heroin – Missouri House of Representatives Newsroom

Task Force resumes look at Missouri’s response to substance abuse

A Task Force that hopes to advance Missouri’s response to substance abuse has resumed work.

*Representative John Black (Photo: Tim Bommel, Missouri House Communications)*

The Substance Abuse Treatment and Prevention Task Force met in the 2023 interim and developed recommendations for the legislature, some of which were enacted. One of those was that it be continued this year, and its chairman, Representative John Black (R-Marshfield), is glad that was passed.

“I think we’ll do more or less the same thing we did last year. We’ll look at some of the issues that we’ve identified for review this year and then hopefully the Task Force will continue to refine those and come up with more issues. The budget, of course, is a big deal,” Black said after the Task Force met Monday.

Representative Del Taylor (D-St. Louis) is glad to be a part of the group.

*Representative Del Taylor (Photo: Tim Bommel, Missouri House Communications)*

“Missouri, as our counterpart 49 other states, as well as most countries in the world, are really struggling with getting our arms around substance abuse disorder.” He said the group heard from experts Monday that, “[Substance abuse] is kind of how we respond to our own different mental illnesses.”

The Department of Mental Health’s Chief Medical Director, Dr. Angeline Stanislaus, opened the session with a discussion of the neurobiology of addiction. She said much has been learned in the last three decades that can guide the state’s programs.

It was believed in the medical field some 20 or 30 years ago that when a substance was out of a person’s system and they resumed using it, it was by choice and they had an issue with discipline or willpower.

“That was the mindset in which we were trained as physicians in the 1990s,” Stanislaus said. “There’s been more research now to show that just because a substance is out of the system … but all the neurotransmitter changes the substance did before it got out, they’re still lingering and the body’s still working on them. This is the new understanding over the last couple of decades, it took us this long to understand that.”

*Dr. Angeline Stanislaus and Director Valerie Huhn with the Department of Mental Health (Photo: Tim Bommel, Missouri House Communications)*

Stanislaus said many people who abuse substances like alcohol, cocaine, and heroin do so because they were victims of childhood abuse or neglect that altered their brain chemistry.

“The brain wasn’t connected the way to produce a natural level of dopamine and neurotransmitters that a brain needs for us to lead healthy lives … same thing with violence. Witnessing a lot of violence changes the brain chemistry. There’s a lot of fear. The neurotransmitters that are impacted by fear will go up, so when you have so many fear neurotransmitters going on in your brain you may seek a substance to decrease that fear.”

A brain disrupted by substance abuse will never return to what it was before, but it can heal.

“The brain is such a wonderful organ. It’s very neuroplastic, that can produce itself more neurotransmitters given enough time, given treatment, this is how treatment works. Give them enough time for the brain to recreate all this dopamine and all those other neurotransmitters, either through medications, combination of therapy, combination of whatever needs to be put together … that’s the true potential of what the brain can possibly do and that’s what we try to do as treatment providers.”

Former Missouri House Speaker Todd Richardson has been the Director of MO HealthNet since 2018. Much of what the Task Force discussed with him was its recommendation from last year that a new state executive be created – what members have tentatively referred to as a “czar” – to oversee substance abuse issues across the various state departments that deal with those.

He said while the idea has merit and could work, giving one figure authority over three, four, and even five departments and asking that person to understand and take on all that is involved in substance abuse issues, could prove too much to ask.

He thinks the effort the Task Force has set in motion should be given time to work.

“I think it is incredibly important that the departments continue to collaborate in this space and make sure that our policies are complimentary of each other … I think that collaboration is better than it has ever been before. While I think the idea behind having somebody to oversee this is the right thinking, I really think the best way to accomplish what you’re trying to accomplish is by trying to continue to encourage that collaboration between those departments.”

To the Task Force’s credit, Richardson said, “I do think the focus that this task force has put on it has already led to more collaboration and coordination and discussion about this subject than I’ve seen in the 15 years I’ve been coming to Jefferson City.”

*Representative Todd Richardson (Photo: Tim Bommel, Missouri House Communications)*

Taylor appreciates the different backgrounds brought to the group. A budget-minded legislator himself, Taylor hopes to get more data about Missouri’s substance abuse response.

