Rachel Winograd presents on “The Current State of Missouri’s Overdose Crisis and Recent Mitigation Strategies” as part of the monthly Discovery Series lecture for NextGen Precision Health. (Photo by Derik Holtmann)

Rachel Winograd – who holds a dual appointment as an associate professor in the Department of Psychological Sciences and director of the Missouri Institute of Mental Health – recently kicked off a lecture with a short yet thought-provoking exercise. She asked the small crowd gathered in the Millennium Student Center Century Rooms at the University of Missouri–St. Louis last Monday to get out a piece of paper or open the notes app on their phone and write down their drug of choice. It could be caffeine, say, or alcohol or nicotine.

Next, Winograd asked attendees to write all the positive things they get out of that drug. What does it do for you? How does it make you feel?

Finally, she instructed the group to cross out the drug, write “I need” and look back at their list.

“We do this as a reminder that people use drugs for a reason,” Winograd said. “Human beings have always used drugs. We will always use drugs. We use drugs for reasons; they fill needs in our lives and in ourselves. It helps with our understanding of shame and stigma and judgment for people who use drugs. We say, ‘Why don’t they just stop?’ ‘Why don’t they just use their willpower?’ Well, what’s going to take its place? If we tell someone clinically that they need to reduce or quit their drug use, that means they’re not going to get an essential need met. How are we going to work with them to get those needs met in other ways? Let’s just keep that in mind as we go through our talk today. Drug use is really complicated. Addiction is really complicated and rooted in a lot of core issues and needs that we don’t have other easy ways of addressing in our society.”

Winograd presented her talk, “The Current State of Missouri’s Overdose Crisis and Recent Mitigation Strategies” as part of the monthly Discovery Series lecture for NextGen Precision Health, which unites the four University of Missouri System universities in order to accelerate innovations in precision health and, in turn, improve health outcomes across the world.

“Precision health has been the frontier in health research for a while now,” said Director of NextGen Communications Ben Stewart. “It’s about developing new techniques for treating diseases that are tailored to individual patients, their environment, their genetics and their behaviors. It’s about devising an intervention for a given disease that takes into account their own genetic profile and can be fit into their schedule so it’s not a hardship on them to maintain for the rest of their life. One intervention might not be as effective for a certain patient as it is for another. In all these different domains, we’re trying to start with the patient and their needs and work our way back and develop a technique that collects more data on them instead of having a one-size-fits-all approach across the board, which has really been kind of a weakness of the health system for such a long time.”

Winograd’s lecture was the first – but certainly not the last – of the Discovery Series to be hosted on the UMSL campus. Stewart said NextGen hopes to visit the UMSL campus at least once a year, and he and his colleagues felt Winograd was the perfect person to kick off that collaboration.

“Her reputation really precedes her,” he said. “She’s someone who has a really novel crossover with that patient-centered approach to health care. Because she intersects with public health, patient-centered care and the neurology and psychology of addiction, that was a perspective that we felt wasn’t captured by any of our other speakers this year.”

In her talk, Winograd outlined the recent landscape of drug use and overdose deaths in Missouri, including the ever-expanding role of fentanyl in the drug supply and the increase in deaths involving stimulants such as methamphetamine and cocaine. She also highlighted the wide racial disparities between Black and white Missourians regarding addiction treatment outcomes and overdose fatalities and outlined how the Addiction Science team has partnered with other community organizations to develop the CENTER Initiative to reduce overdose and confront the impact of trauma in Black St. Louisans impacted by addiction, drug use and overdose.

Winograd also detailed the Addiction Science team’s work developing and implementing a medication-first approach to substance use – which was recently promoted by the Substance Use and Mental Health Services Administration as a best-practice model – and establishing an infrastructure for harm reduction, including distributing over 170,000 Naloxone kits and 360,000 fentanyl test strips across the state of Missouri over the past few years. Yet Winograd also acknowledged that the medication-first model and harm-reduction efforts can only take us so far, specifically noting that they have helped some people more than others.

“What do we need in our communities?” she said. “I’m not trying to say that we only need harm-reduction or we only need medication – we need all of it. What we need is an ecosystem that’s accessible in every neighborhood in every corner of the state that includes everything people may want or need. So yes, residential treatment. Yes, recovery housing. Yes, medical treatment. Yes, peer support groups. Yes, transitional housing. Yes, syringe exchange. Yes, transportation, which is number one for so many people trying to get access to care. And we need people navigating these systems with the people we’re trying to help – community health navigators, community health workers, peer specialists – literally and figuratively holding people’s hands, getting them from one place to another because this is where we lose people, in the gaps between these settings and these bifurcated systems.”

In closing, Winograd offered a call to action for audience members to get involved, whether by carrying Naloxone, helping the team pack harm reduction kits or simply trying to spark conversation over the dinner table.

“Try to change people’s perceptions of people who use drugs and what it takes to ‘get sober,’” she said, circling back to the activity at the top of the hour. “You know now it’s more complicated than that and that we need our bold initiatives to try to keep pace with the changing nature of our volatile drug supply.”

Watch Winograd’s presentation: