Surrounding states push for Missouri to create prescription drug monitoring program
JEFFERSON CITY, Mo. — Neighboring states are pushing for Missouri to create a prescription drug monitoring program, claiming their unwillingness to do so is contributing to the opioid crisis in their states.
Missouri is the only state in the country that does not have a database with prescription information accessible to prescribers and pharmacists
The U.S. Centers for Disease Control and Prevention reported that prescription databases are some of the most promising state-level programs to reduce opioid overdose and abuse. Florida, Tennessee, New York and Oregon have all seen significant reductions in opioid overdose since creating a prescription drug monitoring program, according to the CDC.
For years, those on both sides have participated in debates regarding the issue. Opponents, led by Republican state Sen. Rob Schaaf, say drug monitoring programs are a violation of privacy and advocates say they reduce the likelihood of prescription abuse.
Dr. Bob Twillman, who sits on Kansas’ drug monitoring program board, has come to Missouri every year for six years to urge the state to pass a bill adopting a program, but he said he doubts this year will be any different.
The Kansas board found that 60 percent of “doctor shoppers” — those who fill five different prescriptions at five different pharmacies in 90 days — live in a county that borders Missouri or was just one county over, Twillman said in a recent interview.
“We don’t even know what prescriptions they are filling on the Missouri side,” Twillman said.
Denise Robertson, Arkansas’ prescription drug monitoring program administrator, said they are discouraged every year by Missouri’s failure to pass laws on the issue.
“We have a whole border up there where we don’t know what is going on. A lot of our border counties, they are always having problems with that,” she said.
In 2015, the per capita rate of dispensed Oxycodone was approximately twice as high in several Arkansas counties along the Missouri border, according to state data.
Jason Grellner, a past president of the Missouri Narcotics Association, testified Thursday during a hearing in Jefferson City, Missouri, that he recently attended a narcotics enforcement conference in Washington where the need for a drug monitoring program in Missouri came up.
“There were over 200 narcotics officers in D.C. … in discussions with our neighbors from Tennessee, Kentucky, Iowa, Illinois and Kansas, they are very upset with us that (their residents are) coming to Missouri, doctor shopping and pharmacy hopping, and then bringing those narcotics back to their states and causing problems in their states,” Grellner said.
Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said he was one of the people Grellner talked to at the conference.
“Missouri doesn’t have a wall around it,” Ingram said. “People come in and out every day. It may not be impacting your overdose situation but it may be impacting your neighbor’s, though.”
Opponents note that despite not having a state-wide prescription monitoring program, Missouri doesn’t have the most opioid deaths per capita.
According to the Henry J. Kaiser Foundation, Missouri’s opioid death rate in recent years has been 12 per 100,000 residents. While higher than the national average of 9 per 100,000, it is still below that of 15 other states.
Schaaf’s latest proposal involves doctors submitting data for certain prescription drugs to Missouri’s Bureau of Narcotics and Dangerous Drugs, which would then use an algorithm to issue warnings if any concern has been detected. Under the bill, physicians would only be allowed to look at prescription data if they get an alert that a patient may be abusing opioids.
Schaaf’s bill will be discussed by the full Senate next month.
Another bill, sponsored by Republican state Sen. Dave Schatz, would let physicians and pharmacists see what other prescriptions a patient is taking for what drugs and when it was written and filled.
He acknowledged, “Missouri has become a playground for these kind of medications.”
Schatz said he has been trying to pass his bills for years and believes this might be the year to get it done. Where there used to be no room for compromise, opponents are more willing to have conversations now, he said.
“I can understand their frustration,” Schatz added, when asked about Missouri’s neighbors. “But you have to remember how the Legislature works … it’s not as easy as snapping your fingers and getting it done.”
There are no data breaches that have compromised personal medical information with state programs, the oldest of which dates to 1939, according to Pat Knue, director of the Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University in Illinois.
Drug monitoring programs in states surrounding Missouri share data with each other, so that physicians who have access to their programs can see if their patients have, for example, recently filled a similar prescription in another state.
Kentucky’s prescription drug monitoring program has been online since 1999 and has been invaluable in the state’s understanding of their communities’ experiences, according to its program manager, Dave Hopkins.
Illinois officials did not respond to requests for comment. Nebraska officials said they couldn’t provide any specific information.
Andrew Funk, executive director of the Iowa Board of Pharmacy, said via email: “I have had calls from some prescribers, pharmacists, and law enforcement bemoaning the fact that Missouri has not yet implemented a PMP (prescription monitoring program).”
Dr. Sam Page, a physician-anesthesiologist who specializes in pain management, has been working for about a year to put a prescription drug monitoring program in place at the county level, even though there is no statewide program.
Although the program will be a good starting point, eventually getting all of Missouri’s 114 counties to sign on and pass legislation at a local level can be onerous, Page said.
“The best solution is a statewide solution,” Page said. “We will have this running until we hand it over to the state.”
Thomas writes for the Joplin, Missouri Globe.