introduction and highlights - missouri

On the following pages:

A-01. Report CoverA-02. Title PageA-03. ForewordA-04. AcknowledgmentsA-05 - A-21. Missouri Data Highlights Mental Disorders

Depression

Suicide

Mental Health Emergencies

Specialized Treatment for Mental Health Disorders

Substance Use Disorders

Substance Use among Adolescents

Student Violence

Juvenile Court Referrals

Substance Use among Young Adults

Substance Use among Older Adults

Substance Use Emergencies

Specialized Treatment for Substance Use Disorders

Trends in Treatment of Substance Use Disorders

Deaths Resulting from Substance Use

Drug Arrests

Impaired Driving

Interventions for Impaired Driving

Out-of-home Juvenile Placements

2019 Status Report on Missouri's Substance Use and Mental Health Page A-00

Introduction and Highlights

STATUS REPORT ON MISSOURI'S SUBSTANCE USE AND MENTAL HEALTH

Twenty-fifth Edition -- 2019

MISSOURI DEPARTMENT OF MENTAL HEALTH Division of Behavioral Health

STATUS REPORT ON MISSOURI’S SUBSTANCE USE AND MENTAL HEALTH

TWENTY-FIFTH EDITION — 2019

Randall Smith, M.P.A., M.Ed.

Kateryna Kalugina

Renee Rothermich, M.A.

Patricia Norton, M.P.H.

Mark Stringer Director, Missouri Department of Mental Health

Richard Gowdy, Ph.D. Director, Division of Behavioral Health

Rikki Wright Deputy Director, Division of Behavioral Health

Jason Jones Director of Research and Statistics

MISSOURI DEPARTMENT OF MENTAL HEALTH

Division of Behavioral Health 1706 East Elm Street; P.O. Box 687

Jefferson City, MO 65102 573-751-9499

Website: https://dmh.mo.gov

2019 Status Report on Missouri’s Substance Use and Mental Health Page A-02

The Missouri Department of Mental Health, Division of Behavioral Health would like to

thank the following individuals and their agencies for providing data during the past

year for this 2019 edition of the Status Report:

Carol Bontempo, Missouri Department of Health and Senior Services

Avera Daniels, Missouri Department of Corrections

Susan Depue, Missouri Institute of Mental Health

Dong Ding, University of Missouri—Columbia

Venkata Garikpaty, Missouri Department of Health and Senior Services

TaNea Green, Missouri Office of State Courts Administrator

Amanda Horvath, Missouri Office of State Courts Administrator

Andrew Hunter, Missouri Department of Health and Senior Services

Rebecca Lander, Missouri Department of Health and Senior Services

Sara Linenfelser, Missouri Department of Social Services

Katie Long, Missouri Department of Health and Senior Services

Rick McElfresh, Missouri Office of State Courts Administrator

Angela McKee, Missouri Department of Health and Senior Services

Doug Middleton, Missouri Department of Public Safety

Richard Morrisey, Missouri Office of State Courts Administrator

Mary Mosley, Missouri Department of Health and Senior Services

Patricia Norton, Missouri Department of Mental Health

Mark Ritchey, Missouri Department of Public Safety

Renee Rothermich, Missouri Department of Mental Health

Susan Savage, Missouri Department of Social Services

Julie Starr, Missouri Department of Social Services

DeWayne Sprenger, Missouri Department of Public Safety

Michael Traver, Missouri Department of Social Services

Tanner Turley, Missouri Department of Health and Senior Services

Margaret Tyler, Missouri Department of Health and Senior Services

Rebecca Viet, Missouri Department of Social Services

Shannon Vondras, Missouri Institute of Mental Health

Blake Wenzel, Missouri Office of State Courts Administrator

Shimin Zhuang, Missouri Department of Social Services

2019 Status Report on Missouri's Substance Use and Mental Health Page A-04

ACKNOWLEDGMENTS


DATA HIGHLIGHTS

MENTAL DISORDERS

State‐level estimates from the National Survey on Drug Use and Health (NSDUH) highlight Missouri adults with mental health disorders, based on a recent two‐year reporting period. The NSDUH indicates that 20% of Missouri’s adult population—925,000 residents—had a mental illness in the past year, compared to 18% in the previous study. Missouri’s estimated rates of past‐year mental illness were higher among young adults than for those over age 25, and rates for Missouri’s adults older than 25 were higher than U.S. rates.

