Mississippi Expands Substance Use Disorder Treatment to All 82 Counties Using Epic EHR

Mississippi has quietly become a laboratory for reimagining how states can deliver substance use disorder care. The Mississippi State Department of Health (MSDH) announced this month that it has expanded access to SUD treatment across all 82 counties, using electronic health records and telehealth to identify at-risk patients earlier and bring services closer to home in one of America's most medically underserved states.

The program represents a significant departure from traditional models. Rather than relying solely on specialized addiction treatment centers, Mississippi has embedded SUD screening and intervention into routine primary care visits at its network of public health clinics. Patients now complete standardized screenings through Epic's MyChart portal before appointments or on tablets upon arrival, regardless of the reason for their visit.

"This work reflects a simple principle: Substance use disorder care should be available earlier, closer to home, and as part of normal health care, not only after a person reaches crisis," said Dr. Dan Edney, MSDH Executive Director and State Health Officer.

The Scale of the Challenge

The need in Mississippi is acute and multifaceted. In 2023, nearly half of Mississippi households were either in poverty or earned less than the cost of basic needs. Overdose deaths rose more than a third from 2020 to 2021, including a 51% spike in deaths involving synthetic opioids like fentanyl. Transportation barriers compound these challenges—residents of the Delta region travel an average of 75 miles just to reach primary care.

The healthcare workforce shortage mirrors these geographic barriers. Eighty of Mississippi's 82 counties have whole or partial primary care shortage areas. Seventy-eight counties are designated mental health professional shortage areas. For a state where 327,000 residents aged 12 and older needed but did not receive substance use treatment according to SAMHSA estimates, the gap between need and capacity has been devastating.

"It takes an average of five years before someone's dependence on a substance causes enough problems to make them seek specialty care, even though many of these patients are open to discussing it much sooner," said Jonathan Hubanks, Director of the Center for Injury Prevention and Control at MSDH. "This earlier window is where we have the best opportunity to intervene and improve outcomes."

Technology as Force Multiplier

MSDH is one of the very few state health departments in the country to provide direct, clinic-based substance use disorder treatment. With just four doctors and 18 advanced practice providers serving the entire state, the department knew traditional approaches would fall short.

"We wanted to build something that feels simple for patients and staff, but is powered by sophisticated technology underneath," said Julio Cespedes, Chief Innovation Officer at MSDH.

The Epic EHR integration enables clinicians to meet patients wherever they are on the risk spectrum. Patients with low-risk screening results receive positive reinforcement. As risk scores increase, the system nudges clinicians with standardized intervention guidance, ensuring evidence-based responses without requiring specialized addiction expertise at every encounter.

"With just four doctors and 18 advanced practice providers serving a statewide population with significant need, we knew we had to approach this challenge creatively," said Christina Graham, Director of Epic at MSDH. "Now, across all 84 MSDH clinics, all patients—no matter the reason for their visit—complete an annual screening."

Telehealth Bridges the Distance

For patients screening at high risk, the program offers follow-up care from addiction specialists through video visits. This removes the barrier of travel to providers who might otherwise be hours away, particularly critical in a state where distance and transportation poverty have historically blocked access to specialty care.

The telehealth component also addresses workforce limitations. Rather than attempting to recruit addiction specialists to every rural community—an approach that has failed repeatedly in Mississippi and similar states—the program concentrates expertise centrally while distributing access geographically through technology.

Following a six-county pilot phase, the program now operates statewide. It serves patients in high-volume urban clinics and smaller rural facilities alike, creating a unified system of care that adapts to local contexts while maintaining consistent standards.

Looking Ahead: Care in the Home

As the program matures and more patients engage successfully with treatment, MSDH is exploring how to safely extend care into patients' homes. This evolution would create a model even more accessible and responsive to daily life, potentially including home-based medication management and virtual support groups.

"This is a powerful example of how technology can extend a care team's reach and increase access to care," said Trevor Berceau, Director of R&D at Epic. "By meeting patients on their own terms, MSDH is connecting them to the care they need."

A Model for Rural America

Mississippi's approach offers lessons for other states grappling with similar challenges. The integration of SUD screening into routine primary care—regardless of visit reason—catches patients who might never seek specialized treatment. The use of standardized EHR protocols ensures consistency across a widely dispersed provider network. And the combination of in-person and telehealth services balances accessibility with clinical expertise.

For states where treatment access remains limited by geography and workforce shortages, Mississippi's model suggests that technology-enabled care delivery can extend the reach of limited specialist resources without requiring massive new investments in physical infrastructure.

The program also demonstrates the potential of state health departments as direct care providers. While most state health agencies focus on population-level interventions and regulatory oversight, MSDH's clinic-based approach shows how public health infrastructure can fill gaps left by market-based healthcare delivery—particularly in underserved regions where specialty care is scarce.

As overdose deaths continue to claim lives across rural America, Mississippi's experiment in technology-enabled, statewide SUD treatment offers a potential path forward. Whether other states can replicate this model depends on their existing health IT infrastructure, workforce capacity, and political will to invest in public health-led care delivery. But the early results suggest that with the right combination of technology and clinical leadership, even the most resource-constrained states can expand access to life-saving treatment.