DHSS Director's Message

Policy Changes and Trends in Opioid Use Disorder Treatment in Missouri

Between 2015 and 2023, 22 states enacted legislation prohibiting insurance companies from requiring prior authorization for medication-assisted treatment (MAT) for opioid use disorder. Missouri joined this movement in 2019 with the passage of Senate Bill 514.

Following the implementation of SB 514, Missouri saw an increase in the number of MAT prescriptions dispensed, according to data from the American Medical Association (AMA). However, it's important to note that this rise may not be solely attributed to the policy change. Missouri had already been experiencing consistent annual increases in MAT prescriptions from 2012 to 2018, with the most significant jump occurring between 2017 and 2018—prior to the law’s enactment. Similar upward trends were observed in other states during the same period, suggesting that the growth may be part of a broader national shift in response to rising opioid use and increased awareness of MAT as an effective treatment option.

Since 2020, both Missouri and the nation have seen MAT prescription rates stabilize or slightly decline.

In addition to MAT trends, AMA data highlights a significant reduction in overall opioid prescribing. From 2012 to 2023, Missouri saw a nearly 50% decrease in opioid prescriptions and a 62% reduction in morphine milligram equivalents (MME), closely mirroring national patterns. These figures reflect prescriptions filled at retail pharmacies and do not account for opioids dispensed in healthcare settings or prescriptions that were written but not filled.

Despite these improvements, CDC data indicates that Missouri continues to have a relatively high opioid dispensing rate compared to other states, even as its reductions align with national trends.

Rescheduling of Marijuana:
What it Could Mean for Missouri

The federal government is working toward reclassifying marijuana from a Schedule I to a Schedule III controlled substance—a move that could have significant implications nationwide, including in Missouri. Schedule I substances are defined as having no accepted medical use and a high potential for abuse, while Schedule III substances are recognized as having medical value and a lower abuse potential.

Rescheduling could pave the way for expanded research, reduced barriers for medical use, and potential changes in how cannabis-related businesses operate, particularly regarding banking and taxation. For Missouri, where medical marijuana is already legal and adult-use cannabis was approved in 2022, federal rescheduling could further align state and federal policies, potentially impacting regulation, enforcement, and access.

Although President Trump has signed an Executive Order, a final rule to reschedule marijuana has not yet been issued by the Department of Justice. The timeline for a final rule remains unknown, and until there is a final rule, marijuana remains Schedule I. We will continue to monitor for effects on our state licensed program, unregulated cannabis, and research. 

2024 Provisional STI Surveillance
Update from CDC

2024 STI data are provisional due to the CDC data platform migration. Finalized 2024 data is expected early next year.

Key takeaways:

• Over 2.2 million STIs were reported in 2024 which is a 13% increase since 2015.
• Chlamydia cases are down 1% since 2015 and down 8% year-over-year for the second consecutive year.
• Gonorrhea cases are down 10% year-over-year for the third consecutive year.
• Total syphilis cases are down 9% year-over-year. ▪ The congenital syphilis increase has leveled off resulting in a 2.8% increase in 2024 vs. previous 30%+ annual increases.
  • Nearly one-third of primary and secondary syphilis cases in 2024 were diagnosed among men who have sex with men.
  • Women account for nearly one-third of syphilis cases which have been on the rise since 2015.
  • Early non-primary non-secondary syphilis cases in women increased from 3,000 in 2015 to 14,000+ in 2024.
  • Primary/secondary syphilis in women declined to 11,000 cases in 2024. This is the second consecutive year of decline.
  • Congenital syphilis is a lagging indicator whereas primary/secondary syphilis in women is a leading indicator.
  • Congenital syphilis cases: 3,941 in 2024. This is an increase for the twelfth year in a row, although 2024 marked a slower rate of increase.

Resources:

• Sexually Transmitted Infections Surveillance, 2024 (Provisional) | STI Statistics | CDC
• CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024 | MMWR
• Point of Care Testing Toolkit

Primary Care Policy Menu

The National Academy for State Health Policy (NASHP) and the Milbank Memorial Fund recently released a comprehensive report highlighting innovative policies across the country aimed at strengthening access to primary care. As primary care remains a cornerstone of a high-functioning health system, this report offers valuable insights into how states are working to expand and support these essential services. In Missouri, improving access to primary care continues to be a top priority as we strive to enhance health outcomes and strengthen public health for all residents.

