The opioid epidemic continues to devastate families and communities across the nation, particularly in rural regions where access to healthcare and recovery programs is limited. In Lincoln County, Missouri, an innovative program is demonstrating how medication assisted treatment (MAT) can dramatically change outcomes for individuals with opioid use disorder (OUD), reduce overdose deaths, and restore hope where it was once scarce.

At the recent Missouri MIH Conference, I had the opportunity to meet with Ray Antonacci, Chief Administrator of the Lincoln County Ambulance District, and Sarah Czarnecki, a paramedic and Mobile Integrated Health Liaison. Together they’ve spearheaded a MAT program that not only serves their community, but also eases the suffering of under-served populations in the local jail. Their work shows the profound impact MAT can have when combined with vision, persistence, and compassion.

A Community in Crisis

Lincoln County, located just northwest of St. Louis, has faced a sharp rise in opioid-related incidents. In 2022 alone, first responders answered 166 overdose calls. Opioid-related overdose deaths accounted for nearly 70% of overdose deaths in the county, and tragically, several occurred inside the county jail (Missouri Department of Health & Senior Services [MDHSS], n.d.). For too long, withdrawal in incarceration settings was untreated, leading to extreme suffering and preventable deaths.

Thanks to a $300,000 federal grant through the Rural Communities Opioid Response Program, Lincoln County Ambulance District (LCAD) launched a comprehensive MAT initiative aimed at reducing opioid-related morbidity and mortality. Their approach combines harm reduction, mobile outreach, jail-based care, and strong community partnerships (Czarnecki, 2025).

How MAT Works

At the center of this program is buprenorphine, a medication that partially binds to opioid receptors in the brain. It produces much weaker euphoric effects than opioids while reducing withdrawal symptoms and cravings, stabilizing brain chemistry, and allowing individuals to finally feel “normal” – a state many addicted individuals desperately seek after years of chaos (National Institute on Drug Abuse [NIDA], 2022).

As Antonacci and Czarnecki explained, the changes are often striking. People who once seemed lost to opioid dependence—sometimes even violent or chronically unstable—begin to think rationally again, rediscover humor, and rebuild relationships. Buprenorphine enables them to focus on recovery and reintegration rather than the relentless pursuit of their next dose.

MAT Behind Bars: The UMATR Program

One of the program’s boldest innovations is the Under-served population Medication Assisted Treatment and Recovery (UMATR) initiative within the county jail. When individuals are arrested, they undergo a health screening. If they have a history of opioid use and show withdrawal symptoms, paramedics evaluate them using a clinical scale. Eligible individuals are offered buprenorphine and enrolled in the program (Czarnecki, 2025).

Detainees receive regular doses every 12 hours, stabilizing their condition throughout their stay. Timelines vary, but generally individuals begin receiving treatment over the course of 10 days, and maintain treatment for at least 20 more. If an individual’s goal is abstinence from OUD medication, they can then taper off their treatment for a final 30 days.

The results speak volumes: since the program’s launch in April 2024, there have been zero overdose deaths among participants (Czarnecki, 2025).

Recovery After Release

Czarnecki and Antonacci know that OUD recovery is a long road. After medication stabilizes an individual’s withdrawal symptoms, Lincoln County’s MIH program helps them take the next step by connecting them to ongoing and post-release treatment.

Peer support specialists, courtesy of local counseling program PreventEd, work together with community paramedics to develop a reintegration plan tailored to the individual’s needs. For those continuing with medication, they make sure to find opioid treatment programs that permit MAT, with the MAT itself managed by Mercy Hospital’s Virtual Substance Use Recovery Program (vSURP). For those with mental health needs, they work with the jail’s behavioral health liaison to find qualified specialists through the Missouri-based Compass Health Network.

By combining MAT with peer support, mental health services and other community programs, Lincoln County’s MIH program takes a holistic approach to addiction recovery. They close healthcare gaps, reduce the stigma around opioid use disorder, and help struggling individuals finally find their feet.

A Measured Impact

Before the program’s launch, overdose deaths in Lincoln County were consistently high: 28 deaths in 2022 and 27 deaths in 2023, with a small number occurring in the jail. 2024 marked the introduction of MAT and related harm reduction strategies, and finally the county saw a change: only 8 overdose deaths, with none in the jail (Lincoln County Coroner’s Office, as cited in Czarnecki, 2025). On top of that, opioid overdose 911 calls dropped by 20% in 2024. More than 50 inmates have been successfully enrolled in the UMATR program, and hundreds of naloxone kits have been distributed free of charge.

These results highlight the power of combining evidence-based treatment with innovative delivery methods such as mobile health units, jail-based protocols, and community education.

Changing the Narrative

Beyond the statistics, what stands out most are the personal success stories—the individuals who, thanks to MAT, have been able to reclaim their lives. Those who’ve experienced the program have come to trust it, and – despite the program having no advertisements – that trust is spreading. Newly arrested individuals are proactively asking for enrollment into the program, thanks to the success stories of others in their community (Czarnecki, 2025). Hope is returning to those who’ve felt crushed by opioid dependence.

As Antonacci has noted, harm reduction strategies like MAT can face significant barriers. Early critics argued that MAT simply replaced one drug with another. However, as local law enforcement, healthcare providers, and families witnessed the transformations firsthand, acceptance grew. Lives once marked by repeated overdoses and recidivism began to stabilize, proving that MAT is not substitution—it is treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2021). “If we can show how harm reduction makes a difference and keeps people alive,” Antonacci says, “we can help erase this stigma one person at a time” (Czarnecki, 2025).

A Model for Rural America

The Lincoln County program demonstrates that MAT is not just a clinical intervention—it is a lifeline. By integrating jail-based treatment, mobile outreach, peer support, and strong community collaboration, Antonacci and Czarnecki have created a system that others can learn from and replicate.

Under their leadership, specific team members receive training as Peer Support Specialists and Community Health Workers, and team members continue learning new techniques at Missouri’s annual MIH Summit. Tools like the HealthCall platform help them track patient care interventions, generate reports and scale the program’s efforts. Finally, a dedicated MIH vehicle – including tablets for telehealth and a refrigerator for storing medication – lets them bring care for OUD to the most rural corners of the county. (Czarnecki, 2025)

For communities grappling with the opioid crisis, the lessons are clear: medication-assisted treatment works. It restores dignity, prevents death, and transforms futures. Lincoln County’s trailblazing effort offers hope—not only for the individuals it serves but also for rural America’s broader fight against addiction.

References

Czarnecki, S. (2025, June 11). Mobile integrated health significantly reduces opioid-related deaths. Lincoln County Ambulance District.

Lincoln County Journal. (2024, September 16). Additional space for county jail in early planning stage.

Missouri Department of Health & Senior Services. (n.d.). Drug overdose dashboard – Fatal overdoses. https://health.mo.gov/data/opioids/index.php

National Institute on Drug Abuse. (2022). Medications for opioid use disorder research report. National Institutes of Health. https://nida.nih.gov

Substance Abuse and Mental Health Services Administration. (2024). What is buprenorphine? U.S. Department of Health & Human Services. https://www.samhsa.gov