Figure 1: Estimated Number of Missouri Adults with Past‐Year Mental Illness

Data Source: U.S. Substance Abuse and Mental Health Services Administration (SAMHSA): National Survey on Drug Use and

Health, 2016‐2017. Adolescents 12‐17 years of age are not included in the survey questions assessing mental illness.

An estimated 226,000—nearly 5% of Missouri adults—had serious mental illness during the past year. Serious mental illness (SMI) pertains to adults who have a diagnosable mental, behavioral, or emotional disorder with serious impairment that substantially interferes with important life activities. Major depression, bipolar mood, and schizophrenia comprise most of the SMI disorders. According to the NSDUH, during the past eight years the percentage of young adults with SMI has increased alarmingly nationwide. The latest survey indicates nearly 7% of Missouri adults 18‐25 years of age had a past‐year serious mental illness.

Figure 2: Trend in Rates of Serious Mental Illness among Missouri Adults

Data Source: SAMHSA: National Survey on Drug Use and Health.

Any Mental Illness925,000

Serious Mental Illness226,000

2008‐2009

2009‐2010

2010‐2011

2011‐2012

2012‐2013

2013‐2014

2014‐2015

2015‐2016

2016‐2017

MO Ages 18‐25 3.58 3.56 3.66 4.31 4.73 5.23 5.56 5.53 6.85

MO Ages 26+ 4.18 4.99 4.91 4.55 4.66 5.02 4.53 3.94 4.59

0

2

4

6

8

Percent ofAge Group


DEPRESSION

Major depression accounts for some of the increase in serious mental illness. The NSDUH indicates that 367,000 Missouri adults and 68,000 adolescents had a major depressive episode (MDE) in the past year. The adolescent rate of MDE has increased each of the past five years, reaching 14.5% and surpassing the national rate of 13%.

Figure 3: Trend in Rates of Past‐year Major Depressive Episodes among Missouri Residents


According to NSDUH estimates, rates of past‐year major depression among Missouri residents have generally been higher than U.S. rates. Similarly, the Behavioral Risk Factor Surveillance System (BRFSS) indicates that Missouri’s rates for lifetime depressive disorder have consistently been higher than the national median. The Missouri rates are considerably higher for females than for males.

Figure 4: Trend in Rates of Past‐year Major Depressive Episodes among Missouri Residents

Data Source: Centers for Disease Control and Prevention: Behavior Risk Factor Surveillance System.

2007‐2008

2008‐2009

2009‐2010

2010‐2011

2011‐2012

2012‐2013

2013‐2014

2014‐2015

2015‐2016

2016‐2017

MO Ages 12‐17 8.64 8.91 9.58 8.61 7.62 9.91 10.78 11.49 14.28 14.57

MO Ages 18‐25 9.06 9.15 8.01 7.63 8.52 9.37 8.77 9.67 10.35 11.87

MO Ages 26+ 6.71 6.68 7.22 7.21 6.66 7.01 6.53 6.11 6.43 7.33

0

4

8

12

16

Percent ofAge Group

2011 2012 2013 2014 2015 2016 2017 2018

BRFSS MO Females 24.4 25.0 25.1 27.8 28.4 26.7 29.9 28.6

BRFSS MO Males 15.5 14.8 17.3 15.3 14.7 16.3 14.5 15.5

0

5

10

15

20

25

30

35

Percent of AdultsAges 18+


In 2019, more than 31% of students completing the Missouri Assessment for College Health Behaviors (MACHB) survey experienced past‐year major depression, compared to only 13% a decade earlier. Two‐thirds of these students sought assistance for their depression. Almost one‐fourth of the surveyed students indicated they had suicidal thoughts in the past year.

Figure 5: Trend in Rates of Past‐year Mental Disorders among Missouri College Students

Source: Partners in Prevention Statewide Coalition, University of Missouri: Missouri Assessment of College Health Behaviors.

SUICIDE

An estimated 186,000 Missouri adults had serious suicidal thoughts in the past year. While rates of suicide ideation among older adults have remained below 4% during the past several years, rates for adults 18‐25 years of age have increased to nearly 10% in the most recent survey.

Figure 6: Trend in Rates of Past‐year Serious Thoughts of Suicide among Missouri Adults


In the 2018 Missouri Student Survey, 14% of youth in grades 6‐12 reported they seriously considered suicide in the past year, 11% made a plan, and 6% actually made a suicide attempt. Among college students surveyed in the 2019 MACHB, 23% reported past‐year suicidal thoughts and 1.8% attempted suicide.

