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Counties continue work to implement drug monitoring program after state version fails

The Missouri General Assembly’s failure again to enact a statewide prescription drug monitoring program [PDMP] during its legislative session that ended earlier this month has cities and counties moving ahead with their own PDMP.

For now, St. Charles County officials say they are shooting for July 1 to have enough pharmacies and healthcare providers and data for its portion of the PDMP to become completely operational. St. Charles County is among other municipalities and counties around the state that have joined St. Louis County’s PDMP, which is managed by Appriss, Inc., and is already being used.

A PDMP is a database where healthcare providers and pharmacies record prescriptions, allowing the tracking of patients who may be “doctor-shopping” for duplicate prescriptions for addictive opiate-based drugs.

Missouri is the only state in the nation that doesn’t have a statewide PDMP. For years, efforts to pass a PDMP have been stymied, particularly in the Missouri Senate, because of concerns about maintaining privacy of medical records.

Hope Woodson, the county’s health department director, said counties and cities are recruiting and encouraging pharmacies, physicians and other healthcare providers to sign up to participate in the PDMP.

“[The PDMP] is only as good as the amount of data that’s in the system,” Woodson said.

Woodson said if there isn’t enough base data, PDMP operations may be postponed.

“But right now we feel pretty confident we’ll have it,” she said.

Like other PDMP participants, St. Charles County is a guest. Appriss, which has worked with other states on their PDMPs, runs the system, with other cities and counties contracting with St. Louis County.

Since St. Louis County adopted an ordinance creating the PDMP in March 2016, St. Charles County has joined, as have the counties of Jackson, Ste. Genevieve, Cole, Lincoln and Stoddard, plus the cities of St. Louis, Kansas City, Jefferson City, Columbia and Independence.

St. Charles County hired a PDMP coordinator, who is meeting with pharmacies throughout the county to encourage them to sign up. The county has about 800 potential registered pharmacies and healthcare providers, Woodson said, with close to half signed up to participate in the PDMP. She added that pharmacies are required to register, but physicians are not.

The main goal of the program “isn’t necessarily to bust an individual for doctor-shopping,” she said. There is an educational purpose for collecting the data. Goals include identifying over-prescription trends and groups who are using the drugs.

Physicians can see if other physicians in the county are prescribing the same drugs to individual patients, and pharmacies can see if an individual is picking up drugs from multiple sources.

“If we have a high volume going out to a teenage population, then we need to educate our physicians and our parents more in dealing with those opiate drugs,” Woodson said.

The information helps in developing a public health response. Currently, the only data available are, first, the amount of Narcan [a drug used to revive overdose victims], and second, the number of opiate users who die in hospital emergency rooms, Woodson said.

If a statewide PDMP is finally enacted, users of the St. Louis County PDMP will face the question of whether they want to, or must, participate.

“I think we would only fold into the [state] system if we felt it was equally good or better,” Woodson said. “I think if it was something lesser we probably would maintain our own system, unless for some reason we were not allowed to do so.”

Whether the state eventually enacts a PDMP remains an open question. St. Charles County Executive Steve Ehlmann said there has been some discussion that Missouri Gov. Eric Greitens will include a statewide PDMP if he calls a special legislative session.

“Who knows,” Ehlmann said last week.

Ehlmann said a localized PDMP is “still viable, but it’s still the second best thing,” as doctor-shoppers can go to outlying counties to obtain prescriptions, which can be brought back and sold in the county. The more counties, the better, but it’s not going to be as effective as going statewide, he said.

“I hope we can get started on this, get as many people as we can, and maybe next year or at a special session, the state will pass one, I don’t know,” he said.

Ehlmann said he’s received no information that the situation with opiate abuse and heroin is getting any better. He remains mystified why legislators have not passed a bill.

He suggested checking with “one of our heroes in Jefferson City” to let them explain why it didn’t get out the session this year. “I can’t believe if democracy was working, this would not be law by now,” he said. “I still don’t quite understand what the problem is.”

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