“Consistently I want to know: what are the programs and how do we measure effectiveness? Is the program actually working? How much have we appropriated for that program and are we spending the money that we appropriate? Let’s at least be honest and up front about how much of that is actually going to get used, how many people are you going to actually hire, and how much of that is going to lapse?”

Some members weren’t present at Monday’s hearing due to technological or medical issues. Black hopes more members will be able to attend in subsequent hearings.

“The more people we have, the more involvement, the more good questions. That would be beneficial, but I’m very happy that the Senate, the House, and the governor’s office are supportive of the continuing work of the task force.”

The Task Force will meet again in July.

House endorses adding fentanyl, ‘date rape’ drugs to trafficking laws

The Missouri House has proposed strengthening the state’s trafficking laws to include the potent pain reliever fentanyl and its derivatives, as well as Rohypnol or GHB – both commonly known as “date rape” drugs.

Representative Nick Schroer (photo; Tim Bommel, Missouri House Communications)

House Bill 239 would make possession or trafficking of those drugs a felony. Penalties range from three years to life in prison, depending on the amount of the drug involved. Missouri laws against trafficking do not include any of those substances.

Lawmakers heard that the abuse of fentanyl steadily increased between 2013 and 2017, and doctors said many people are being treated in emergency rooms because they took heroin mixed with fentanyl.

Bill sponsor Nick Schroer (R-O’Fallon) said there is a hole in Missouri’s trafficking law, so prosecutors often must charge for whatever drug fentanyl is laced with. He said more and more it’s being trafficked by itself, as it’s becoming more popular to abuse.

“I have two beautiful, amazing daughters that I kind of want to ensure … that they are not going to be exposed to these things such as fentanyl and carfentanyl and these other drugs of choice that are so dangerous that being prescribed in a micro-milligram fashion can actually kill you,” said Schroer.

Fentanyl is 50 to 100 times more potent than morphine and is legally used to manage pain, especially after surgery.

“We saw right before the hearing [on HB 239] that there was a record bust in the United States – 260 pounds was busted at the [U.S.] border … but in years past we’ve had many different seizures on Highway 44, Highway 70, where it was 30, 40 pounds, which was enough to kill not only everybody who’s in this Capitol right now, and this Capitol is full, it could kill many Missourians,” said Schroer.

As a criminal defense attorney Schroer represented a number of people who had battled heroin addiction. That’s how he became aware of the rise of fentanyl.

“The majority of those people said, ‘Once fentanyl came into the picture a lot of my friends either died or a lot of my friends became so hooked that we thought it was a lost cause,’” said Schroer.

Representative Gina Mitten (photo; Tim Bommel, Missouri House Communications)

Representative Gina Mitten (D-St. Louis) sponsored the amendment that would make possessing or trafficking Rohypnol or GHB punishable by the same penalties as those for other controlled substances.

“If you’ve got somebody at a party that’s got 37 grams of marijuana, why would they have received a greater sentence than somebody that has less than a gram of Rohypnol or GHB?” asked Mitten. “My amendment … ensured that there was parity between those substances, because personally I believe that the ‘date rape’ drugs are apt to do a heck of a lot more damage than a large amount of marijuana or even heroin.”

Schroer and Mitten both acknowledged that Rohypnol and GHB are also used extensively in sex trafficking.

“If we’re going to take a hard stance on human trafficking it needs to include these substances,” said Mitten.

Schroer anticipates some in the Senate might try to make additions to HB 239 and then send the bill back to the House. He is optimistic that Governor Mike Parson (R) would sign the bill if it gets to him.

House asked to back needle exchanges to stem potential disease outbreaks

Members of a House Committee have been told a bill to exempt needle exchange programs from drug paraphernalia laws could help combat a potential outbreak in intravenous diseases like HIV and Hepatitis C.

Representative Holly Rehder (photo; Tim Bommel, Missouri House Communications)

Representative Holly Rehder (R-Sikeston) told the Special Committee on Urban Issues that abusers who take advantage of needle exchange programs are five times more likely to enter treatment programs.

The committee also heard that the Centers for Disease Control have identified 10 counties in Missouri where conditions could lead to an outbreak like that in Scott County, Indiana. In that county of more than 24,000 people, 227 became infected with HIV in 2015 and 2016 due largely to sharing needles used to abuse intravenous drugs.