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

MO College: Suicidal Thoughts 13.1 13.4 13.6 13.6 15.0 15.0 17.4 17.6 20.4 23.1

MO College: Major Depression 12.9 12.1 12.5 12.5 17.6 18.5 21.4 22.9 24.6 26.8 31.4

MO College: Bipolar Disorder 2.7 2.3 2.3 2.1 2.3 2.6 2.8 2.8 2.5 2.3 3.4

0

5

10

15

20

25

30

35

Percent ofCollege Students

Surveyed

2008‐2009 2009‐2010 2010‐2011 2011‐2012 2012‐2013 2013‐2014 2014‐2015 2015‐2016 2016‐2017

MO Ages 18‐25 6.30 6.55 6.54 6.41 6.84 7.94 7.67 7.18 9.75

MO Ages 26+ 3.49 3.91 3.72 3.53 3.58 3.57 3.29 2.86 3.11

0

2

4

6

8

10

Percent ofAge Groups


During the past 10 years, the rate of Missouri deaths due to suicide increased from 13.1 per 100,000 population in 2008 to 20.1 per 100,000 in 2018. During that same period, the homicide rate increased from 8.2 to 10.7 per 100,000 population.

Figure 7: Trend in Deaths among Missouri Residents Due to Suicide and Homicide

Data Source: Missouri Department of Health and Senior Services.

MENTAL HEALTH EMERGENCIES

In 2017, more than 66,000 Missouri residents who entered hospital emergency rooms had a mental disorder primary diagnosis according to medical coding. Among these were approximately 43,000 with a disorder classifiable as serious mental illness (SMI). Additionally, more than 284,000 individuals who received emergency room services in 2017 had a mental disorder secondary diagnosis.

SPECIALIZED TREATMENT FOR MENTAL HEALTH DISORDERS

In state fiscal year 2019, mental health centers funded by the Division of Behavioral Health (DBH) provided mental illness treatment services to more than 83,000 Missouri residents—approximately 43,000 females and 40,000 males. They included more than 20,000 children and adolescents and nearly 63,000 adults.

Figure 8: Mental Health Treatment Recipients by Age Group, Fiscal Year 2019

Data Source: Missouri Department of Mental Health: Customer Information Management, Outcomes & Reporting system.

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

MO Suicide 775 857 850 921 901 958 1,004 1,043 1,132 1,151 1,230

MO Homicide 486 440 438 416 429 390 440 539 570 654 657

0

200

400

600

800

1,000

1,200

1,400

Deaths

865

5,094

7,5047,156 6,897

6,2326,603

7,0296,320

6,7667,272 7,486

8,274

<6 6‐9 10‐13 14‐17 18‐24 25‐29 30‐34 35‐39 40‐44 45‐49 50‐54 55‐59 >59


The 83,000 individuals who received services in FY2019 had more than 142,000 diagnosed mental disorders. Mood disorders accounted for over one‐third of the diagnoses.

Figure 9: Diagnosis Categories of Individuals Treated for Mental Illness in DBH‐Funded Programs in FY2019


The number of individuals treated for anxiety and fear disorders increased 50% between state fiscal years 2012 and 2019. Other notable increases were the numbers treated for trauma and stress, impulse control and conduct, and depressive mood disorders.

Figure 10: Trends in Disorders Treated in DBH‐Funded Programs


Anxiety and Fear 14%

Bipolar Mood 12%

Depressive Mood 25%

Developmental 9%

Impulse Control & Conduct 5%

Personality 5%

Schizophrenia/Psychotic11%

Sexual 0.5%

Trauma & Stress 13%

Other & Unknown 5%

FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019

Anxiety and Fear 13,402 14,386 14,901 16,704 18,465 18,623 19,293 20,073

Bipolar Mood 20,228 20,478 20,046 19,955 20,111 19,255 18,342 17,525

Depressive Mood 30,521 32,216 31,786 32,609 33,450 34,060 35,335 36,016

Developmental 11,382 11,807 11,454 11,573 12,668 12,680 12,743 12,787

Impulse Control & Conduct 5,242 5,568 5,453 5,594 7,218 7,215 7,338 7,249

Personality 9,413 9,440 9,168 9,093 8,857 7,840 7,230 6,672

Schizophrenia/Psychotic 15,081 15,129 14,844 14,743 16,065 15,624 15,224 15,005

Sexual 202 209 199 246 346 335 340 364

Trauma & Stress 13,811 14,718 14,749 15,492 17,160 17,744 18,637 19,183

Other 1,346 1,414 1,359 1,460 2,280 2,777 3,177 2,864

0

10,000

20,000

30,000

40,000

Mental Disorder Diagnoses


The percentage of Missouri college students who experienced past‐year panic attacks more than doubled from 12.3% in 2009 to 27.6% in 2019.

