Recidivism Reduction

Recidivism Reduction

The Treatment Support staff at University of Missouri Saint Louis-Missouri Institute of Mental Health (UMSL-MIMH) reached out to Angela Plunkett who is the Criminal Justice Services Manager of the Division of Behavioral Health at the Missouri Department of Mental Health (DMH) to get her perspective on the mission of the program, "The majority of people in Missouri’s criminal justice system have behavioral health (substance use and/or mental illness) conditions, but the state lacks the necessary community-based treatment and service capacity to improve recovery and recidivism outcomes.  Unmet treatment needs among people on probation and parole contribute to negative public safety impacts, an increased prison population and higher overall system costs. …

Four Classes for a Brighter Future

Four Classes for a Brighter Future

The Opioid Training and Education Series (OTES) is an SOR-funded series of four classes that encompass a wide variety of topics relating to Substance Use Disorder (SUD) from health, safety, and legal concerns. After an individual enrolled in the program completes all four classes, their case is dismissed and their felony charge is dropped.

We reached out to attorney and Diversion Coordinator for the Saint Louis Circuit Attorney’s office, Megan Kaatz to learn more about OTES classes. Megan has been integral to the program that aims to connect participants to resources and provide education on topics for those in active substance/opioid use as well as for individuals seeking recovery. In her own words, Megan explains the mission of the program and her bright hopes for the graduating participants in the future

Everyday Heroes, Mo' Heroes

Everyday Heroes, Mo' Heroes

"Mo' Heroes was an expansion of the MO-HOPE Project [www.mohopeproject.org], that launched with the start of STR, to provide overdose education and naloxone in criminal justice settings. When we started this project we were going to focus on specific high need areas but it has grown and grown under SOR and now we are in a place of trying to expand to state-wide.

We initially got the program up and running in both Saint Louis City jails. Shortly afterward, we expanded to the County. As we grew, we learned that this is a lengthy process. It’s not merely going into a jail and training staff; it’s customizing each program to fit into the current work flow of that specific precinct. What works with one jail might not necessarily work for another. In the City jail, they don’t quite have the infrastructure to ask their staff to provide the training themselves, so our consultants go in and facilitate the training for them. The County, however, has the internal bandwidth to make accommodations within their own staffing for trainings. That’s a lot of what we do on the back end
helping people set up protocols to make trainings work in their setting without causing any sort of disruption...

A Project for HOPE

A Project for HOPE

The Treatment Support staff reached out to Brandon Costerison, the MO-HOPE Project Manager for the Saint Louis National Council for Alcoholism and Drug Abuse (NCADA) to discuss the MO-HOPE Project and its development across Missouri. NCADA, UMSL-MIMH, and Missouri DMH collaborate on the MO-HOPE Project to spread overdose awareness, provide education on how to reverse an opioid overdose, supply individuals with life-saving naloxone, and refer individuals to treatment when they are ready to take that step toward recovery. Brandon explains MO-HOPE's expansion to include overdose education and naloxone training (OEND) with Missouri Police to assist them in their development of post-overdose interventions and connections to resources.

Stories of Success

article originally published in the Summer 2019 SOR Justice-Focused Update Newsletter 8/22/2019

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Hey. My name is Ahmad. I’m 25. I came over to the United States when I was four years old. I never thought I belonged in any sort of group; I thought I was different from everyone else until I came into recovery and met other people who were like me who struggled with substance use.

I’ve been addicted to one substance or another since I was 13 years old. I have a single mom and two siblings that I love dearly. My mom, not only a single parent, but also a refugee coming from Afghanistan, always tried to raise me the best she could. Growing up, I just felt like I was different from everyone else. I didn’t know who I was or where I was supposed to fit in. As a way to cope from always feeling like the outsider, I started smoking weed when I was 13. I remember that first time I got high, it felt like an epiphany, like I finally had a reason to be alive. I had a purpose in my life; I was born to get high. I felt like I finally belonged somewhere. Like I could finally be happy. I thought, I want to do this for the rest of my life. And I tried to, and things sort of went downhill from there.

