Missouri’s unique status of being the only state in the union without a prescription drug monitoring program [PDMP] to track addictive opiate medication is again being challenged this year.
But establishing a statewide PDMP could remain an elusive goal for health advocacy groups and law enforcement and government officials. State legislation creating a PDMP and a bill that allows more use of an emergency medication for heroin overdoses are poised in the Missouri General Assembly this legislative session.
Whether any of that legislation becomes a reality remains unclear at presstime.
Authorities say the use of opiate-based painkillers such as OxyContin and Vicodin can become addictive and lead to users turning to heroin, which is stronger and cheaper. A PDMP is viewed as a means to track “doctor shoppers” who obtain prescriptions to abuse and sell the drugs.
“I’m 100 percent in favor of a prescription monitoring program, it’s an absolute necessity,” said St. Charles County Prosecuting Attorney Tim Lohmar.
There have been moves in that direction recently – notably St. Louis County agreeing to develop its own PDMP because of the lack of legislative progress in the last few years. St. Charles County officials say they are examining what St. Louis County has done.
The bills in the General Assembly are mired in a standoff and some legislators say that will mean that a PDMP may be again squashed. “I think that’s a huge mistake,” Lohmar said.
This year, State Sen. Robert Schaaf [R-District 34] is sponsoring bill creating a drug monitoring program – a change from his position in the past of opposing any PDMP program. Schaaf’s bill would warn physicians and pharmacists that a patient had received a medication – a red flag would come up, he said.
Schaaf’s PDMP would not allow access to more specific records. It would use an existing database developed by the State Data Center through the Missouri Office of Administration. The act would require voter approval and expire on Aug. 28, 2021.
A physician, Schaaf has opposed a state PDMP for years, including leading an eight-hour filibuster that killed legislation last year.
The bill he and a small group of senators killed last year and in 2014 was sponsored by state Rep. Holly Rehder [R-District 148]. Rehder’s bill would require the Missouri Department of Health and Senior Services to start a database to track opiate prescriptions. Her bill was approved by a 91-68 vote in February, but requires a vote in the Senate, where it has stalled in the past and may stall again this year.
Schaaf said in an interview that he’s willing to compromise with his bill or have Rehder’s bill put to a vote. But he said he’s unwilling to “compromise the liberty of his constituents.”
“The Senate has already shown that they will not tolerate Holly’s bill, they might tolerate my bill,” Schaaf said in an interview earlier this month. “But the House has already shown they won’t tolerate my bill. I think we’re at a stalemate.
“And I can tell you that myself and several other senators are not going to tolerate Holly’s version, it just puts the people at risk.”
The risk is privacy of medical records. Rehder’s bill would allow a wider number of people and agencies access to medical records, Schaaf said. He said databases in five states have been hacked.
“If grandma has her OxyContin on the database, it’s not a stretch to imagine that grandma’s house will be broken into if somebody can see that,” he said.
PDMPs are ineffective, he said, because people illegally using drugs don’t get them from doctor shoppers, they get it from those who go to the doctor once a month sell the pills.
“I think there is a small subset of people who abuse the system,” Schaaf said. “I just have to be frank with you, it’s just wrong for my mother who is 100 years old to have her drugs on a government database because of some criminals.”
Schaaf also questions whether PDMPs reduce opiate abuse and are constitutional.
“I don’t know if they have ever been tested in the courts,” he said. He said it would be great to have a vote on a PDMP because it may be turned down by state voters.
Meanwhile, Rehder said earlier this month that she was optimistic about a bill being enacted because of a change in House leadership. When looking at other states – California formalized its PDMP in 1939 – there have not been privacy issues, she said.
Rehder’s district is in the southeast corner of the state near Kentucky, Tennessee, Arkansas and Illinois.
“What my pharmacists are seeing is that a good number of folks from other states are coming into our area to go to the doctor and get their prescriptions filled in Missouri because we don’t have a program,” Rehder said. “My bill allows physicians and pharmacists to see the information, it’s under HIPPA law, so they can’t just go on a fishing expedition and look at everybody.”
HIPAA or the Health Insurance Portability and Accountability Act of 1996 protects the privacy of health records.
Howard Weissman, executive director for the National Council on Alcoholism & Drug Abuse – St. Louis [NCADA], called the privacy issue a “red herring” and not a major concern in 49 states, Puerto Rico and Guam.
“It’s hard to believe that Missouri is the only state that has it right,” Weissman said. “That just strains credulity.”