Figure 11: Anxiety, Panic, and Sleep Disorders among Missouri College Students.

Data Source: Partners in Prevention Statewide Coalition, University of Missouri, Columbia, MO. Missouri Assessment of College Health Behaviors.

SUBSTANCE USE DISORDERS

Estimates from the NSDUH indicate more than 7% of Missouri’s population 12 years of age and older—371,000—had a past‐year substance use disorder (SUD). As with mental disorders, substance use disorders negatively affect important life functions, responsibilities, safety, or health. Estimates are available for three categories of substance use disorders: alcohol, illicit drugs, and pain relievers. Alcohol use disorders are the chief substance disorder. The NSDUH estimates 271,000 residents had alcohol use disorders in the past year. Additionally, 129,000 Missouri residents had illicit drug use disorders and 35,000 had disorders resulting from pain reliever use. The three categories total more than the overall SUD estimate because some individuals have disorders involving more than one type of substance.

Figure 12: Estimated Number of Missouri Residents with Past‐year Substance Use Disorders

Data Source: SAMHSA: National Survey on Drug Use and Health, 2016‐2017.

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

MO College: Panic Attack 12.3 11.6 12.5 11.7 13.4 15.4 17.2 19.2 21.5 24.5 27.6

MO College: Anxiety 35.8 32.7 34.9 34.4 39.4 44.1 45.0 47.3 49.0 52.1 57.4

MO College: Sleep Disorder 16.6 15.6 16.8 15.0 18.1 18.8 18.2 18.5 17.1 18.8 20.0

0

10

20

30

40

50

60

Percent ofCollege Students

Surveyed

Alcohol Use Disorder271,000

Illicit Drug Use Disorder129,000

Pain Reliever Use Disorder35,000

371,000 Missouri Residents with Substance Use Disorders


The estimated number of Missouri residents with a substance use disorder has gradually declined from the peak estimate of 499,000 in 2004. Most of this decline has been in the adolescent and young adult populations. The SUD estimate for adolescents decreased from 10.5% in the 2003‐2004 NSDUH to 3.7% in 2016‐2017. During that period, the rate for young adults dropped from 24% to about 13%. Among adults older than age 25, the SUD rate has hovered around 7% for longer than a decade.

Figure 13: Trend in Rates of Substance Use Disorders among Missouri Residents


SUBSTANCE USE AMONG ADOLESCENTS

Over the past decade, the decrease in Missouri adolescent substance use disorders has included decreases in both alcohol and illicit drug use disorders. Rates for most substances have continued to decline. Past‐month alcohol use appears to increase slightly in the 2016‐2017 NSDUH and the 2018 Missouri Student Survey, while continuing to decline in the 2017 Youth Risk Behavior Survey.

Figure 14: Trend in Substance Use among Missouri Adolescents


2002‐2003

2003‐2004

2004‐2005

2005‐2006

2006‐2007

2007‐2008

2008‐2009

2009‐2010

2010‐2011

2011‐2012

2012‐2013

2013‐2014

2015‐2016

2016‐2017

MO Ages 12‐17 9.19 10.48 9.80 8.67 8.19 8.01 7.27 6.84 6.99 6.31 5.76 4.87 4.44 3.72

MO Ages 18‐25 23.72 24.04 24.62 25.45 23.08 23.03 21.20 18.48 18.25 17.51 18.07 17.11 15.05 13.08

MO Ages 26+ 7.14 8.18 7.59 7.33 7.49 7.33 7.15 6.35 5.50 6.55 7.06 6.77 6.82 6.77

0

10

20

30

Percent ofAge Group

2002‐2003

2003‐2004

2004‐2005

2005‐2006

2006‐2007

2007‐2008

2008‐2009

2009‐2010

2010‐2011

2011‐2012

2012‐2013

2013‐2014

2014‐2015

2015‐2016

2016‐2017

Past‐Month Alcohol Use 19.67 20.20 19.96 17.55 16.28 14.90 13.76 15.16 14.96 12.83 12.40 10.91 9.83 9.91 10.80

Past‐Month Binge Alcohol Use 12.61 13.67 12.84 10.77 10.31 9.47 8.80 9.55 8.46 7.60 7.46 6.70 5.62 5.82

