Drug overdose deaths in Missouri decreased for the second consecutive year in 2024, according to the latest data from the Missouri Department of Health and Senior Services. The drop in drug-related fatalities — a 26% decrease compared with the previous year — brings the total to its lowest number since 2017.
Last year, the deaths of 1,450 people in Missouri were related to opioids, stimulants and other drugs, compared with 1,948 in 2023.
The drop is “absolutely the most significant decline that we've seen since we've been gathering and reporting data,” said University of Missouri-St. Louis professor Rachel Winograd, who leads the team that compiles and reports the data. “It’s a really big deal, and it's worth acknowledging.”
For nearly a decade, overdoses have killed hundreds of Missourians annually as deadly synthetic opioids circulated among drug users. The latest data indicates the decrease in deaths could be a sustained trend.
Statewide, deaths are decreasing across demographics and geographic regions, according to data compiled by the Missouri Institute of Mental Health.
The Kansas City region is an exception. While overdose deaths declined there, the region saw an increase in such fatalities among Black people, while deaths among the same demographic in the St. Louis region decreased dramatically.
St. Louis Public Radio’s Sarah Fentem spoke to Winograd about what the latest data reveals concerning the state’s fight against overdose fatalities.
This interview has been edited for clarity and length.
Sarah Fentem: I know that there's a difference between what [data] is reported and actual reality. What's your take on how well this matches up to what people are seeing on the ground?
Rachel Winograd: What we do know is that this is the best data that we have, and to the extent that we can compare it year over year, we do think that there are valid reasons to compare year over year.
I think a separate question that you're asking is, how do these decreases in death match up with people's lived realities out in the world? And that's a much bigger, more nuanced question. And I think one thing that I do want to stress is that death is only one marker of this addiction and overdose crisis that we're in. It is the most extreme, it is the most objective, and it is the most final metric that we have to track what's going on.
There is a lot of suffering still out there. There is a lot of struggle. People continue to not be able to get the services they need when they need them, for all sorts of reasons, people continue to have a ton of motivations to use drugs to numb their pain and squelch their trauma.
Fentem: Does the drop in overdose deaths necessarily indicate a drop in drug use? Public health officials have really credited [the overdose reversal drug] naloxone in particular with helping curb this huge human toll. And so does this indicate that fewer people are using or just that fewer people are dying?
Winograd: I’ve heard sort of the same sentiment, which is, “That is interesting that deaths are going down because it doesn't feel like that.” And I think there's something real there.
It may be a little bit of both. It may be naloxone, it may be that yes, the same number of people are using drugs, but just more people are being revived.
It may be that the prevalence of drug use has gone down, and we're saving more people. There is some evidence that suggests that fewer young people are initiating drug use, specifically fentanyl, because they're scared.
This is something in theory we could and should track from a public health standpoint, but it's also incredibly slippery. We never will know the true denominator of how many people are using drugs in private, in their own homes, in their own groups of friends that we never hear about because there's never a fatality, or there's never a 911 call, or they never access services.
So we do the best we can with the data we have, but everyone is sort of speculating and trying to put puzzle pieces together.
Fentem: What other reasons might there be for this big decrease?
Winograd: The drug supply has changed. I am not a scholar in terms of, like, drug trafficking or drug supply or drug seizures, but I've read and listened to enough people I respect to say like, yeah, the prevalence of fentanyl is going down.
Why is that happening? People can point to all sorts of reasons, but there does seem to be something to that that may be in any given bag of dope.
Fentem: Another thing I’ve been keeping an eye out is the distribution of opioid settlement funds to states and cities. Have you seen the funds from lawsuits with drugmakers and distributors making a difference here so far?
Winograd: One hundred percent. The report we released in conjunction with the death report was our fiscal year 2025 naloxone distribution report.
It is only one part of the picture, [but] it is a meaningful part of the picture. We wanted to … show that in fiscal year 2025, our team, which serves as the statewide hub for naloxone, was able to essentially double our purchase and distribution efforts statewide.
The reason we were able to do that is directly because of opioid settlement funding. And so those funds for our team don't just pay for the medication itself (of which we distributed nearly 1.3 million doses in a year). It's also funding some of the messengers; the people who get out on the streets to give it out, the people who train others how to teach their patients and participants.
Every decrease in death is an objectively good thing. We can hold multiple truths at the same time. This is a good thing. It's worth acknowledging that this is a good thing, and we are, by no stretch of the imagination, out of the woods.
