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Prescription drug monitoring program one step closer to law, but obstacles still remain

A capsule of pills.
FDA | file photo

Prescriptions for opioids like hydrocodone and Vicodin that have been dispensed have quadrupled since 1999. Because these drugs are highly addictive, 49 states have implemented a drug monitoring program to ensure doctors don’t over-prescribe their patients. 

Just one state lags behind: Missouri.

Rep. Holly Rehder, R-Sikeston, is attempting to change that. She’s sponsoring a bill (HB 1892) that would establish a statewide prescription drug monitoring program similar to others used around the country.

Doctors would be able to access a third-party database of patient prescription history when prescribing opioid drugs, and they’d receive alerts when patients have been prescribed narcotics from multiple providers. That system aids doctors in identifying addicts and recommending appropriate treatments.

Such programs have proved successful in other states. The National Press Foundation reports that after New York implemented a prescription drug monitoring program, the number of patients who received opioid prescriptions from multiple doctors dropped by 75 percent in that state. (Patients who see multiple doctors for prescriptions are more likely to overdose.)

“This is a tool for your physician, for your pharmacist to start catching addiction from the front end, curtailing it, giving people the access to the program that they need to help pull them off of this opioid addition,” said Rehder.

Rehder’s prescription drug monitoring program bill received a public hearing on Wednesday morning. It garnered support from organizations throughout the state, including: 

  • Missouri Nurses Association
  • St. Louis Area Business Health Coalition
  • Missouri Coalition for Community Behavioral Healthcare
  • American Insurance Association
  • Missouri Academy of Family Physicians
  • Missouri Association of Osteopathic Physicians and Surgeons 
  • Missouri State Medical Association
  • Missouri Hospital Association
  • Missouri Pharmacy Association
  • Mallinckrodt Pharmaceuticals (an opioid producer)
  • Missouri Society of Anesthesiologists 
  • Missouri Ambulatory Surgery Center Association
  • Missouri State Troopers Association

Greene County’s Keep the Republic and Missouri First were the only groups to oppose the legislation. Representatives of the two organizations cited government surveillance as major concerns. 
Impending Obstacles

Rehder is determined to get this bill on Gov. Jay Nixon’s desk before session ends.

“I think it’s shameful that we’ve not passed this yet,” Rehder said in a February interview. “It’s a lifesaving tool that’s showing success in all the other states.”

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

The bill has already passed out of the House, and is waiting on a Senate committee vote. If it gets to the Senate floor for debate, it will be greeted by Sen. Rob Schaaf, R-St. Joseph, who has threatened to filibuster the measure.

For years, Schaaf has strongly opposed a prescription drug monitoring program in Missouri. He says it would be an infringement of privacy. 

“It is wrong to take away the liberty of every law-abiding citizen to stop a very few from breaking the law, especially when they are putting their own lives at risk by doing so,” said Schaaf. “The people who overdose must take some responsibility for their actions.”

He’s proposing his own prescription drug monitoring bill (SB 768) that counters Rehder’s, which also received a public hearing on Wednesday.

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

Schaaf’s bill would deny doctors access to the patient prescription database. It would instead require the hiring of additional government employees in the Department of Health and Senior Services to sift through the data.

When entering a new prescription for a patient, doctors would be alerted if that patient’s prescription history posed concerns, but the doctor wouldn’t be able to see the specifics of the timing or type of drugs previously prescribed.

Dr. Stephen Keithahn, a representative of the Missouri Chapter of the American College of Physicians, says Schaaf’s plan to have state employees identify addicts would not be effective.

“I think this is a horrible idea,” said Keithahn. “… It’s like closing the barn door after the cows have left.”

If passed through both chambers, Schaaf’s measure would be put up to a vote by the people of Missouri. He says he's confident that Missourians won't pass the bill, and has offered to support Rehder's legislation if she adds a ballot clause.

“What we are talking about here is the issue of liberty,” said Schaaf.

If Rehder doesn't add language to the bill that will let voters ultimately decide, Schaaf says it will be dead upon arrival at the Senate floor.

But Rehder says she’s not willing to make any changes. 

“He uses [the ballot clause] as a stall tactic,” said Rehder. “He does not want this to get through. We have experienced deaths this week. We’ve experienced overdoses this week. We have experienced addiction being fed this week. We do not need to wait until the end of this year to vote on this. We need this program as soon as possible.” 

Cindy O’Neil voiced similar opinions during the public hearing. Her husband committed suicide after being prescribed a dangerous combination of medication from multiple doctors. 

“Had he lived anywhere else, there’s a chance my husband would still be here with us today,” said O’Neil. "It was doctors not being able to see what other doctors were prescribing … It needs to stop. There’s no privacy [to protect] if a person is dead.”

The Senate committee has not scheduled a vote for either bill at this time. 

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