Past‐Month Tobacco Use 21.01 20.33 19.21 15.88 13.94 13.90 14.52 15.85 15.12 12.28 11.41 10.56 9.28 8.45 7.27

Past‐Year Marijuana Use 16.15 16.74 14.97 13.00 12.39 12.22 11.45 12.15 13.07 13.32 13.78 12.48 12.94 12.55 11.81

Past‐Month Marijuana Use 7.43 8.17 7.53 6.45 6.41 6.29 5.71 6.42 7.28 7.28 7.10 6.45 6.56 6.23 5.80

Past‐Month Illicit Except Marijuana 5.40 5.60 5.65 5.23 5.21 4.73 4.06 4.15 3.94 3.68 3.41 2.83 4.26 3.07

0

5

10

15

20

25

Percent ofMissouri Adolescents

Ages 12‐17


Figure 15: Trend in Substance Use among Missouri Secondary School Students

Data Source: Missouri Institute of Mental Health: Missouri Student Survey.

Despite the decline in the percentage of secondary school students who are using substances, Missouri public schools reported that more than 2,800 students were disciplined for violations of substance-related laws or school policies during the 2018-2019 school year. The number of drug discipline incidents has averaged 2,300 annually during the past 10 years while reported alcohol violations have averaged 450. Disciplinary action related to tobacco use has seen a recent upturn, presumably due to an increase in youth vaping.

Figure 16: Public School Discipline Incidents involving Substance Use

Data Source: Missouri Department of Elementary and Secondary Education.

2010 2012 2014 2016 2018 Lifetime Alcohol Use 42.9 38.2 33.3 35.3 34.5 Past 30-Day Alcohol Use 19.8 16.9 13.9 14.2 14.5 Lifetime Cigarette Use 26.6 22.7 19.1 17.6 14.6 Past 30-Day Cigarette Use 13.7 10.6 8.1 6.2 5.3 Lifetime Marijuana Use 17.7 16.5 15.2 15.2 15.1 Past 30-Day Marijuana Use 9.4 8.6 7.6 7.0 6.5

0

10

20

30

40

50

Percent ofMissouri Students

Grades 6-12

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Alcohol 488 433 479 475 435 399 398 463 415 524 472 Drugs 2390 2624 2978 2818 2324 2121 2028 1900 1918 2148 2152 Tobacco 129 112 100 121 61 58 79 64 38 76 226

0

500

1000

1500

2000

2500

3000

3500


STUDENT VIOLENCE Schools discipline incidents related to violent behavior have declined 50% during the past 10

years, while weapons offenses have declined 30%.

Figure 17: Public School Discipline Incidents involving Weapons and Violence

Data Source: Missouri Department of Elementary and Secondary Education.

JUVENILE COURT REFERRALS The number of adolescents cited and referred to juvenile courts for alcohol and drug offenses

has declined considerably during the past two decades. In 2018 there were 1,570 juvenile court

referrals for drug offenses compared to 3,280 in the year 2000. During that same period, alcohol

offense referrals dropped from 1,503 to 381. Court referrals for juvenile violent offenses

declined from 11,648 in 2000 to 5,456 in 2018.

Figure 18: Referrals to Missouri Juvenile Courts for Selected Offenses

Data Source: Missouri Office of State Courts Administrator.

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Violence 1072 1283 1051 1065 865 816 922 812 551 514 528

Weapons 857 853 743 730 665 688 617 681 624 690 581

0

200

400

600

800

1000

1200

1400

0

2000

4000

6000

8000

10000

12000

14000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Violent Offenses Drug Offenses Alcohol Offenses


SUBSTANCE USE AMONG YOUNG ADULTS

Among Missouri adults 18‐25 years, reductions in alcohol use disorders have been the chief factor in the decline in SUD rates. Alcohol use disorders in this young adult group have dropped from nearly 20% in 2003 to 9.5% in 2017. Alcohol use and binge drinking are trending downward. In contrast, illicit drug use disorders have only declined from 8.5% to 6.2% during the same period. While marijuana use in this age group has increased in recent years, past month use of other illicit drugs has dipped to under 6% after reaching 9% a decade ago.

Figure 19: Trend in Substance Use among Missouri Young Adults


Nearly 61% of students who completed the 2019 Missouri Assessment of College Health Behaviors survey reported past‐month alcohol use—a reduction of six percentage points from the 67% a decade earlier. Although cigarette use continues to decline, overall tobacco use took an upturn in 2019. About 30% of Missouri college students have used marijuana during the past year, consistent with the 32% NSDUH estimate for young adults ages 18‐25. More than 5% of college students have used illicit stimulants in the past year, and 4% have used cocaine.