My using always carried consequences. I remember by the time I was in the seventh grade I was using almost every day. I had my first run in with an officer when I was fourteen but I just kept on getting high off of
anything and everything I could get my hands on; it wasn’t just weed anymore. I started doing air-duster, and Z-Quil, cough and cold medicine, Benadryl, and Dramamine, all on top of smoking while also trying to go to school. Needless to say my grades suffered. More problems with the law which led to house arrest and a stint in a juvenile center for a couple months. After I got out, I went back to school and started going to an outpatient program. That was my first treatment I ever went to. That was the first of seven other treatment programs before I finally stayed sober.

I was around fifteen at this point and I had gotten into harder drugs. I started tripping acid and doing shrooms and popping pills and stuff like that. At sixteen I started using heroin. I went back to treatment. It didn’t stick. I kept thinking that if I could just get sober, I could stay sober but I just wasn’t getting to that place mentally or physically by myself. On my own, I would go back to getting high every time.

I’ve been locked up 37 times. I have over 50 misdemeanors on my record. I got caught in a couple felonies. All of the the arrests, every single one, I can trace clearly back to my addiction. I felt really hopeless, like I didn’t have a way out and that this life was my destiny. I felt like I was just going to have to keep living like this until I finally died as an addict.

My using lead to not only using heroin but I also started using meth. I would always promise myself that it was the last time. I would promise myself that I would just smoke weed but not do heroin anymore. I promised myself I would just pop pills, or I would only use meth, but not heroin. Or maybe I would only use heroin but give up everything else. I would always try to figure out a way to manage my addiction but it was just too big; it always took over. I lived like this for a really long time. I was abusive to my family through all of this when they were always there for me; my sisters would always cry whenever I would OD. I’ve have overdosed 10 times and they were around for 4 of them. I was breaking their hearts almost daily but I just couldn't stop.

I wanted to stop. I went to a lot of treatments, I went to a lot of Psych wards. I’ve been to six psych wards. Any help I could get I was trying. I finally tried 12-steps when I was 19. I was getting out of treatment and I was using Suboxone® to get off of heroin. A lot of times I would just try to kick it on my own but I was giving Suboxone® a shot. On Suboxone® I was able to stay sober for a little over three years. I was working the 12-steps, I had a sponsor, I had fellowship, I had friends, and a good support system. I bought a house. Things were going really great up until a particular traumatic event. It really shook me to my core. I won't go into it, but I relapsed after that and I ended up overdosing three more times. I was causing more chaos and pain to the people around me again. I knew that if I wanted to stop again and stay stopped, I would need to go back into the 12-step program and get some medical assistance.

So I swallowed my pride and walked back into the rooms of 12-step fellowship and immersed myself again in the program. I got another sponsor. I went back to treatment at Bridgeway. I started taking Subutex
®. I rebuilt a support system and today—life is pretty good. I mean, it’s hard. Life didn’t get easy, but it got pretty good. I have made some of the best friends I’ve ever had in recovery. I’m patching up my relationship with my family. They still love me and have always supported me. I bought a house. I am starting my own business. I have two lovely dogs and a truck. I am finally at a healthy weight. I started going back to the gym. I’m doing pretty good, man.

Wrapping up, I would just say, if you’re out there in addiction, just keep trying to stay sober. Don’t give up on yourself if you have relapsed. You can always try again. You can always get help and try again and one day sooner or later, things will get better. Don’t lose faith in yourself. It will get better.


Stories used with permission. Specific authorship and identifying details may be redacted to protect anonymity. Editor reserves right to redact content involving coarse language as well as content that could be triggering to readers in recovery from Substance Use Disorder. Additional edits made to grammatical choices to provide cohesion of text.

