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Rules and regulations
Missouri adheres to strict federal and state regulations regarding methadone clinics, outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA) and Missouri Department of Mental Health. All clinics must be licensed and accredited.
Certification procedures
To open a new opioid treatment program in Missouri:
- Submit application to state opioid treatment authority
- Undergo facility inspections, plan reviews
- Demonstrate capacity to provide required services
- Have certified medical director and staff
- Meet security standards
Benefits of medication-assisted treatment
Benefits of methadone maintenance therapy include:
- Reducing opioid cravings and withdrawal
- Allowing focus on recovery and rehabilitation
- Lowering risk of overdose and infectious disease
- Improving overall health and functioning
How clinics operate and their purpose
Methadone clinics provide supervised methadone dosing, counseling, case management to support recovery from opioid addiction. The goal is harm reduction and improved wellbeing.
Insurance Coverage
- Missouri Medicaid covers methadone treatment
- Some private insurers may offer limited coverage
- Uninsured individuals may qualify for state-funded treatment slots
Drug Use in Missouri
- Over 1,700 opioid overdose deaths in 2020, a 34% jump since 2019, declared a public health crisis
- Over 500,000 people reported misusing prescription opioids from 2015-2019
- Methamphetamine, alcohol, cocaine, and cannabis also widely used
Addiction Treatment Overview
Inpatient Treatment
- Focuses on medical stabilization, counseling, group therapy in a residential facility
- Typical stay is 30 days
Outpatient Treatment
- Services while living at home – counseling, medication management
- 1-5 days a week for several hours per day
Treatment Level Unreported
An estimated 18% did not specify treatment level
Comparison of Availability
| City | Treatment Centers | Inpatient Beds | Cost of Treatment |
| St. Louis, MO | 234 | ~1,800 beds | $5,000+/month |
| Memphis, TN | 123 | ~900 beds | $10,000+/month |
Methadone Treatment
What is Methadone
Methadone is an opioid agonist medication used in medication-assisted treatment (MAT) and opioid treatment programs (OTPs). It binds to opioid receptors, reducing cravings and withdrawal symptoms. Society has mixed opinions on methadone treatment—some view it as replacing one addiction with another, while advocates emphasize its efficacy as harm reduction. Put simply, methadone stabilizes patients and enables functioning.
Methadone Distribution
Missouri strictly regulates methadone distribution:
- Urine testing: Patients undergo at least eight random drug tests in the first treatment year to ensure compliance.
- Take-home doses: Patients are limited to a 24-hour methadone Supply for the first 14 days, with more take-homes allowed over time if patients meet certain criteria.
- Monitoring: Methadone clinics have interprofessional teams overseeing treatment, including counseling, case management, and care coordination.
- Prescription drug monitoring: Clinicians review the PDMP to carefully cross-reference methadone dosage with other medications, as methadone has a narrow therapeutic index and risk of interactions.
Missouri categorizes methadone as a Schedule II controlled substance, indicating potential for abuse and dependence.
Methadone Treatment Effectiveness Research
Methadone has been effectively used to treat opioid addiction since 1947.
Evidence for Effectiveness: Studies show participation in a methadone program is linked to reduced opioid use, infectious disease transmission, and criminal acts:
- 33% fewer opioid-positive drug tests
- 4.44 times more likely to stay in treatment
Retention in methadone treatment lowers overdose and disease risks while increasing employment.
Major Drawbacks:
- Potential for misuse/diversion
- Severe withdrawal if stopped suddenly
- Possible QTc prolongation/cardiac issues
- Respiratory depression/overdose risk when combined with other substances
Comparison to Other Medications: Research shows methadone and buprenorphine have equal effectiveness for reducing illicit opioid use.
About Missouri
Missouri is located in the Midwestern United States, bordering Iowa, Illinois, Kentucky, Tennessee, Arkansas, Oklahoma, Kansas, and Nebraska. The capital and largest city is Jefferson City and Kansas City, respectively. Missouri covers 68,742 square miles of land. Infrastructure includes interstate highways, airports, railroads, inland waterways along the Missouri and Mississippi rivers, and ports along the Missouri River.
Population Statistics
The total Missouri population is approximately 6 million residents.
Demographics:
- Gender: 51% female, 49% male
- Age brackets: 23% under 18 years, 61% between 18-64 years, 16% over 65 years
Occupations:
- Healthcare and social assistance (18% of jobs)
- Manufacturing (14%)
- Retail trade (11%)
- Accommodation and food services (9%)