Efforts for Missouri pharmacists and physicians to track prescription drugs through a statewide database received majority support Wednesday from a House committee, passing it along to another scheduled to hear testimony today.
The Narcotics Control Act, sponsored by Rep. Holly Rehder, R-Sikeston, would establish a prescription drug monitoring program (PDMP) in Missouri, permitting the two groups of medical professionals to monitor citizens' medication lists. The legislation is designed to catch "doctor shoppers," those going to multiple physicians' offices for prescriptions of addictive pain killers - such as hydrocodone, oxycodone, morphine, codeine and more.
Missouri is the only state without a PDMP. The District of Columbia and Guam, a U.S. territory, have their own programs.
Rehder and bill supporters, including various state medical-related organizations, say the system could identify patients in the early stages of drug addiction. Many prescription drug abusers turn to heroin, a cheaper opioid, when prescription pills become too costly.
Prescription drug monitoring bills have been filed in Missouri every year since 2011.
"It's very important to address this now and not wait and allow people to die and more lives to be ruined," Rehder told the News Tribune.
If the bill is passed, pharmacists will have seven days after filling a prescription to enter the information into a database controlled by the Department of Health and Senior Services. Physicians will be given access, but they are not mandated to use the program. Rehder said other states started with a seven-day waiting period and later shortened the time frame to 48 or 24 hours. Oklahoma is the only state with real-time monitoring, which Rehder would eventually like to see in Missouri.
The Sikeston lawmaker said her proposal is an extension of Missouri's established PDMP for Medicaid patients.
Physicians who notice doctor shopping or other signs of prescription abuse can confront their patients about early stage addictions and guide them to a path to recovery, Rehder said. Under her plan, pharmacists notify patients' physicians when prescriptions seem suspicious.
"That's what we need to be doing in Missouri, with physicians deciding whether moving patients to an alternative (medication) or helping them get into a treatment facility," she said. "Our physicians know what the outlets are, they know what opportunities patients have here in Missouri. To me, the medical professionals need to get involved and not wait until law enforcement has to get involved."
Turning drug abusers toward treatment rather than incarceration could save the state money, Rehder said, adding about 75 percent of Missouri inmates have some form of drug addiction.
Sen. Rob Schaaf, R-St. Joseph, who is also a doctor, has always been opposed to this type of PDMP. Privacy is his concern, and he remains skeptical the federal government won't be able to access the information.
"It is a government database that will include personal medical data in which 30,000 people would have a password," he said. "And that's just in Missouri. If they go nationally, it will be more than a million people with a password to every citizen's medical data. ... It's a severe intrusion on our privacy."
While she shares his concern, Rehder said the information cannot be used by federal or state officials and falls under the Health Insurance Portability and Accountability Act (HIPAA). The legislation imposes a felony penalty to anyone dispersing the medical information.
Rehder said there have been no privacy breaches nationwide. But Schaaf said he's read reports of breaches in Virginia, Florida, Colorado, Utah, Washington and Oregan.
This session, Schaaf has filed his own PDMP legislation, but it takes a different shape than Rehder's proposal. His program would also create a database through the Department of Health and Senior Services, but wouldn't allow physicians and pharmacists to view medication lists.
They can enter prescription information, and if the database detects a problem, it will warn the physician or pharmacist. It's up to the physicians and pharmacists to use their professional judgment from there.
Misty Snodgrass, director of public policy for the Missouri Coalition for Community Behavioral Healthcare, said a Missouri PDMP would alleviate the overwhelming number of drug abusers.
"I will tell you that our system, the safety net for Missouri, is underwater because of this opioid and heroin addiction," she said to the committee last week. "We are seeing it all across the state. It's not just in cities, it crosses all racial and socio-economic backgrounds, and it's all ages - we're even seeing it in the geriatric population."
Pharmacists are trying to solve the problem on their own, Missouri Pharmacy Association CEO Ron Fitzwater testified.
"They've formed informal bands within their community; they try to work with other pharmacists; they try to stop scripts they have concerns about," he said.
"We have a huge problem within our pharmacies, and our pharmacists are just asking, "Give us resources, help us set up a network that can help resolve this issue.'"