, I am at my wit’s end,’” Dawsey said, “if we just keep mopping up the mess without taking a second to actually figure out what’s causing this mess in the first place, then we’re spinning our wheels.”
The man had just lost a friend and was in desperate need of treatment for his disorder.
Dawsey’s work as the executive director of Prevent+Ed is to prevent people from ever getting to that point. Her line of work has never been more important as drug overdose deaths have risen to historic heights in Missouri and the entire U.S.
“You’ve probably seen or heard the old adage where all these bodies are floating downstream,” Dawsey said, “and people are just picking them up and taking them out of the water and no one stops and says ‘why are all these bodies here?’ So, instead of putting an ambulance down at the bottom to figure out how to get these bodies from flowing downstream, let’s put a gosh darn fence up.”
Data from the Missouri Department of Health and Senior Services show nearly 7,800 Missourians died from a drug overdose from 2016-2020. In 2016 alone, the department estimates that 32,517 potential years of life were lost due to overdoses.
Dawsey is a middle school teacher by trade. The staff at Prevent+Ed is a group of about 60 people, half of them educators and most of the rest counselors or social workers.
Part of Prevent+Ed’s work is addressing the shortfall in the understanding of addiction through education. At the high school level, the program starts to address more serious addictions like heroin and fentanyl.
The hope is to catch the most at-risk kids before they become addicts.
“We do our best work when nothing happens,” Dawsey said, “when overdose deaths are not being covered by the media, because there aren’t any to cover.”
The nonprofit served about 65,000 students in 260 schools last year, spanning seven counties in eastern Missouri. Dawsey said prevention efforts are currently underfunded.
“It is not taken seriously,” she said. “It’s not. And that is my life’s work and that’s the work of Prevent+Ed is to legitimize what prevention is and to help people understand how gosh darn important it is.”
MO Network Outreach Center impacts all of Missouri with its harm reduction efforts. It gives free Narcan and fentanyl test strips to prevent overdoses. Harm reduction, however, isn’t the first line of defense in battling drug addiction.
“We need a lot more [Narcan],” Chad Sabora, executive director of MO Network Outreach Center, said, “but we need a lot more education around substance use disorder, around drug policy, around drug users, around things in the harm reduction world like syringe access programs, safe consumption sites.”
He, too, spoke of a lack of resources.
“The situation right now is that we’re bare bones for funding,” Sabora said. “Harm reduction centers that work off of a philosophical approach operate like a car driving on fumes.”
The synthetic opioid fentanyl is the main driver behind the rising overdose fatality rate. By 2020, synthetic opioid deaths passed car crashes and shootings as the leading cause of death for people ages 18-45 in the U.S. The latest overdose death data from counties in the St. Louis region, analyzed and compiled by News 4, showed more than 70 percent of overdose deaths involved fentanyl.
Although fentanyl is alarming, Dawsey said, it’s important to not get too caught up on any particular drug.
“We can’t put our focus just on one thing because that always gets us into trouble,” Dawsey said, “and when we were just focused as a nation on crack, then whoop, meth came in. And when we were laser-focused on meth, sure enough, here comes heroin and prescription drugs.”
The bodies continue to float down the river. There will always be an ambulance downstream, but a fence, or at least one that’s big enough, still hasn’t been put up so people don’t drown.
“The way the world and funding is set up,” Dawsey said, “we’re just playing a game of whack-a-mole with the next thing and that’s the other reason why prevention is so cool because you’re not laser-focused on the one substance that’s not going to be the substance du jour tomorrow.”
Missouri lags behind other states in concrete policies to combat drug addiction. Missouri was the last state in the U.S. to pass a prescription drug monitoring program when Gov. Mike Parson inked his signature on Senate Bill 63 in 2021.
“I had sponsored that for eight years before,” Missouri Sen. Holly Rehder said. “It was really just a fight every single session.”
Rehder, a Republican representing southeastern parts of the state, is at the forefront of creating policy to combat drug addiction. Rehder has experienced the toll of addiction firsthand by seeing family members go through it.