Figure 20: Trend in Substance Use among Missouri Young Adults

Data Source: Partners in Prevention Statewide Coalition, University of Missouri, Columbia, MO. Missouri Assessment of College Health Behaviors.

2002‐2003

2003‐2004

2004‐2005

2005‐2006

2006‐2007

2007‐2008

2008‐2009

2009‐2010

2010‐2011

2011‐2012

2012‐2013

2013‐2014

2014‐2015

2015‐2016

2016‐2017







0

10

20

30

40

50

60

70

Percent ofMissouri AdultsAges 18‐25

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Past‐Year Alcohol Use 81.3 79.5 79.9 79.8 79.3 77.0 76.3 74.8 74.7 75.9 74.7 74.1

Past‐Month Alcohol Use 68.1 66.7 67.2 66.2 62.6 63.5 70.9 60.1 58.7 63.5 62.5 60.7

Past‐Year Tobacco Use 30.3 43.4 43.6 48.5 38.2 37.6 36.1 33.5 26.6 25.4 30.4

Past‐Year Marijuana Use 21.8 23.1 21.6 23.4 21.0 22.1 22.3 22.2 23.3 30.1 31.4 29.5

Past 2‐Week Binge Alcohol Use 31.2 35.7 33.8 32.8 27.9 27.2 28.3 24.7 25.0 26.9 25.2 22.6

0

20

40

60

80

100

Percentage of College Students Surveyed


SUBSTANCE USE AMONG OLDER ADULTS

Seven percent of Missouri adults older than age 25 have substance use disorders. This rate has shown little fluctuation during the past 14 years. About 5% of these older adults have alcohol use disorders and 2% have illicit drug use disorders. In the most recent NSDUH surveys, 55% of Missouri’s older adults were past‐month alcohol users including 25% who were past‐month binge drinkers. The estimated rates of binge drinking for this age group have been increasing since 2010. Past‐month illicit drug use is also increasing, reaching 9% of adults older than 25. Marijuana use—at 7%—accounts for most of this increase. Past‐year marijuana use among older adults has increased to 11%, compared to 7% ten years ago. Approximately 1% of the over‐25 age group are past‐year users of cocaine and methamphetamine, and about one‐third of a percent are using heroin. Tobacco use has declined to 29% in this age group, and cigarette smoking to 23%. Missouri adult males have considerably higher rates of past‐month binge drinking than adult females, according to the Behavioral Risk Factor Survey.

Figure 21: Trend in Substance Use among Missouri’s Older Adults


SUBSTANCE USE EMERGENCIES

In 2017, more than 42,000 Missouri residents entered hospital emergency rooms with a substance use disorder primary diagnosis. They included 24,000 with an alcohol use disorder and 18,000 with a drug use disorder. Emergency rooms discharged more than 33,000 after providing emergency services but admitted 9,000 to hospitals for further medical treatment. Emergency rooms also treated 50,000 Missouri residents with secondary alcohol disorders and 64,000 with secondary drug disorders.

2002‐2003

2003‐2004

2004‐2005

2005‐2006

2006‐2007

2007‐2008

2008‐2009

2009‐2010

2010‐2011

2011‐2012

2012‐2013

2013‐2014

2014‐2015

2015‐2016

2016‐2017







0

10

20

30

40

50

60

Percent ofMissouri Adults

Ages 25 and Older


SPECIALIZED TREATMENT FOR SUBSTANCE USE DISORDERS

In state fiscal year 2018, behavioral health treatment centers funded by the Division of Behavioral Health admitted more than 50,000 Missouri residents for substance disorder services. Admissions included more than 33,000 for substance disorder treatment and 17,000 for substance‐related traffic offender assessments and services. Among those admitted for treatment were 21,000 males and nearly 13,000 females.

Figure 22: Substance Use Disorder Treatment Recipients by Age Group, Fiscal Year 2018


Alcohol use was the primary concern in nearly 10,000 of the substance treatment admissions. Stimulant use—mainly methamphetamines—accounted for more than 8,000 admissions. Nearly 8,000 treatment admissions involved heroin and other pain reliever use. Marijuana—with over 6,000 admissions—and cocaine with 1,000 accounted for most of the remainder.

