The Missouri Department of Health and Human Services said the state's Naloxone Standing Order is helping to bring overdose deaths down.
The document allows all pharmacists in Missouri to give naloxone to anyone who walks in and requests it at no charge or at low cost through the state's Medicaid program and private insurance. Naloxone, which is under the brand name Narcan, reverses an opioid overdose. It's available over the counter, but it can cost $45 or more, so the standing order makes it available to more people.
Missouri Medical Director Dr. Heidi Miller said thousands of Medicaid patients per year have accessed the drug, and that has saved lives.
"So, we know that at least 11,000 prescriptions in Missouri per year are being dispensed based on the state standing order. Fortunately, that correlates with the reduction of opioid overdose deaths going down," she said."
The Missouri Department of Health and Senior Services issues the naloxone standing order each year. Miller said, before they do, they scrutinize it to see if there are any improvements they can make and to ensure the order is evidence-based. Because there are new synthetic opioids in the Missouri, DHSS changed the order to allow pharmacists to double the quantity of naloxone a person may receive if they feel that it is indicated. The agency also added a specific comment about rescue breathing to the order.
"The reason why an opioid overdose kills a person is they stop breathing," said Miller. "So, even in the worst scenario, if someone is near who's had an opioid overdose, and they call 911, and they don't have naloxone nearby, there have been people who have survived on rescue breathing until EMS was able to get there."
The third update on the standing order ensures that people of all ages have access to the overdose-reversing drug.
Access to naloxone is just one reason for a recent decline in overdose deaths. Miller also pointed to a team effort across the state to bring down numbers as well as Good Samaritan laws, which allow a person who is with someone who overdoses to call 911 and not get in trouble. The increased use of fentanyl test strips, she said, has also helped as has increased training in how to treat opioid use disorder.
But she said, even though overdose deaths are down, the state can't get complacent.
"We're seeing an increased use of naloxone, and we're seeing a little bit less of fentanyl in the drug supply," said Miller. "But there are new dangerous substances that are readily accessible that also hit the opioid mu receptors and can cause opioid overdoses."
Those include the synthetic opioids nitazenes, which have been detected in Missouri's wastewater system. Miller said those are extremely potent, and it takes very little of them to have a big impact. They've been found laced in other substances, like counterfeit benzodiazepines, cocaine, methamphetamine and black market cannabis liquid.
Copyright 2026 KSMU