“This bill is to, honestly, sanction existing programs that we have running in the state,” Rehder told the committee about her bill, House Bill 1620 . “Right now we have syringe access, or needle exchange which it is also called, running in the St. Louis area and the Kansas City area. These have been ongoing for some time but the problem is that they’re running in a somewhat grey area because Missouri’s law has a paraphernalia charge that could be charged. The local jurisdictions have not pressed that because they see the good in these programs.”

Chad Sabora is a former prosecutor who became a heroin user, and is now an activist in fighting heroin addiction. He runs one of the needle exchange programs operating in Missouri, which he said won’t stop an outbreak but is a “crucial piece of the puzzle.”

“80-percent of the people that use my syringe access program I put into treatment within three months, because as Holly stated it’s early engagement,” said Sabora. “They walk into my office seeking clean needles and nothing else, and what they get is something different. They get conversation, they get compassion, they get treatment resources that they did not know exist, and once they find out that all these options are available for them most of them reach out for help, and I never would have told them about those options if they didn’t walk into my office just to get that clean needle that day.”

The committee heard needle exchange programs could also save the state money. Rehder told the committee the cost to treat HIV patients on Medicaid is expected to increase this year because of changes to the Medicaid program.

Sabora told the committee that a rule change by the Department of Social Services means that anyone with Medicaid can receive treatment for Hepatitis C.

“Before that passed, when it was only the very limited few that got Medicaid treatment, the state still spent upwards of $80-million in 2014. We can reduce these infections, we can reduce future cost of treatment, and lower the cost to the state,” said Sabora.

Rehder has led legislative efforts in recent years to pass a statewide drug monitoring program to help fight opioid abuse, and has shared how opioid addiction struck her family; her daughter became addicted to opioid painkillers after being treated for a cut she suffered at work. Rehder said she sees this as another tool to fight opioid addiction.

“We’ve got to be sure that we move emotion to the side and actually look at the numbers, look at the statistics – what’s working?” said Rehder. “When people first hear about needle exchange one of the first things they say is that’s enabling a user, but you have to look past that. You have to look beyond the stigma of addiction and you have to see, ok but what helps? What works? What gets better outcomes?”

Rehder said if her bill passes to remove the “gray area,” she believes needle exchange programs will spread to other parts of the state including the counties flagged by the CDC.

“There are some federal dollars that we’re passing up right now because we don’t have in statute that these are clear of any gray area, so once we get this passed these individual health departments or individual needle exchanges can reach out to get some of that help in some of these more underserved areas,” said Rehder.

The committee voted unanimously to pass HB 1620. It next goes to the House Committee on Rules.

Sponsor of bills to help overdose victims looks for next challenge in drug abuse fight

The sponsor of Missouri’s new law providing some immunity for those seeking help for overdose victims says he’s achieved all he set out to do, and is looking for other ways to help substance abusers.

Representative Steve Lynch (photo; Tim Bommel, Missouri House Communications)

Senate Bill 501 contained language offered by Representative Steve Lynch (R-Waynesville). It provides immunity to anyone seeking medical help for themselves or anyone else who is overdosing, from crimes including possessing small amounts of drugs; probation, parole, or restraining order violations; and underage drinking.

Lynch said that combined with other laws allowing first responders, friends, and loved ones of abusers to have and administer naloxone – a drug that counteracts opioid overdoses – could save lives. Lawmakers considering the bill heard that often a person will die of an overdose or from drinking too much because others don’t call for help out of fear they will be prosecuted for crimes or face other consequences.

“In North Carolina where they did their bills the same year it was just a couple years later that there were more drug rescues than there were overdose deaths,” said Lynch. “We are certainly hoping that will be the case for us.”

Lynch also sponsored the language that in 2014 and 2016 became the laws related to naloxone.

He began working on these issues after learning that the son of one of his childhood friends died of a heroin overdose.

“What inspired me was he was taking his sadness and turning it into something positive, and he became an advocate that other parents wouldn’t have to go through what he did,” said Lynch, who said as he’s worked on these issues he’s seen many other parents who do the same. “To turn all their energies around and to try and get laws changed, to raise awareness … It inspired me to get into an area that I don’t really know much about.”

