The Missouri State Epidemiological Workgroup [SEW] has four major roles in the Strategic Prevention Framework State Incentive grant [SPF SIG]:

1.       to systematically think about the causes and consequences of substance use

2.      to promote data-based decision making throughout the Strategic Prevention Framework

3.      to promote cross-systems planning, implementation, and monitoring, and

4.      to provide support to the project staff and the advisory committee.

 

 

Needs Assessment

The needs assessment is an integral component of the four roles above, particularly in providing data for decision-making by the project staff of the Missouri Department of Mental Health, Division of Alcohol and Drug Abuse [ADA], with guidance from the SPF SIG advisory committee.

 

This initial assessment of drug use in Missouri is designed to:

• highlight census data in our state that may help in understanding current and future drug use;
• review existing reports on Missouri’s drug problems
• review indicators of use of several major drug categories
• identify some key areas of concern. After the initial assessment and strategic plan are in place, analyses of the data will continue in order to support decision making.

Data for the needs assessment were obtained from various sources and databases, such as the Missouri State Highway Patrol [MSHP], Centers for Disease Control and Prevention [CDC], National Institutes of Health [NIH], Youth Risk Behavior Surveillance System [YRBS], Uniform Crime Reporting [UCR] Program, Treatment Episode Data Set [TEDS], Missouri Information for Community Assessment [MICA], National Surveys on Drug Use and Health [NSDUH], and Behavioral Risk Factor Surveillance System [BRFSS]. The information was then analyzed to determine the prevalence of each substance in the state and, where possible, in the counties. Rates were calculated in order to compare the prevalence between counties.

 

A review of the various substance abuse indicators reveals a number of areas of concern for prevention policy makers in Missouri. Several of these drugs can be grouped to form major areas of concern. Briefly, the areas that should be considered by these policy makers include:

 

a.      Drugs of Abuse:

§         ‘Licit Drugs’ Used Legally and Illegally (Underage) – Underage drinking, and its associated problems of binge drinking, alcohol-related crashes and violence, and alcohol-related health problems, are problems for Missouri. Large rates of tobacco use and low rates of tobacco taxation are also issues in the state, resulting in tobacco-related health consequences statewide.

§         Marijuana – Present statewide, marijuana is the most widely used illicit drug among adults and represents the first illegal substance used by many Missourians. Use of this drug can result in respiratory problems, cancers of the head, neck and lungs, as well as behavioral and cognitive problems. Further, Missouri arrests for possession of marijuana are second only to those for driving under the influence, and almost 50% of those admitted for treatment in the state report marijuana use. It was one of the most reported primary drugs of use when individuals were admitted to treatment in Missouri in both 2002 and 2003, second only to alcohol. 

§         Stimulants – Crack cocaine use is statewide, but it is a critical problem in our urban areas (particularly St. Louis) and has had a large impact on the African American communities in many parts of Missouri. Smoking this drug can cause acute respiratory problems, and there has been a significant increase in drug abuse problems and drug-related violence with the emergence of crack. Although amphetamine type stimulants (ATS), especially methamphetamine, have received a huge amount of publicity for our state, methamphetamine is used by fewer persons than other drugs such as alcohol, tobacco, cocaine and marijuana. Still, the rural communities have felt the greatest impact of the health and public safety problems that go along with this substance.

§         Opiates – Heroin and narcotic analgesic prescription drugs are the major opiates being abused in Missouri. While narcotic analgesics are a problem throughout the state, heroin is primarily an issue in the St. Louis, Kansas City and smaller urban areas. Southeast Missouri also has a major problem with opiate prescription abuse.

§         Local Community Substances – St. Louis ranks high on benzodiazepine abuse, Kansas City has a very high level of phencyclidine [PCP], and inhalant abuse is a big problem among youth in many Missouri communities.

 

b.      Geographic Areas of Concern/High Poverty Areas:

§         Urban – These are natural areas of concern because their large populations result in the most substance abusers. They have multiple problems and the highest levels of many substances, including alcohol, heroin, and crack cocaine.

§         Suburban – Although difficult to classify due to the great degree of variation among communities, the assumption that suburban areas do not experience major drug problems is not valid.

§         Rural – These areas demonstrate a large degree of variability in drug use patterns and tend to have higher rates of use of a number of substances and fewer resources and less experience to carry out comprehensive prevention programs.

§         Southeast Missouri, select rural counties, St. Louis City, and Jackson County – These areas of the state have the highest percentage of people living in poverty, placing their residents at risk for numerous problems but little infrastructure for prevention work.

 

c.       Communities of Interest

Several socio-demographic and related factors define communities that transcend geopolitical boundaries within our state and may be potential priorities; however, more data need to be identified and collected at the community level to determine target populations. These communities might include:

§         Racial and ethnic minorities - Is it possible to identify these groups as communities on a statewide basis and plan interventions accordingly?

§         Language ability - Are there groups of ethnic minorities or deaf/hard-of-hearing persons which could be treated as ‘communities’ for the sake of prevention interventions?

§         Older substance abusers - Most prevention efforts are directed at youth, but there is a need to continue prevention efforts throughout the lifespan, especially as Baby Boomers, who historically have had permissive attitudes towards drugs, enter old age.

§         Disabled - Missourians with disabilities are at increased risk of abusing substances. There are many residents with physical and/or cognitive disabilities who require specific prevention initiatives.