Addressing the Overdose Crisis and Enhancing Recovery Services in High-Need Carter County, Missouri

The Carter County Courthouse is located in the southeastern Missouri Ozarks. The proposed initiative aims to address the opioid, stimulant, and substance use disorder (SUD) crisis in Carter County, a community of 5,303 residents severely impacted by high rates of addiction and limited access to healthcare and treatment services. Carter County has experienced a significant increase in both fatal and nonfatal overdoses, with a 50% rise in annual drug-related overdose deaths in 2022. From 2019 to 2023, Missouri saw nearly a 75% increase in overall overdoses, primarily driven by fentanyl. Suicides are also becoming more common, with over one in three involving a substance use disorder. Carter County residents report substance use as the most pressing health issue in the community. 
 
The goals of the project are to reduce the harm caused by opioids, stimulants, and other substances to individuals, families, and the community; lower recidivism and nonfatal overdose rates; and reduce preventable deaths where substance use is a factor, including overdoses and suicides.  
 
This project will be implemented in collaboration with the Carter County Courthouse, Family Counseling Center, and Washington University in St. Louis.  The Carter County Courthouse will implement a prosecutor-led diversion program, distribute Narcan, and offer case management services working closely with recovery and housing agencies. The Family Counseling Center will provide peer support and patient navigation services to ensure a continuum of care between organizations, emergency department discharges, and law enforcement interventions. Additionally, a drug take-back program will be implemented to reduce the availability of unused medications. The intended beneficiaries of this project are individuals with SUDs, their families, and the broader community affected by substance use. 
 
The project evaluation will measure performance, utilizing data from court systems, healthcare providers, and community surveys. This will track treatment engagement, overdose rates, and recidivism, alongside focus groups to capture the lived experiences of those affected by SUDs.  Washington University will serve as a research partner.  The Carter County Hope Coalition, a multidisciplinary body, will help guide efforts, ensuring community involvement and interorganizational collaboration.  
 
By integrating these components, the project aims to reduce the harm caused by substance use, lower overdose and suicide rates, and enhance long-term recovery outcomes for Carter County residents.