Turning the Tide on the Overdose Epidemic in Saint Louis

Targeting the most at-risk neighborhoods in Saint Louis, Dr. Turner is bringing Narcan education into church congregations and helping to shine a light on racial disparities surrounding the philosophy of harm reduction and access to care. With her enthusiastic approach to outreach efforts, clinical practice, community building, and harm reduction education, Dr. Turner is bringing not just hope and healing to the Black communities of Saint Louis, but the idea that recovery is for everyone.

STR Highlight

STR Highlight

In-line with STR Medication First principles, overall medication utilization significantly increased among STR episodes of care (EOCs) during the first year of the grant relative to the year prior, primarily driven by increased utilization of buprenorphine. Approximately 84% of STR EOCs involved medication compared to only 40% in the year prior to STR. Please note, the “mixed” group is composed of EOCs in which both an antagonist and agonist were prescribed. This group is highly heterogeneous and administrative data does not provide an indication of the intended treatment path. This group was created to ensure the exclusive buprenorphine and XR naltrexone groups were limited to these medications only.

Community Outreach Day

Community Outreach Day

On April 19, 2019, a handful of staff from UMSL-MIMH and local partners from St. Louis City and County Health Departments partnered with the St Louis County Health Department to go out into some of the underserved, predominantly Black neighborhoods of St Louis to talk to business owners and everyday pedestrians about naloxone use, and how to access treatment.

Springfield Recovery Community Center

Springfield Recovery Community Center

The mission of the Springfield Recovery Community Center is empowering people in recovery to regain hope, enjoy life and become a vital part of the community. Before STR/SOR funding, our meeting space was limited to holding no more than two groups at the same time. We were operating under limited hours since we were staffed only by a group of volunteers. At this point we were maintaining about forty groups a month and being open for only about eighty hours a month. Thanks to STR/SOR funding, we are now able to dramatically expand our hours, pay our staff, and because of these internal, administrative changes we are able to host more groups and additional pro-social activities. We now are hosting over eighty events and activities and are open over two hundred fifty hours a month to better meet the needs of those we encourage and support.

Stories of Success

Originally published to the April STR/SOR Newsletter Wed, May 01, 2019 2:55 pm

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This month's story of success was sent to us by Better Family Life, reminding us that naloxone is not just a life-saving drug, it is a beacon of hope for concerned parents with children with OUD.

During Fountain Park Neighborhood Triage, a curious Ms.Cox joined the triage in an attempt to learn more about what all the commotion was about. “What services do you all have to offer?” she asked. An outreach specialist verbally listed the resources aloud, “Housing, clothing Narcan®...” Ms. Cox abruptly interrupted, “Narcan®!” She then spoke on her teenage son who had an opioid overdose two days prior. “I was scared and didn't know what to do other than to call 911 and they used Narcan® to revive him.” She stated she needed to keep her home safe and was glad to see the Narcan® displayed on the table. Ms. Cox expressed her gratitude after the training ended and said, “until he is ready to go to rehab I know I am at least prepared in case he overdoses again.”

This month's Stories of Success contributions were curated by Lauren Green, Overdose Prevention Coordinator at UMSL-MIMH.

Stories used with permission. Specific authorship and identifying details may be redacted to protect anonymity. Editor reserves right to redact content involving coarse language as well as content that could be triggering to readers in recovery from Substance Use Disorder. Additional edits made to grammatical choices to provide cohesion of text.

Unwavering Growth

Unwavering Growth

As a partner receiving STR/SOR funding, the Coalition has made strides increasing access to buprenorphine waiver trainings to providers across Missouri. A team of six exceptional physicians: Dr Luis Guiffra, Dr. Roopa Sethi, Dr. Daniel Vinson, Dr. Fred Rottnek, Dr. Jaye Shyken and Dr. Evan Schwarz have collectively led a total of nineteen waiver trainings since STR funding began back in May, 2017. To date, these trainings have yielded a turnout of 247 interested medical professionals. 