Figure 21: Primary Drug Problem among Individuals Admitted for Substance Use Treatment, FY2018


TRENDS IN TREATMENT OF SUBSTANCE USE DISORDERS

Considerable changes have occurred during the past decade in the substances identified in treatment admissions. In FY2009, two‐thirds of the treatment admissions were for alcohol or marijuana. Heroin and other pain relievers, methamphetamine and other stimulants, and crack and other cocaine each accounted for about one‐tenth of the admissions. Since then, there have been increases in treatment admissions for meth and heroin use and declines in admissions for alcohol, marijuana, and cocaine.

1,751

4,001

5,988 5,7935,219

3,314

4,828

2,858

<18 18‐24 25‐29 30‐34 35‐39 40‐44 45‐54 >54

Alcohol 28%

Heroin 16%

Pain Relievers Except Heroin 7%Meth & Other Stimulants 25%

Crack & Other Cocaine 3%

Tranquilizers 1%

Marijuana 19%

Hallucinogens 1%

Other 1%


Figure 23: Trend in Primary Drug Problem among Individuals Admitted for Substance Use Treatment


DEATHS RESULTING FROM SUBSTANCE USE

While deaths attributable to cigarette smoking are slowly declining after reaching a peak of 10,300 in 2015, deaths with an underlying cause of alcohol and drug use continue to climb. Opioids account for most of the drug‐induced deaths in Missouri. In 2018, heroin and other opioid overdose deaths reached 1,132.

Figure 24: Trend in Missouri Substance Induced Deaths

Data Source: Missouri Department of Health and Senior Services.

FY2009

FY2010

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016

FY2017

FY2018

Alcohol 16404 16436 14640 14361 13874 12757 11989 10672 10229 9522

Marijuana 10901 10688 9465 8823 8234 7986 7591 7044 6783 6460

Meth & Other Stimulants 3722 3875 4150 4653 5322 5804 6153 6872 8027 8329

Heroin 2329 2846 3098 3195 3507 3673 4062 4681 4629 5339

Pain Relievers Except Heroin 1922 2185 2331 2269 2507 2249 2172 2205 2097 2439

Crack & Other Cocaine 3623 3036 2570 2274 1488 1487 1216 1192 1135 1070

All Other Substances 882 807 939 990 945 873 782 740 674 593

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Drug Induced Deaths 334 380 455 561 591 674 810 774 804 901 1,019 994 952 1,042 1,121 1,088 1,411 1,425 1,658

Alcohol Induced Deaths 329 358 334 335 385 329 379 316 387 372 396 366 449 444 475 509 536 555 597

0

300

600

900

1,200

1,500

1,800


DRUG ARRESTS

Arrests for illicit drug possession plateaued at 40,000 arrests in Missouri in 2017, then declined

to about 37,000 in 2018. Arrests for illicit drug selling or manufacturing have declined from

7,910 arrests in 2002 to 2,373 in 2018—a 70% reduction.

Figure 25: Missouri Arrests for Possession and Sale/Manufacturing of Illicit Drugs

Data Source: Missouri State Highway Patrol, Statistical Analysis Center. Uniform Crime Reports (UCR).

Prison admissions for drug convictions have also begun to level off yet remain at 6,000 new

incarcerations per year. More than 10,000 individuals per year are placed on probation for drug

violations.

Figure 26: Disposition of Missouri Drug Convictions

Data Source: Missouri Department of Corrections.

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Drug Possession 32556 35188 35526 34659 36138 39687 36155 31362 31122 30849 31358 32209 32808 31238 34116 39108 40022 36836

Drug Sales/Manufacturing 6661 7910 7313 7193 6390 6127 5703 5808 5958 5211 5290 5151 4838 4052 3921 3885 2933 2373

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

Illicit DrugArrests

FY2009

FY2010

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016

FY2017

FY2018

FY2019

DOC Probation 8485 7682 7265 7670 8203 8899 9132 9311 10304 10753 10618

DOC Prison 5753 5389 5508 5557 5779 6165 6068 6152 6649 6508 6025

DOC Parole/Conditional Release 4321 3942 3879 3923 3887 3917 3782 3708 4225 4564 5320

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12000

Case Openingsor Admissions forDrug Convictions


IMPAIRED DRIVING

Substance-impaired driving contributes to more than 6,000 traffic crashes every year in Missouri. In 2018, 253 individuals died in crashes caused by alcohol or drug impaired drivers.

Figure 27: Traffic Crashes Attributed to Substance Impairment

Data Source: Missouri State Highway Patrol, Statistical Analysis Center. Missouri Traffic Safety Compendium: 2018.