Rehder’s daughter cut her finger when she was 17 and got a prescription from a doctor for Lorcet, an opioid pain reliever. She became addicted, spending 13 years fighting to get sober.
“[People] still think of it as a moral failing when science and medicine has proven for years now that it’s a brain disease,” Rehder said. “So with that, I’ve been very forthcoming in why I sponsor legislation and why I understand it.”
Rehder said she’s dealt with ignorance from her colleagues as she proposed legislation aimed at tackling one of the deadliest crises in American history.
“People don’t know what they don’t know,” she said, “and that was hard for me to accept when I got in the legislature because people seem really pompous that haven’t seen this face to face.”
Some comments she’s heard have stuck with her.
“Gosh, if we used Narcan on them multiple times, there’s no reason to go back again the next time we get called,” Rehder recalled one legislator saying. “An addict’s always gonna find their next fix,” another one said.
Rehder said combating substance abuse is not a priority in Jefferson City. Four interview requests for this story sent to ranking members of the Missouri House of Representatives were met with silence.
Those on the front lines of the crisis such as Sabora are facing roadblocks from funding and backing from much of the community.
“You’re gonna have your little band of rebels like me that push forward no matter what,” Sabora said, “and we don’t stop, and we’re the minority compared to the rest of the people working on this but we’ll always be there in one form or another…We’ll always be a thorn in your side, pushing for what actually needs to happen.”
There is no one at the City of St. Louis Department of Health who is employed specifically to address the overdose epidemic. Dr. Mati Hlatshwayo Davis, the department’s director of health since October, wants to change that.
Davis shared a vision of community-based interventions, supporting healthcare systems and using data to deploy resources in the city’s neighborhoods that need them most.
“I inherited a health department that didn’t have this built into the infrastructure,” Davis said. “There’s no bureau or division that was even conceived of before I came. So, I’m excited to really move that conversation forward.”
Davis was appointed director of health amid a year-old pandemic and a decades-old epidemic. As much of the public health focus nationwide was on COVID-19, overdose deaths outnumbered Covid deaths in St. Louis City in 2020 and 2021.
Davis said she does not want to prioritize one crisis over another.
“We have multiple crises at the same time. That’s the real issue,” Davis said. “The real issue is a lack of understanding of the fact that there are multiple public health crises that haven’t been tended to for a long time. So the overdose problem wasn’t born out of the pandemic. This has been going on for decades.”
Missouri is last in the country in public health spending per person at $7, according to the State Health Access Data Assistance Center. Davis said disinvestment in public health is at an all-time high.
“So it is a combination of a chronic,” Davis said, “years and years, not new, not something that’s happened in the last couple of months, disinvestment in public health at a time when there’s multiple crises.”
Davis said the department of health will be working with the state and the CDC as she makes a record request from the mayor’s office for new positions to address drug misuse in St. Louis. She said she wants to be able to close the gap in care between medicated treatment and behavioral health support.
“The dream is for there to be no barriers,” she said. “The dream is that policy aligns with available treatment methods.”
People go to treatment, Sen. Rehder said, to get clean and healthy. Recovery, such as behavioral support, takes more time and resources.
“You have to have a community of recovery specialists around you while you walk that out,” Rehder said. “Some people it takes two years, some people maybe your entire life that you still need that support.”
It takes about $200 for Prevent+Ed to go out and teach one class of 25 students comprehensive drug and mental health education. It’s a drop in the bucket compared to the costs of overdoses, overdose deaths and prison sentences that often stem from addiction. The U.S. government spends more than $80 billion annually on prisons, jails, parole and probation, according to the Prison Policy Initiative.
Dawsey said Prevent+Ed has been working with organizations in charge of dispersing the $458 million in Missouri opioid settlement money.
“We know that the opioid settlement money is predominantly going to go to what they’re calling abatement and then also treatment,” Dawsey said. “Abatement has to include prevention.”
Rehder said Missouri has come a long way since she joined the state legislator in educating people about the stigma around addiction. That being said, she said there is still much ground to be made.
“I’ll just keep talking about it on the Senate floor and in the media,” she said, “and hopefully others will also and find the courage to not hide those parts of their family and those parts of themselves because we all have struggles.”
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