STR Treatment Outcomes

The graph shown represents two key outcomes - six month treatment retention and median monthly cost - from evaluation of the first nine months of treatment delivery under the STR grant (July, 2017 to March, 2018). STR treatment data is compared to data from STR-contracted treatment agencies from the first nine months of the year prior to STR. Numbers reflect episodes of care (EOCs) for uninsured individuals with an Opioid Use Disorder (OUD) only. Through STR, six month treatment retention more than doubled, while the median monthly price of treatment decreased 19%. The median monthly price of treatment reflects costs incurred to the State and includes costs of all services delivered within an EOC (e.g., medication, counseling, case management, administrative incentive payments). Though monthly costs are lower during STR, overall EOC costs across pre-STR and STR are the same or higher during STR because people are staying in treatment longer. As longer retention is our shared clinical goal in the treatment of any chronic condition, we assessed monthly costs instead of full EOC costs when making cost comparisons.

Judgment-Free Zone

Judgment-Free Zone

With neighborhoods besieged with crime, homelessness, drug dealing, and substance use, Saint Louis based organization Better Family Life has established triage locations in some of the most densely crime heavy areas of the city. Offering access to Narcan®, HIV testing, blood pressure screenings, direct intake into residential treatment, access to care, harm reduction strategies, as well as a number of other necessary resources, Better Family Life aims to clean up their neighborhoods by combating crime with honest, judgment free help. The Treatment Services staff at UMSL-MIMH reached out to Jerry Rodgers, the Community Outreach Case Manager Supervisor at Better Family Life, to learn more about the mission of Ground Zero, the keys to success, and what the future holds for the organization.

Putting Recovery to Work

Putting Recovery to Work

Outside of chores and tidying, work is an integral part of New Beginning Sanctuary. Whether it’s attending classes or getting a job to secure financial stability, pulling one’s proverbial weight is considered an absolute. Personal relationships, connection to a higher power, abstaining from drug or alcohol use, are also measures of success. The two tangible ones are money and sobriety, these are the two that we can measure by action and not just words (nbsanctuary.org.) New Beginning Sanctuary is a safe place to maintain sobriety and pursue a fresh start. And with the emphasis on education and employment, residents are not just provided a place to sleep, they are given the blue prints with which to build a structured and stable life in sobriety.

Healing House: Open-House

On Friday, March 22, 2019 Kansas City based recovery organization, Healing House held an open-house celebration for their new Recovery Community Center. This warm and accommodating space will contain a computer lab, comfortable areas to hold meetings, kitchen and pantry facilities, as well as areas designated specifically for the training of staff members as well as for the personal development of residents.

Stories of Success

Originally published to the March STR/SOR Newsletter Thu, Mar 28, 2019 5:54 pm

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Two individuals who received rehabilitative services through Gateway Foundation share their stories of how STR helped turn their lives around, and on rebuilding their lives one day at a time.

