Drug Monitoring in Missouri: It Takes Two

Last year in the St. Louis area alone, more than 700 lives were lost to fatal opioid overdoses. This is a breathtaking number. We lost 712 fathers, sons, mothers, daughters, sisters and friends, and as the death toll climbed, the Missouri legislature again failed to pass a statewide Prescription Drug Monitoring Program (PDMP).

A PDMP is a proven asset. It enables doctors and pharmacists to see what drugs a patient is currently being prescribed. This helps prevent “doctor shopping,” or obtaining multiple prescriptions for a drug from multiple doctors. A PDMP also improves health outcomes, especially among elderly patients who are seeing several different specialists for different conditions, because it enables their doctors to see all the medications they’re taking and gives them a tool to prevent adverse drug interactions. For these reasons it’s important that doctors and pharmacists have access to the prescription drug monitoring database. We are all quite accustomed to sharing this kind of information with our doctor or pharmacist.

A PDMP is an effective way of reducing drug diversion and the harms of drug dependence. Every other state (even Puerto Rico and Guam!) has one. But—largely due to the misguided efforts of Rob Schaaf, a senator from St. Joseph, Missouri, who believes that a PDMP violates our right to personal privacy—Missouri stands alone on the wrong side of history.

Thankfully, last February, something innovative happened: St. Louis County stepped in and created the nation’s only local PDMP. The only upside of Missouri’s being last to adopt a drug monitoring program, is that St. Louis County had 49 other PDMPs to examine so, with consultation from the Brandeis University’s Center for Excellence, they were able to develop a state-of-the-art program, built on best practices, and capable of being scaled up. This ingenious workaround would make it possible to bring this database, county-by-county, to the entire state.

Almost immediately, St. Charles County joined, then St. Louis City. Others followed, and one by one, counties signed up for the program, and as of today, 58% of Missouri citizens are protected and 74% of providers are joined to this database. The system isn’t perfect because it isn’t statewide, but it’s a start, and it grows larger and more complete every week.

On July 17, Governor Greitens signed an executive order. And though he refers to his executive order as a statewide PDMP, that’s a bit misleading. It is, in fact, a brilliant and unique adjunct to the local program that began in St. Louis County.

The Greitens’ plan has received a some criticism from the Missouri Foundation for Health, the Missouri State Medical Association and U.S. Sen. Claire McCaskill. This is understandable because, on its own, the Governor’s plan is insufficient. Doctors and pharmacists are denied access to the data; and while this might please those in the state legislature who worry about PDMPs posing a risk to personal privacy, the lack of patient data is an enormous deficiency.

On its own, the Governor’s plan will do nothing to help patients avoid dangerous drug interactions, it will do nothing to improve health outcomes, and it will do nothing to stop addicts and dealers from “doctor shopping” for opioids or other addictive drugs.

But the Governor’s executive order was clearly not intended to create a stand-alone PDMP. We believe it was intentionally designed to complement the program that began in St. Louis County.

Together, the Governor’s and St. Louis County’s PDMP give Missourians all the protection they require and take Missouri from last aboard to first in class.

But only if they are used together.

We urge all counties to join the Prescription Drug Monitoring Program that began in St. Louis County. Do not settle for only the Governor’s necessary-but-insufficient plan. Give your people the benefit of both because, together, they set a new standard for what works.

Now, if we commit to additional measures like making treatment more available and more affordable, and expanding universal, school-based substance-use prevention for all kids in all schools in all grades, we can rein in this epidemic and prevent the next one from arising.

Howard Weissman is the Executive Director of NCADA.

Categories: Commentary

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