Quick answer
St. Louis City has the highest drug overdose death rate in Missouri, at 65.1 per 100,000, and fentanyl is present in nearly all of its opioid-involved deaths. Medication for opioid use disorder is the standard of care and MO HealthNet covers it. Hopewell Center runs treatment in north St. Louis. Here is how to start.
St. Louis City has the heaviest overdose burden in Missouri, and fentanyl is the reason. It is present in nearly every opioid-involved death here, and it is often mixed with other drugs people do not know they are taking. That is the case for acting now. Opioid use disorder has effective medication, and north St. Louis has a clinic that provides it.
What St. Louis City's numbers show
The UMSL-MIMH Addiction Science team reports that drug-involved deaths in St. Louis City fell 36% in 2024 — one of the steepest declines in the region. But the city still has the highest drug overdose death rate in Missouri, at 65.1 per 100,000, and its first-half 2024 report found:
- Fentanyl present in 98–99% of opioid-involved deaths in the city
- Xylazine involved in 31% of city drug-involved deaths, up from 20% in 2023
- Stimulant-involved deaths rising in the city even as opioid deaths fell
Statewide, Missouri counted 1,450 overdose deaths in 2024, down 26% from 1,948 in 2023, with fentanyl-involved deaths down 39%.
Medication is the standard of care
The National Institute on Drug Abuse describes medication for opioid use disorder as the standard of care and reports that people treated with methadone or buprenorphine are less likely to die or overdose than people who go without.
- Buprenorphine — a daily tablet or film, prescribable in a clinic or doctor's office.
- Methadone — dispensed daily at a certified opioid treatment program.
- Naltrexone — blocks opioid receptors, but only after full detox.
Medication works best alongside counseling, and it can continue safely through pregnancy under medical care. Ask a clinician which option fits.
Where to get care in St. Louis
Hopewell Center, part of Betty Jean Kerr People's Health Centers, is a Certified Community Behavioral Health Clinic that has served north and central St. Louis City for more than 40 years. Its behavioral health services include:
- Substance use treatment for adults and teens, with counseling and case support
- Crisis intervention — walk-in or by phone
- Medication services, therapy, and community support
The main behavioral health locations are on Delmar Boulevard and Dr. Martin Luther King Drive in north St. Louis (314-367-7848).
Naloxone and harm reduction
Fentanyl is lethal in tiny amounts and is often pressed into counterfeit pills, so everyone using opioids should carry naloxone and the people around them should know how to use it.
- Missouri has a statewide naloxone standing order, so pharmacists can dispense naloxone without a separate prescription — and it is available over the counter as well.
- Free mail-order or pickup naloxone can be found through GetMissouriNaloxone.com.
One caution: xylazine is not reversed by naloxone. If someone is unresponsive, call 911, give naloxone for the opioid part, and keep them breathing until help arrives.
Paying for treatment
MO HealthNet (Missouri Medicaid) covers medically necessary substance use disorder treatment for eligible members, including medications for opioid use disorder. Many members enroll through managed care plans such as Healthy Blue, Home State Health, and UnitedHealthcare Community Plan. Hopewell and other community providers also serve people who are uninsured.
How to start today
- If someone is unresponsive or breathing slowly, call 911 and give naloxone if you have it. For a crisis, call or text 988.
- Call or text (800) 653-9376 to talk through options with a treatment specialist — free and without obligation:
Calling is free; the referral service is paid for by treatment providers.
- Call Hopewell Center at 314-367-7848 and ask for a substance use assessment, or walk in for crisis intervention.
- Ask about starting buprenorphine or methadone this week — same-day or next-day induction is possible at many programs now.
Fentanyl use disorder is treatable, and St. Louis has providers ready to start. The first call is the hardest part.
Emergency and crisis lines
Call 911 first if someone is unresponsive, breathing slowly, or turning blue. For a mental health or substance use crisis that is not a medical emergency, call or text 988, the national Suicide and Crisis Lifeline.
This page is general health information, not medical advice. It is not affiliated with or endorsed by any facility named above.
Last updated: Mon Oct 19 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
Frequently asked questions
How bad is the overdose problem in St. Louis City?
St. Louis City has the highest drug overdose death rate in Missouri, at 65.1 per 100,000 in 2024 - nearly three times the state average. The UMSL-MIMH Addiction Science team reports city drug-involved deaths fell 36% in 2024, but fentanyl is present in 98-99% of opioid-involved deaths.
What medications treat opioid use disorder?
The FDA has approved methadone, buprenorphine, and naltrexone for opioid use disorder. Per NIDA, people treated with methadone or buprenorphine are less likely to die or overdose than people who get no medication, and medication works best alongside counseling.
What is xylazine and does it affect treatment?
Xylazine is a veterinary sedative that has been mixed into the illicit drug supply. In the first half of 2024 it was involved in 31% of St. Louis City drug-involved deaths. Naloxone does not reverse xylazine, so call 911 and give naloxone for the opioid part, then keep the person breathing until help arrives.
Where can I get treatment in St. Louis?
Hopewell Center, part of Betty Jean Kerr People's Health Centers, is a Certified Community Behavioral Health Clinic serving north and central St. Louis City, with substance use treatment for adults and teens, counseling, case support, and walk-in or phone crisis intervention.
What should I do if someone is overdosing right now?
Call 911 immediately and give naloxone if you have it - naloxone will not harm someone who is not overdosing. For a mental health or substance use crisis, call or text 988, or call or text (800) 653-9376.