Substance use is a serious concern in Missouri, though the state has seen its most significant decline in overdose deaths on record. Key figures:

• 1,948 overdose deaths in 2023, down to 1,450 in 2024, according to the UMSL Addiction Science Team.
• A 26% decline from 2023 to 2024, the second straight year of decline.
• Fentanyl and synthetic opioids are involved in 68% of overdose deaths.
• Drug overdose is the leading cause of death for adults aged 18-44.
• Over 70% of overdose deaths involve opioids.
• The decline was the most significant on record.

Missouri’s crisis peaked recently and is now easing fast. Overdose deaths fell 26% from 2023 to 2024, the steepest drop the state has recorded, even as fentanyl remains the dominant driver.

Missouri expanded Medicaid in 2021 after voters approved Amendment 2 by ballot initiative in 2020, though the Legislature resisted and the Missouri Supreme Court had to order implementation. The state’s Department of Mental Health oversees substance use treatment. Of the 227 facilities listed below, 180 accept Medicaid.