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Missouri’s prescription drug monitoring tool seen having limited impact

Missouri’s prescription drug monitoring tool seen having limited impact

Missouri will soon join the other 49 states that already have prescription drug monitoring programs that aim to combat the opioid crisis, but the program being put in place has more of a law enforcement focus and other restrictions that will limit its effectiveness in combatting the epidemic, according to experts.

Missouri Gov. Eric Greitens recently signed an executive order on July 17 directing the Missouri Department of Health and Senior Services to create a statewide prescription drug monitoring program for Missouri.

Despite previous failed legislative efforts including House Bill 90, which was introduced by State Representative Holly Rehder, R-Sikeston, in January and would have created a statewide PDMP, this measure finally implements a statewide program.

“The opioid crisis is a modern plague,” the governor’s office said Tuesday in an emailed statement. “It killed over 900 Missourians last year. There is no time for more inaction. We have to do something to change our direction.”

The monitoring program will “address doctor shopping by identifying and taking action against ‘Pill Mills’ that pump out too many prescriptions for narcotics,” the statement said. “Using data from private sector partners, our Department of Health and Senior Services will be able to determine which prescribers are abusing the system.”

The new program will utilize data from pharmacy benefit management organization St. Louis-based Express Scripts Holding Co., making Missouri the only state with this type of program.

“Under the governor’s plan, the Missouri Department of Health and Senior Services will enter into contracts with private-sector companies like Express Scripts to analyze doctor and pharmacy prescription and dispensing data for schedule II through IV controlled substances,” Express Scripts said Monday in an emailed statement. “The state will use data to identify activity and investigate whether controlled substances are being inappropriately prescribed or dispensed.”

Schedule 2 substances have a high potential for abuse which may lead to severe psychological or physical dependence. Schedule 3 substances have a potential for abuse may lead to moderate or low physical dependence or high psychological dependence. Schedule 4 substances have a low potential for abuse relative to substances in Schedule 3.

Missouri’s new PDMP will be limited to law enforcement and regulatory boards, which some experts feel only serves one purpose.

“The other monitoring programs do allow licensing boards, regulatory boards and law enforcement to have access, but they also allow representatives from the health care community to have access like doctors and pharmacists,” said Patrick Knue, Waltham, Massachusetts-based director, Prescription Drug Monitoring Program Training and Technical Assistance Center. “That's what's missing from the governor's executive order.”

PDMP’s serve “multiple purposes, but the two primary purposes are a health care tool and a law enforcement regulatory tool,” said Mr. Knue. “I don't mean to be negative about this because I think it's a tremendous first step on a statewide level from the governor's office since they weren't able to get legislation passed. I think it's a great first step to try and get an idea of what's going on in Missouri as far as potential criminal activity with the controlled substance prescriptions but there is a major piece that's missing. The benefit of the monitoring programs is it's a tool for health care professionals and that's the piece that's missing.”

Experts say that the new program is more of a prescriber monitoring program than a prescription drug monitoring program.

“A real PDMP allows physicians and other prescribers to see patient data so that they can treat those patients and what was done by executive order does not allow for that,” said Jeff Howell Jefferson City, Missouri-based general counsel, director of government relations at the Missouri State Medical Association said.

“What the governor’s executive order establishes is a means for someone at the Department of Health to look at prescribing data, said Mr. Howell. “Then someone over there will determine what's appropriate prescribing and what's inappropriate prescribing and then they will turn over what they think is inappropriate to law enforcement. And it doesn't treat patients, and it doesn't treat addiction, it doesn't stop doctor shopping, and it doesn't let prescribers help their patients. It's definitely a law enforcement tool, it is not a prescription drug monitoring program.”

While this program aims to launch as early as next month, there is currently a limited PDMP that was launched by the St. Louis County Department of Public Health.

“There’s been one already launched up to a point, kind of a patchwork solution by the St. Louis County Department of Public Health where they've launched a PDMP and they're adding a number of other counties and other jurisdictions to participate with them and that one is up and operational now,” said Mr. Knue.

“We have a rather robust county effort,” said Mr. Howell. “A county by county PDMP and as that continues to grow, it will eventually become a statewide PDMP — one that actually acts like the ones other states have passed.”


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