Kick-off: An Early Look at Missouri's 2026 Legislative Session

Lawmakers set a new record at the start of pre-filing on December 1, with nearly 500 bills filed in the Missouri House alone. Well over 1,000 bills have been filed to date with the number continuing to grow. A previous message highlighted areas of priority for the department. 

While early analysis points to emerging themes in legislation like economic policy, education and local regulation, we anticipate a growing number of important health-related issues like drug policy, health safety and emerging diseases to be present as well. The department is actively compiling a list of public health-related bills and assessing potential impact. Our department’s goal is to be available to discuss these important pieces of legislation with sponsors, committees and others offering insight and education as appropriate.

HIV in 2025: Breaking Stigma

December is HIV Awareness month. Amid the focused outreach activities, Dustin Hampton, Bureau Chief of our Bureau of HIV, STI and Hepatitis, appeared on Fox 2 St. Louis's B-REEL podcast explaining the disease. Take a listen! The conversation reminds us of the importance of education, prevention and treatment in helping people live a quality life and accomplish all of the things each of us holds important…a career, health and helping others. 

Missouri State Board of Nursing awards $3.1 million in grants to 21 colleges and universities

Last week, the Missouri State Board of Nursing announced $3.1 million in grant funding for 21 Missouri colleges and universities through the Nursing Education Incentive Program (NEIP), advancing the state’s efforts to recruit, train and retain a high-quality nursing workforce.

Since 2011, the board has awarded over $27 million in NEIP grants to expand nursing program capacity and pilot new education programs. This year’s awards include $1 million in funding approved by Governor Mike Kehoe through an appropriation by the Missouri General Assembly, as well as an additional $2.1 million allocated from the board.

Funding was awarded to the following nursing programs this year:

Research College of Nursing, Kansas City, MO – $64,730

Development and launch of a Quality Matters–aligned course review initiative to improve instructional quality and expand online BSN education.

Metropolitan Community College, Kansas City, MO – $99,943

Technology investments to increase NCLEX pass rates.

State Technical College of Missouri, Linn, MO – $100,000

Virtual reality equipment and faculty development.

Jefferson College, Hillsboro, MO – $125,000

Technology resources to support instructional enhancement and professional development.

William Jewell College, Liberty, MO – $137,000

Quality Matters investment, simulation lab upgrades and clinical instructor salary packages.

Southeast Hospital College of Nursing and Health Sciences, Cape Girardeau, MO – $150,000

Faculty development, simulation coordinator salary and expanded clinical placements.

Crowder College, Neosho, MO – $150,000

Hybrid LPN-to-RN program development and instructional design.

Ozarks Technical Community College Direct Entry, Springfield, MO – $50,000

Simulation lab upgrades.

Lincoln University, Jefferson City, MO – $150,000

Scholarships for MSN and DNP students and laptops for BSN students.

Southwest Baptist University, Springfield, MO – $200,000

Faculty retention bonus program.

University of Missouri–Sinclair School of Nursing, Columbia, MO – $200,000

Expansion of BSN program with new evening/weekend option. 

Central Methodist University, Fayette, MO – $200,000

Additional faculty lines, full-time student success coach and clinical faculty positions.

Rockhurst University, Kansas City, MO – $200,000

Expansion of Accelerated BSN Program, RN Return to Practice Program, and dual-credit nursing exploration program.

Bolivar Technical College, Bolivar, MO – $200,000

High school student scholarships, preceptor payment program and technology investments.

University of Missouri–Kansas City, Kansas City, MO – $150,000

Scholarships for MSN/PhD students and simulation lab technology updates.

College of the Ozarks, Point Lookout, MO – $173,327

Scholarships, standardized patient programming and faculty salary support.

Maryville University, St. Louis, MO – $150,000

Simulation lab technology enhancements.

Missouri Western University, St. Joseph, MO – $150,000

Standardized patient simulation program and wearable simulators.

Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO – $150,000

Nurse educator faculty expansion, wearable simulators and competency-based curriculum development.

Columbia College, Columbia, MO – $150,000

Instructional technology enhancements and program enrollment expansion.

Missouri Baptist University, St. Louis, MO – $150,000

Additional faculty and expanded simulation and instructional technology.

The NEIP is an annual grant program designed to increase the physical and educational capacity of professional nursing programs throughout the state. The Missouri State Board of Nursing coordinates with the Missouri Department of Higher Education and Workforce Development to determine annual recipients.