January 23, 2019

Medical Treatment for Addiction in Missouri as told by Mark Stringer, Director of Missouri Department of Mental Health

Director of the Missouri Department of Mental Health, Mark Stringer, presented "Medical Treatment for Addiction in Missouri" during the Office of National Coordinator of Health's (ONCs) monthly Substance Use Disorder (SUD)/Opiate Use Disorder (OUD) Affinity Group convening. During the presentation, Mark explained the Medication First Model, and the successes, difficulties and results since the adoption of the model. 
 
The Medication First Model has four strategies:
  1. People with OUD receive addiction meds as quickly as possible (3-36 hours), prior to lengthy assessments and treatment planning sessions.
  2. Maintenance pharmacotherapy is provided without arbitrary tapering or time limits. (Preferred agents for Opioid Use Disorder: Suboxone film, Vivitrol, Naltrexone, and Buprenorphine.)
  3. Individualized psychosocial services are offered but not required as a condition of pharmacotherapy.
  4. Medical treatment is not discontinued unless patient’s condition is clearly worsening.
 
During the adoption process, the state of Missouri struggled to integrate SUD treatment with the rest of healthcare. The Department of Health found it difficult to secure physician and nursing services due to lower reimbursement rates (than that of primary care) and staff shortages. Missouri also battled with an ongoing threat of reduced funding due to State budget cuts.
 
Despite the challenges faced, results show that individuals enrolled in Medication First are more likely to receive medication, get medication sooner, receive fewer psychosocial services and be engaged in treatment at one and three months.
 
Medication is an important part of the services available to people struggling with alcohol and opiate use disorders.  Research shows that when treating substance use disorder, a combination of medication and behavioral therapies is the most effective. Through the adoption of the Medication First Model, Missouri has seen a positive impact on the statewide opioid overdose crisis. To view Mark’s entire presentation, follow the link:    https://gcach.org/apps/website_resources/record/eb94cb7f78d973e258bb1a975e61f03c/jan2019m.stringermedicaltreatmentforaddictioninmo.pptx.pdf. For more information, please contact Mark Stringer at mark.stringer@dmh.mo.gov.