Distracted or inattentive driving is a factor in 20,000 crashes annually, and driver fatigue or falling asleep is a factor in nearly 3,000 more.

Figure 28: Traffic Crashes Attributed to Inattention

Data Source: Missouri State Highway Patrol, Statistical Analysis Center. Missouri Traffic Safety Compendium: 2018.

INTERVENTIONS FOR IMPAIRED DRIVING

Arrests for substance-impaired driving are declining. Data from the Missouri DWI Tracking System (DWITS) indicates that arrests for driving under the influence of alcohol or drugs have decreased from 39,552 in 2006 to 22,030 in 2018—a 44% reduction.

2012 2013 2014 2015 2016 2017 2018 Driver Alcohol Impaired 5868 5674 5179 5335 5299 5321 5182

Driver Drug Impaired 1229 1282 1201 1314 1389 1393 1387

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Traffic Crashes

2012 2013 2014 2015 2016 2017 2018 Driver Distracted or Inattentive 22163 21378 20067 21292 21676 20896 19876

Driver Fatigued or Asleep 1842 2050 2133 2510 2848 2932 2727

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Traffic Crashes


Figure 29: Missouri Arrests for Driving Under the Influence of Alcohol or Drugs, and Traffic Crashes Involving Driver Under the Influence of Alcohol or Drugs

Data Source: Missouri State Highway Patrol, Statistical Analysis Center. DWI Tracking System (DWITS) and Uniform Crime

Reports (UCR).

The number of individuals clinically assessed in the Substance Awareness Traffic Offender

Program (SATOP) has likewise declined—from 30,749 in FY 2009 to 16,644 in FY 2019. Based on

their assessments, traffic offenders are referred to education, intervention, or treatment

services. Every year, 40% to 45% of the assessed offenders are admitted to SATOP intervention

or clinical treatment programs (WIP, CIP, YCIP, or SROP).

Figure 30: SATOP Assessments and Program Admissions by Fiscal Year


Aside from SATOP, some DWI offenders—particularly prior and persistent offenders—are

placed on probation or sentenced to jail or prison. State incarcerations and probation openings

have followed the downward trend of impaired driving arrests.

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Impaired Driving Arrests 39552 39683 38937 35543 35059 33649 33510 29341 26362 22815 22457 22944 22030

Impaired Driving Crashes 8994 8883 8431 8455 7475 7275 7097 6956 6380 6649 6688 6714 6569

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Impaired DrivingArrests & Crashes

FY2009

FY2010

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016

FY2017

FY2018

FY2019

SATOP Assessments 30749 30109 24511 25871 24423 22729 20936 18892 17445 16914 16644

SATOP Education (OEP, ADEP) 14124 13213 10600 10901 9904 8950 8263 7142 6523 6119 6287

SATOP Intervention or Treatment (WIP.CIP, YCIP, SROP)

12396 12028 10011 11057 11148 10333 9431 8484 7882 7591 7097

0

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20,000

30,000

40,000

Assessed Offenders and Numbers Admitted to Each Program Category


Figure 31: Disposition of Missouri DWI Convictions

Data Source: Missouri Department of Corrections.

OUT‐OF‐HOME JUVENILE PLACEMENTS Children may be removed from their homes by juvenile authorities and placed in alternate care

when unfavorable conditions are present in the home. In 2018, nearly 7,000 children were

removed from their homes. Over 12,000 conditions were documented in the placements, with

some cases involving more than one adverse condition. Every year, parental drug use tops the

list of removal conditions.

Figure 32: Conditions Present in Removal of Children from Homes by Juvenile Authorities

Data Source: Missouri Department of Social Services, Children’s Division.

FY2009

FY2010

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016

FY2017

FY2018

FY2019

DOC Probation 1421 1526 1800 2082 2077 1986 1851 1725 1540 998 536

DOC Prison 1187 1190 1176 1201 1127 1030 919 820 743 529 338

DOC Parole/Conditional Release 583 543 516 563 573 510 445 414 343 335 367

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Case Openingsor Admissions forDWI Convictions

0 500 1000 1500 2000 2500 3000 3500

Child Alcohol Use

Child Disability

Relinquishment

Parent Death

Child Drug Use

Parent Alcohol Use

Sexual Abuse

Abandonment

Child Behavior Problem

Parent Incarceration

Caretaker Inability to Cope

Physical Abuse

Inadequate Housing

Neglect

Parent Drug Use

Number of Adverse Conditions

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