The first story we received comes from Joe, a 37 year old, white male who stated, “he was addicted to drugs for over 20 years, but he wanted something different.”
Prior to coming to treatment, Joe explains that he had experienced many challenges including “legal issues, homelessness, overdose, and poor mental and physical health.” He stated that he wanted to seek medication as a tool in his recovery process “to break the cycle” and that “suboxone helped with withdrawals and cravings and Vivitrol is now a huge part of his recovery.” He says because of medication, “I no longer crave and I know there is no reason to use with it.” In addition to medication, Joe indicated that “counseling, peer coaching, and recovery housing” have also been helpful in achieving and maintaining his recovery.
Today, Joe describes himself as someone “that has a strong passion to live a “life”and stay clean and sober.” He described his life now by stating there is “just an overall change with my health, I feel better physically and mentally. I am in a sober living house, and it is a huge part of my recovery. I have a network that I can go to now on a daily basis. As a result of my recovery, I am employed and very active in helping others.”
Furthermore, he stated, “as a result of medication I am able to maintain my mental health, keep up with my schedule for my physical health appointments, maintain stable housing, believe in my purpose of helping others, and continue to give back and live with integrity.”
Our next story comes from an individual who describes herself as “a 37 year old, divorced mom of two beautiful teenagers who loves to cook.”
When asked how she got here, she responded “after a month of looking up Missouri Network for Opiate Reform and Recovery online, I finally went in and got information for rehab. I did not have insurance so I had no idea where to go. At MoNetwork, they provided me with information and numbers to call. I was on the phone calling before I drove away. My drug of choice was heroin and pain pills but I would do anything I could find. I lost my job due to me using. But the main reason I wanted to get clean was because my 17 year old daughter and I were fighting one day and she told me she could tell when I was on stuff and my heart sank.”
She described how she had tried other forms of recovery before and that she chose to seek medication as a tool in her recovery process because “she knew she was not able to quit on her own.” She stated, “the suboxone has helped keep me from going back because I can focus my time and energy on my recovery. I do not have the urge to go find pills.
When asked what other supports have been helpful in achieving and maintaining her recovery, she stated “my family, children, and boyfriend. Also, my home group and that I have people in recovery at my job in the kitchen, and also my amazing counselor Liz!”
When asked to describe her life now, she stated, “As a result of medication, I am able to be a productive member in society. I wake up feeling good. I take care of what I need to during the day. I am able to spend quality time with my two kids making memories that will last a lifetime. My daughter and I are camping together at the end of the month and we are going to a concert together in May. Because of medication, I am able to take care of my loved ones at home and I have found my place in NA.”
Furthermore, she stated, “as a result of medication, I am hoping to keep putting my best foot forward. I am hoping to continue to thrive at my job and build relationships with my friends in recovery, my family, and my children. I am hoping to save up some money for a new couch and upgrade a few things around the house. And I hope to keep attending meetings and I like to help others in whatever way I can – I like to bring in breakfast for my co-workers once a week and I try to give people rides when needed.”

This month's Stories of Success contributions were curated by Lauren Green, Research Specialist at UMSL-MIMH.

Stories used with permission. Specific authorship and identifying details may be redacted to protect anonymity. Editor reserves right to redact content involving coarse language as well as content that could be triggering to readers in recovery from Substance Use Disorder. Additional edits made to grammatical choices to provide cohesion of text.

ASK ME ABOUT NALOXONE

ASK ME ABOUT NALOXONE

The Pharmacy Team is currently working on two exciting new initiatives; a naloxone-friendly pharmacy list and opioid overdose prevention button. The naloxone-friendly list is a curated index of pharmacies that have fully implemented the Missouri naloxone standing order, which is the Missouri law that authorizes pharmacists to dispense naloxone without a prescription. (For more information on the Missouri naloxone standing order, click the link below.) This list is not publicly available, rather it is for St. Louis-based local providers and individuals seeking to procure naloxone through a pharmacy.

Urban Legends for Reversing Opioid Overdose —Why They Exist, and What is the Truth?

Urban Legends for Reversing Opioid Overdose  —Why They Exist, and What is the Truth?

It is vital to separate the facts from the pulpy fictions and know what to do when someone is overdosing. First, know the signs of an overdose: pinpoint pupils; blue lips; cold, limp body; lack of response to painful stimuli (harmreduction.org). If these signs are present, check for a pulse. If there is no pulse, begin chest compressions (heart.org). If there is a pulse, even a faint one, administer naloxone, call 911, and begin rescue breathing. Naloxone (or Narcan®) knocks the opioids off the receptors in the central nervous system to reverse the effects of the overdose in a matter of minutes. Naloxone and rescue breathing,not these urban legends, are the most effective strategies for helping a person survive an opioid overdose.

Building a Better Missouri

Since 2015, the Missouri Coalition or Recovery Support Providers has grown into a network of one hundred partnering agencies. MCRSP aims to lend a voice and provide representation to faith and community based recovery support providers. In the past four years, they have served 47,788 individuals. The Treatment Services team at UMSL-MIMH reached out to Marsha Hourd who is the MCRSP Eastern Chair to learn more about how they overcome obstacles and about their passion for helping others find recovery.