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Heroin antidote, drug registry get some support, but legislative passage remains elusive in Missouri

A kit containing the opioid overdose antidote naloxone.
File Photo | Camille Phillips | St. Louis Public Radio

Legislation that would expand access to Narcan, a medicine that can reverse the effects of an opioid overdose, is being weighed by a Missouri Senate committee. The bill's sponsor, Rep. Steven Lynch, R-Pulaski County, says this is just one aspect of statewide drug policy reform.

“Narcan is not a solution for this epidemic, it is a rescue remedy to keep people alive until we can figure out how to deal with the complex problem of drug addition, use, and treatment,” said Lynch.

Under current law, Narcan can only be administered by those who have a certain level of certification. This bill (HB 1568) would allow over-the-counter prescriptions so anyone could obtain and administer the drug “in good faith.”

The committee’s public hearing occurred just a day after a report was released by St. Louis County’s Department of Public Health that detailed the severity of heroin use in the area (see previous coverage from St. Louis Public Radio’s Camille Philips).

Not Just a Heroin Problem

Although the rates of heroin use are troubling, prescription drug use in the state is also sounding an alarm. An advocacy group from St. Louis met with state legislators Tuesday to lobby for comprehensive drug policy reform. They agree with Lynch that Narcan accessibility isn’t the end-goal.

Chad Sabora, co-founder and director of Missouri Network for Opiate Reform and Recovery, says the Narcan legislation is a step in the right direction, but he refuses to call the current crisis a “heroin epidemic.”

“Epidemics only last for a couple of weeks,” says Sabora. “This has been going on for years. We have a serious opiate problem we have to deal with.”

Prescription opioids like Vicodin and codeine are wreaking havoc in unexpected demographics, like the elderly and injured athletes.

“Most people overdose on prescription drugs, so a lot of times (Narcan) is used in the home with prescription drugs, not illegal drugs,” said Brent Hemphill, who represents the Missouri Ambulance Association. “… These are mainstream athletes that suddenly have a pain-med for a sprained ankle, and they like that fix. They’re just too young to make good decisions.”

The bill was not voted on in committee on Thursday. It did pass the House with only two “no” votes earlier this month.

Comprehensive drug policy reform

Sen. Maria Chappelle-Nadal, D-University City, says she’s in full support of the bill, but doesn’t think it addresses the root of the issue.

"We are a drugged-up society," she said.  

Chappelle-Nadal suggests we need to figure out how to change our culture. Missouri is lagging behind.

“We are the only state without a prescription drug monitoring program,” said Rep. Holly Rehder, R-Sikeston.

She’s sponsoring a bill (HB1892) that would create a statewide prescription drug monitoring program through the Department of Health and Senior Services. It would allow physicians and distributing pharmacists to track a patient’s prescription history for schedule II-IV controlled substances.

Rep. Holly Rehder, R-Sikeston
Credit Marshall Griffin | St. Louis Public Radio | file photo
Rep. Holly Rehder, R-Sikeston

U.S. Sen. Claire McCaskill strongly supports Rehder’s bill. Earlier this year, McCaskill traveled to Jefferson City to urge legislators to do something about the state’s indecision.

“… My Missouri common sense tells me maybe we’re the problem, not the other way around,” said McCaskill.

She says heroin use and prescription abuse aren’t mutually exclusive.

“Studies show that four out of five people who abused prescription opioids eventually transition to heroin, as pills become too difficult or expensive to obtain,” said McCaskill. “Today’s prescription opioid abuser could easily become tomorrow’s heroin user.”

This is why supporters believe a prescription drug monitoring program is necessary. But the bill is not getting the warm reception that supporters wanted. Rehder says she’s taking a step back to address concerns from her fellow legislators.

“You know, some of the issues that have been brought up [are about] privacy concerns — that’s a red herring because no other state has had issues,” said Rehder. “There has not been a mass exodus of these programs because of privacy concerns.”

But Rehder is hopeful her bill will be voted on soon in the House.

