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 budget proposal aims to help people when they want help with addictions

      The budget proposal that the House will consider this week includes $4.5-million for a drug treatment network that targets people with addiction issues at a most crucial time:  when they are seeking help, and before they get discouraged and fall away.

      “This is [Federally Qualified Health Care Centers] money to address our, not just our opioid, [but] our addiction crises,” said Marshfield representative John Black (R), the sponsor of this funding item.  “The key language in the description,” he said, “is the [words] ‘prevention network.’”

      Black told his colleagues on the House Budget Committee that professionals in Missouri know there are many good treatment options available in the state for those who are dealing with substance abuse disorders, but those options aren’t always well connected.  It is the gaps between resources through which people seeking treatment often fall.

“A person who presents for treatment, by that I mean comes into a doctor’s office or a clinic’s office and says, ‘I’ve got a problem, I need help,’ may not be able at that time to see a psychiatrist or a physician and may need to come back for an appointment like everybody else, but people with those kinds of problems don’t do well sometimes with coming back.  There needs to be, if possible, someone who can work with them almost immediately to keep them in the network to try to get them back to the medical providers when it’s time to do that, by encouraging them, coaching them, helping them understand the process.”

      That’s where, Black said, the network supported by this budget item would come in. 

“There would be some professional – counselor, caseworker – that would be available.  That would be their purpose, to help people stay in a mentality to be able to take the next step.”

“This is an approach … to try to do something that we haven’t effectively done yet to deal with addiction problems … a comprehensive approach to try to develop networks to help these folks,” said Black.

The proposal was added to the budget on a unanimous voice vote.  Springfield Democrat Betsy Fogle encouraged other budget committee members to support it.

“We’ve had a lot of conversations about the substance abuse crisis our country’s facing and this is a great step,” said Fogle.  “Something I really like about this proposal is I think it addresses patients that don’t have insurance, patients who have Medicaid, patients who have private insurance; all Missourians for all walks of life.  We know there’s a shortage of providers for each and every one of those groups of people.”

      The proposed item includes a combination of state and federal money, half of which will go through a network in the Springfield area, with the other half available for any similar program elsewhere in the state that is ready to do the same work. 

      That spending proposal is part of the committee’s budget plan that will be debated by the full House this week, and from there could be advanced to the Senate for its consideration.  It is found in House Bill 11.

House approves bipartisan collaborative effort to extend Medicaid coverage for postpartum substance abuse care

A bipartisan, collaborative effort to extend Medicaid benefits for postpartum substance abuse treatment has been approved by the Missouri House.

Representatives Marsha Haefner, Martha Stevens, Cora Faith Walker, and Jay Barnes (photos; Tim Bommel, Missouri House Communications – click for larger version)

House Bill 2280 extends MO HealthNet benefits for pregnant women who are receiving substance abuse treatment within 60 days of giving birth for up to 12 additional months.  Any participating woman must follow the treatment in order to benefit.

Bill sponsor Marsha Haefner (R-St. Louis) said extended treatment has been proven necessary for success.

“Opioid and substance abuse during pregnancy is on the rise, with opioid use during pregnancy mirroring that of the general population,” said Haefner.  “The current time offered for substance use disorder treatment, which is 60-days for these new moms, does not allow for enough treatment for most women to experience success with recovery.  If a new mom is doing well then loses support and treatment for her abuse she will often relapse.  Another risk of pulling treatment too soon is after a period of non-use, women experience an increased risk of overdosing because their tolerance is low.”

HB 2280 was combined with similar bills filed by Representatives Cora Faith Walker (D-St. Louis), Martha Stevens (D-Columbia), and Jay Barnes (R-Jefferson City).

Stevens told lawmakers she was glad that the bill will cover a full range of treatments.

She said that one thing that came out of the committee hearing on the bill was that, “new moms need not just substance use disorder treatment.  That we really need to have comprehensive, wrap-around services, and so I’m very pleased that this bill is full Medicaid coverage so that these new moms can get substance use disorder treatment, they can get mental health care, they can go see a primary doctor, and really support them that first year after giving birth.”

Representative Faith Walker commended the lawmakers involved in the legislation for the bipartisan effort that led to its passage.

“It is a very common sense, evidence-based approach to dealing with the opioid epidemic here in the State of Missouri and it will both save taxpayer dollars as well as save lives,” said Faith Walker.  “I want to encourage the body to look at this effort that was put forward by all the bill sponsors moving forward for the rest of the session.”

Representative Keith Frederick (R-Rolla) said the bill represents something the legislature should do to help the most vulnerable in the state.

“The bottom line is that if we have ladies that are pregnant and have the struggle of addiction, they are in a special, vulnerable situation, as is their child,” said Frederick.

The bill’s projected cost is more than $4-million dollars through 2021, but Haefner noted it would save the state money that would have gone to caring for children who could go to state care if their mothers aren’t afforded treatment, and other cost avoidance.  She said the budget the House is debating this week also includes money to pay for the projected costs to extend this coverage.

The bill has been sent to the Senate for its consideration.  If it becomes law, the state will have to seek a waiver from the federal government to allow for the program to be created and implemented.  Missouri would be the first state to seek such a waiver.

Haefner is hopeful the state could get an answer from the federal government by the beginning of 2019.