St. Louis County Issues Public Health Alert After Nearly 200 Nonfatal Overdoses in North County

The St. Louis County Department of Public Health issued a public health alert this week after recording nearly 200 suspected nonfatal overdoses from late August through September 2026. Emergency department visits for suspected overdose ran above expected levels during three separate weeks, and the cases were not spread evenly across the county: they clustered in a single north-county ZIP code.

This is an alert about people who survived. That is the point. A rise in nonfatal overdoses is one of the earliest signals a health department gets that the local drug supply has changed, that use has intensified, or that people are being cut off from care — and it is a signal that arrives weeks or months before death records are finalized.

What the county reported

The numbers, as released by the county health department:

• 54 suspected overdose-related emergency department visits during the week of August 23, and 47 the following week.
• Approximately 200 suspected nonfatal overdoses in total from late August through September.
• Overdose-related emergency visits above expected levels in three separate weeks.

Most cases involved men between the ages of 34 and 44, and most patients were Black. Cases were concentrated in the 63136 ZIP code, which includes Jennings and Castle Point in north St. Louis County.

Officials said the overdoses involved all drug types — over-the-counter, prescription, and illicit. Opioids were the primary concern, and several reports specifically mentioned fentanyl. Benzodiazepines and marijuana were also identified in the county's data.

"Whenever we see non-fatal overdoses, that could be a proxy to someone actually experiencing a fatal overdose," said Kanika Cunningham, MD, director of the St. Louis County Department of Public Health. Nonfatal overdoses, she said, are "the opportunities that we can still intervene and save a life."

Why nonfatal overdoses are taken seriously

A person who survives an overdose is at substantially higher risk of experiencing another one. An emergency visit is also one of the few moments when someone who uses drugs is in front of a clinician — a window to offer naloxone, a referral, and treatment before the person is discharged. When that connection is not made, the window closes.

Two clinical details matter for anyone in a household where opioids may be present:

Naloxone does not last as long as the opioid. A person can wake up after naloxone and then slide back into overdose as the medication wears off while the opioid is still active. This is why staying with the person until emergency help arrives is not optional. Call 911, give naloxone, and stay.

Mixing opioids with benzodiazepines raises the danger sharply. Benzodiazepines such as alprazolam (Xanax) and opioids both slow breathing. Naloxone reverses only the opioid, not the benzodiazepine — so even after someone wakes up, emergency care is still needed. The county's data specifically identified benzodiazepines alongside opioids in this cluster.

Fentanyl also complicates the picture for people who do not think of themselves as opioid users. It is potent in amounts too small to see, and it turns up in counterfeit pills and powders that are sold as something else. The prevention organization PreventEd, based in St. Louis, put the practical version of this plainly: "It can happen to anyone, and it can happen anywhere."

What to do if you see an overdose

Know the warning signs, and treat them as an emergency:

• Slow, shallow, or stopped breathing
• Snoring or gurgling sounds
• Pinpoint (very small) pupils
• Cold and clammy skin
• Extreme drowsiness or difficulty waking the person
• Unresponsiveness

If you see these signs: call 911, give naloxone if you have it, and stay with the person until help arrives. If the person is not breathing, dispatchers can talk you through rescue breathing.

Missouri's Good Samaritan law for overdose emergencies protects people who seek medical help for an overdose from prosecution for certain drug possession offenses. Fear of police involvement should not delay a 911 call — the minutes that decision costs are the minutes that matter most.

Families who have a loved one using drugs can keep naloxone at home and tell others in the household where it is stored. Knowing the location in advance is the difference between a fast response and a search.

Where to get help and naloxone in St. Louis County

Naloxone — often sold under the brand name Narcan — reverses opioid overdoses and has been available over the counter since 2023. In St. Louis County, it is also available at no cost:

• County naloxone vending machines
• County libraries
• By mail, on request
• Walk-in at health department locations, with no appointment or ID required

Questions about the county's overdose program can be sent to OD2ALOCAL@stlouiscountymo.gov.

For treatment, the federal SAMHSA National Helpline at 1-800-662-4357 offers free, confidential referrals around the clock. People in crisis can call or text 988.

Families whose loved one has recently been treated for an overdose can ask the care team directly about medications for opioid use disorder — buprenorphine or methadone. These medications lower the risk of future overdose, and buprenorphine can often be started in the emergency department itself. Asking is reasonable, and it is the question most likely to change what happens next.

PreventEd's Jenny Armbruster noted that simply talking about overdose at home reduces the stigma around it. "Talking about overdose," she said, "really reduces the stigma and helps us be prepared for when we might witness or see someone who is experiencing an overdose."

The bigger picture

This local cluster fits a national picture that health agencies have been tracking closely. The CDC's Nonfatal Drug Overdose Surveillance and Epidemiology (DOSE-SYS) system, which collects emergency department data from 47 states and the District of Columbia, uses exactly this kind of signal — survived overdoses reported in near real time — to spot changes before death records catch up. Syndromic surveillance like this is fast by design; mortality data can take months to finalize.

Earlier this month, that national picture also included a formal CDC health advisory on cychlorphine, an emerging synthetic opioid that fentanyl test strips often fail to detect, and an increase in medetomidine-driven withdrawal. St. Louis County's current alert does not name a single adulterant as the cause, and that is itself important: the alert describes a broad rise across drug types, not one contaminated batch. Local health departments issue these notices when the pattern — not any one substance — warrants attention.

Cunningham framed the county's aim as practical rather than alarmist. Drugs are present in the community, she said, and the goal is to make sure people have access to the tools that keep them alive.

Our takeaway for families and neighbors is equally practical: know the signs, know where your naloxone is, call 911 without hesitation, and treat a survived overdose as a reason to ask about treatment — not as a close call that is now over.