“This is a lifesaving tool that, this year, fear-mongering just kind of took over,” she said.

Privacy Rights and Patient Care

Sabora isn’t quite as confident. He says privacy rights have always been “a sore subject” with the Missouri legislature.

Sen. Rob Schaaf, R-St. Joseph
Credit Marshall Griffin | St. Louis Public Radio
Sen. Rob Schaaf

Sen. Rob Schaaf, R-Buchanan County, has a bill (SB 768) that proposes a different kind of drug monitoring program. In past years, Schaaf, a physician, has opposed any kind of program like this.

Before the 2016 General Assembly began, Schaaf explained his legislation to St. Louis Public Radio’s Marshall Griffin.

"Health-care professionals could log on, and if this person had seen multiple physicians or had already received the medication that the doctor was dispensing, a flag would come up," Schaaf said. "That way, they could get the knowledge that this person might be doctor shopping, but the (person's medical) information itself would be protected.”

In contrast, Rehder’s bill would allow physicians and dispensing pharmacists to view a patient's past prescriptions in a database set up by a third-party vendor. She says two main companies provide these services to most states.

Schaaf’s legislation would use an existing database developed by the State Data Center through the Office of Administration. Only officials in the state narcotics bureau could view the histories of patient prescriptions.

Schaaf’s bill hasn’t yet been scheduled for a public hearing, but has been referred to the Senate’s committee on transportation, infrastructure, and public safety.

A national issue

“States around us are begging us to implement this,” said Rehder.

She says pharmacists in her district (which is easily accessible from Illinois, Kentucky and Arkansas) have seen “truckloads” of folks looking for a place to get more prescription drugs. Missouri’s lack of a monitoring program is complicating the effectiveness of programs in neighboring states, she said.

The Center for Disease Control describes prescription drug monitoring programs as "among the most promising state-level interventions to improve painkiller prescribing, inform clinical practice, and protect patients at risk."

Sabora says counties will start creating their own programs (something St. Louis County is talking about) if a statewide database isn’t agreed upon, which will end up being most costly. His focus is not just on local policy, however. Sabora says federal policies are also inhibiting drug treatment and recovery.

“We’re stuck under a federal (Institutions for Mental Disease) rule that if you accept Medicaid, your treatment centers can only have 16 beds,” said Sabora. “I have 15,000 people in Missouri that need drug and alcohol treatment. I have 437 beds, roughly. That’s just the same in every state in the country.”

Many legislators have discussed the need for additional mental health funding in Missouri.

Sen. Maria Chappelle-Nadal
Credit Missouri Senate
Sen. Maria Chappelle-Nadal

“Since I’ve been in state government, that department has been underfunded,” said Chappelle-Nadal. “… I’m glad that the governor finally woke up and realized that people need mental health care and more services, but this has (taken) a long time.”

In a press conference earlier this month, Sen. Kurt Schaefer, R-Columbia, voiced his frustration with the governor’s attitude toward mental health funding as well.

“In this year’s budget for 2016, we put $70 million in there to increase programs for mental health,” said Schaefer. “The governor withheld that, and [wouldn’t] release it … for six months out of the year. January to July. Then, (for the) next year, he turns around puts the exact same thing we did this year in the budget, and demands that we fund it. That’s a gimmick.”

Schaefer was responding to a question from the media about Gov. Jay Nixon opposing potential cuts to Medicaid spending to secure funds for fixing Missouri’s transportation sector.

Sabora, who works with recovering addicts, seems tired of all the politics. His work puts a face to the statistics and reports brought to legislators.

“This is a brain disease,” said Sabora. “It effects everybody … I’m a lawyer and in recovery from heroin addiction … It doesn’t care who you are, just like cancer or diabetes. It doesn’t care. If you suffer from this disease, unless you get it treated, you’re not going to make it.”

Mallory Daily is an intern at the State Capitol Bureau for St. Louis Public Radio. Follow on Twitter: @malreports