Missouri legislators have a common message: opioid abuse is a statewide problem.
Since the legislative session began, several bills targeting implementation of a statewide prescription drug-monitoring program (PDMP) been filed with hopes of Missouri joining the 49 other states - and nine Missouri counties, including Cole - that have implemented programs to combat the epidemic.
Legislators agree there is a problem, but are not sure that there is a cure-all solution that can be written into law. So far, three bills have been filed to address the need for and potential impact of the program.
State Rep. Holly Rehder, R-Sikeston, and state Sen. Dave Schatz, R-Sullivan, have PDMP legislation that mirrors one another. House Bill 90 and Senate Bill 314 outline the role of a statewide system that grants access to health care professionals, including pharmacists and dentists, who prescribe narcotics. The system would allow health care professionals to see a patient's prescription history, enabling doctors to flag potential opioid abusers.
Organizations like ACT Missouri and Council for Drug Free Youth support the statewide PDMP model, calling it the only way to combat substance abuse among youth.
"We're the only state in the country that doesn't have a PDMP program," said Melle Richardson, CDFY project coordinator. "Prescription drugs are very accessible to youth, so we need a monitoring program so we know who's getting the drugs. This will be crucial to helping protect our youth against drug abuse."
In a committee hearing this month, Rehder told the audience that when physicians can look at their patients' narcotic history, they can make the best call for the patients.
"Yes, we want to be able to catch the doctor shoppers so that we don't have a plethora of pills out on the street. But more importantly, though, we want the physician to be able to say we have a problem here and start looking at other paths," Rehder said.
Some say this movement is overdue.
Kristi Campbell, director of the Cole County Health Department, recently got approval from the Cole County Commission to subscribe to the St. Louis County Department of Public Health's PDMP, which would allow health care professionals in Columbia, Independence, Jackson County, Kansas City, St. Charles County, Ste. Genevieve County, St. Louis County and St. Louis City to link to the PDMP and help reduce doctor shopping.
As with Rehder and Schatz's legislation, health care professionals in Cole County will be able to see a pharmacy's drug enforcement number and the date the prescription was given.
Other key information the database may hold includes the prescription number, whether the prescription is new or a re-fill, quantity and dosage, along with identifying information such as a driver's license number; Social Security number; insurance cardholder number; and the patient's name, address and date of birth.
Campbell told the News Tribune that the PDMP would be implemented by Apriss, a prescription drug database, who has has implemented PDMPs in 23 other states.
"The PDMP is using the most current version of the national standards for transmission of pharmacy data from The American Society for Automation in Pharmacy and meets all standards required by the Health Insurance Portability and Accountability Act," Campbell said.
State Sen. Rob Schaaf, R-St. Louis, defines his Senate Bill 74 as a way to protect patients' civil liberties while giving physicians the information they need to make informed decisions.
"The other bills allow every citizen's data to be available to every licensed subscriber with just a user name and password," Schaaf said. "This is the lowest level of security offered."
He said there have been PDMP breaches in other states like Florida and Utah using the alternative PDMP system that has been proposed.
Ultimately, Schaaf would like to see a system that limits the information health care professionals can see in real time. He said there are algorithms that support this function. The PDMP system would flag a physician if there is a health concern. He added he has compromised to allow a doctor to see a patient's full prescription history if there is a red flag.
Rehder disagreed with this approach, saying the medical history is how a doctor knows how to treat a person effectively.
"It's unfortunate that the counties across Missouri have to take this effort upon themselves," Rehder said.
"It's a health care epidemic, and I think the responsible thing to do is for the Legislature to do it."