Having sponsored now a series of laws aimed at saving the lives of overdose victims, Lynch is now wondering what the next such issue to tackle might be. He’s meeting with the advocacy groups he’s worked with before in looking for the next steps that could be taken.

“Most of those areas are going to be in the treatment side and in the prevention side, and certainly those are so important,” said Lynch. “Saving their lives is such a narrow part but important part of it, but if we can get people not to use it or if we can get people off of heroin or the opioid addiction … I’m really looking forward to making some progress on some treatment laws.”

Meanwhile, Lynch says there must be an awareness campaign so that people with drug problems know about the laws that have been passed in recent years and can take advantage of them.

“I’ve already talked to some of the people that I’ve been dealing with on these bills for years, particularly in the metropolitan areas, to run some big awareness [campaigns] that you can call because if they don’t know, they’re still not going to call,” said Lynch. “Unfortunately it’s not just the metro areas that are having problems – it’s everywhere.”

The immunity law is often called the “Good Samaritan” law, or “Bailey and Cody’s Law,” for two overdose victims whose parents believe having it in place might have saved their children’s lives.

House backer of prescription drug monitoring wants a special session to get program passed

The legislative session has ended without passage of a statewide prescription drug monitoring program (PDMP), but the top advocate for that issue hopes the legislature will be called back early to try again.

Representative Holly Rehder (R-Sikeston) has been pushing for a statewide PDMP for several years. Missouri is the only state that does not have one, though several of its counties are participating in a program based in St. Louis County.

She kept fighting until the final hours of the session on Friday for passage of a bill to create a program. Now she hopes Governor Eric Greitens (R) will call a special session of the legislature to focus on the issue.

“I think if there’s any hope of us getting a statewide [PDMP] passed it’s going to have to be a special [session] sooner than later, and I’m going to have to have help from [legislative] leadership,” said Rehder.

Backers of PDMPs say they help fight prescription drug abuse, particularly opioids. PDMPs collect and monitor drug prescription and dispensing data to look for, among other things,

“doctor shopping;” the visiting of multiple doctors in an attempt to get as much as possible of drugs that are commonly abused.

Rehder came away from a conference between selected House and Senate members with a version of the program that would purge patient data after two years; would include reporting on all schedules II through IV drugs; and a mandate that all physicians would have to report to the system. She said she simply ran out of time Friday to educate fellow lawmakers on the measure to get it passed.

She said in order to get a statewide PDMP passed time is now of the essence, because with no program having been approved by the legislature, more counties will be looking to join St. Louis County’s system.

“We’ve kind of reached a tipping point with these counties,” said Rehder. “We can never get that type of a robust program out of both [chambers of the legislature], yet I need counties’ representatives’ votes to get it out of the House, and so … if we don’t get this out in something like a special session right away, the more counties that get added, just the more reps that are going to have to be against it.”

Rehder believes if the legislature is called back for a special session it will be able to come to agreement on a monitoring program, and she thinks it will look much like the bill that came out of the conference committee in the final days of the session.

Rehder said if a county-by-county PDMP is the only option, she’ll support that, but she still thinks it is important that a state-run PDMP be created.

“We shouldn’t be penalizing people’s safety because of their zip code,” said Rehder, saying anyone could drive until they are in a county that isn’t participating in a program.

She noted proposals for a state program would also prohibit authorities from using prescription data to prevent individuals from owning guns – a provision the St. Louis County program doesn’t have.

In order for a bill to pass the House, Rehder would likely need to regain the support of urban Democrats whose districts are covered by the St. Louis County program. Many voted against the final proposal to come before the House, viewing the program it would create as less robust than the county’s.

House asks Senate to come to the table on proposed prescription drug monitoring program

The state House has asked the Senate to debate the changes it made to the House’s proposed prescription drug monitoring program (PDMP).

A PDMP aims to fight the abuse of prescription drugs by entering into a database information on people’s prescriptions to see who is getting large numbers of drugs that can be abused. Backers say the program will help identify abusers and cut back on “doctor shopping,” or going to multiple doctors to get multiple prescriptions for drugs.

The House passed House Bill 90 earlier this month that would require pharmacists to report to the database in real time by 2020, require the Department of Health and Senior Services to notify law enforcement if it believes any law or professional standard has been broken, and keep submitted prescription information confidential except when there has been a breach.

The Senate proposed several changes to the House plan. It would require that information only be kept on the database for 180 days; limit the database to opioids and benzodiazepines (the House proposed including all schedule II, III, and IV drugs); and mandate that doctors check the database before writing prescriptions for specified drugs.

The sponsor of HB 90, Sikeston Republican Holly Rehder, has been pushing for passage of a PDMP for years, driven in part by how drug abuse has affected her family. She opposes some of those proposed changes and wants to see if the House and Senate can work out differences.

She said those in the medical field she has talked to say the database won’t be effective if information is only kept on it for 180 days. They want it to be on there for at least two years.

“Typically when you’re looking at addiction, your first two years you have more relapses,” Rehder explained. “Once you get past that two-year mark you’re doing pretty good.”

Rehder said limiting a PDMP to opioids and benzodiazepines wouldn’t go far enough.

“Ritalin – Adderall is one of the highest drugs of misuse and abuse, so we need to be sure that we have all schedule II through IV (drugs) in my opinion,” said Rehder.

Rehder said she would not fight the change that requires doctors to check the database before writing a prescription.

Representative Justin Hill (photo; Tim Bommel, Missouri House Communications)

The Senate also proposed letting the legislature decide after six years whether to continue the PDMP, and requiring training for database users.

Lake St. Louis Republican Justin Hill opposes Rehder’s proposal and urged the body to deny her motion. He said if Missouri is going to have a PDMP it should include the 180-day provision.

“I hope we keep the 180-days in because if we’re talking about addiction and pill shopping, then let’s try it. Let’s see if it works with 180-days,” said Hill.

Hill would rather Missouri not have a PDMP. He argues they haven’t worked in other states except to push more people from abusing prescription drugs to heroin.

“49 other states admit that this doesn’t work,” Hill told Rehder.

“No, no, tell me a state that admits it. You can’t just throw things out like that on the House floor and not have anything to back you up,” Rehder responded.

The House passed Rehder’s motion to seek a conference with the Senate, and now awaits the Senate’s answer. Fewer than four weeks remain in the legislative session for lawmakers to attempt to reach a compromise.

House passes bill to shield those seeking help for overdose victims

The state House has approved a bill that supporters hope will prevent overdose deaths.

House Bill 294 would give immunity from charges for minor possession of drugs or paraphernalia or being under the influence to a person who calls for emergency medical attention for someone who is overdosing on drugs or alcohol, and would give immunity to the person in need of medical attention.

The bill’s sponsor, Representative Steve Lynch (R-Waynesville), called the bill an effort at “harm reduction,” and refers to it as “Bailey and Cody’s law,” for two overdose victims whose parents believe that having such a law in place might have saved their children’s lives.

“I fight hard on this issue because I believe that every life is valuable, and that some, because of bad decisions, or bad circumstances, or bad home life, or running with the wrong group, make one wrong decision sometimes and because heroin or opioids are so powerful, it takes all those dreams that they had and all those goals, and it becomes the next fix that becomes their focus,” said Lynch.

Lynch’s legislation won bipartisan praise and support. Velda Village Hills Democrat Clem Smith said in the neighborhood he grew up in, he saw people who had overdosed and their bodies were left, sometimes for days, in places like alleys and empty lots by people afraid of being prosecuted if they called for help.

“I’m glad that your bill will allow that somebody could get some help. Sometimes it’s those minutes that make a difference,” said Smith.

Lynch said this “Good Samaritan” bill has been shown in other states and local areas to save lives, particularly when working in conjunction with bills that allow first responders or friends and loved ones to have and administer naloxone – a drug that counteracts overdoses to opioids, including heroin. Missouri in 2014 and 2016 enacted such laws, both also sponsored by Lynch.

Lake St. Louis Republican Justin Hill, a former police officer, was one of 21 “no” votes against HB 294. He said by giving immunity to callers and those overdosing, the bill takes away an opportunity to get those individuals into treatment programs.

“There’s all kinds of problems with this, and here’s another bill that purports to help people with a drug problem that makes it worse,” said Hill.

The bill passed with 134 votes and goes to the Senate for consideration.

Earlier story: Proposed ‘Good Samaritan Law’ aims to save the lives of some who would overdose