Missouri Lacks a Prescription Drug Monitoring Program

These days, it is hard to pick up a professional pharmacy publication without seeing a reference to prescription drug monitoring programs (PDMPs) in various states.

These programs are key tools in states’ responses to the crises related to substance use disorders, as they monitor controlled substance prescriptions through an electronic database.¹

New York implemented the first PDMP in New York State in 1918, though the program was eliminated 3 years later. In 1939, California was the first state to establish a program that has been continuously operating since its implementation.² From 1939 to 1999, just 15 states had enacted programs. However, from 2000 to 2012, an additional 30 states joined this group, leaving those without PDMP programs in the minority.³ By 2019, almost every state had joined the movement to harness the capabilities of information technology to help combat prescription opioid abuse, except Missouri.⁴ In 2016, Missouri ranked 19th in the nation for opioid overdose deaths, with 908 deaths that year.⁵ This number is still trending upward.⁶ What is taking Missouri so long to jump on board?

Many residents of the Show-Me State worry about their privacy when it comes to this subject. Former Missouri State Senator Rob Schaaf openly opposed the creation of a PDMP in the state for years for this very reason, saying: “This is private medical information; the people of Missouri are not going to want to have everyone with a password to this program have eyes on that.”⁶

The former senator tapped into this fear and used it to his advantage when trying to prevent passage of a PDMP bill. Although some bills have been proposed, they have all come up short when the votes in the legislature were tallied. As Schaaf’s term limit approached, concluding his service in office, he completely changed his mind on the issue. During the 2020 session there was a proposed bill for a voluntary PDMP. But an impasse arose in the House, and no bill was enacted.

Schaaf had said he would agree to a PDMP only if it were made mandatory, stating: “If they’re going to take our liberty away for something that’s never been proven to work, doctors have to use it.”⁶

Although that shift in opinion is not exactly based on full support of the bill, it brings up a good point: What is the benefit of a mandatory over a voluntary PDMP? Although a voluntary program is better than nothing, research has shown that states with mandatory programs have better results. Voluntary programs are useful but, naturally, they are not required to be used. Health care providers must be dedicated to stopping the opioid epidemic and take the extra time to use the program. In states where a PDMP is mandatory, however, health care providers must access the program before prescribing or dispensing opioid drugs.

When one looks at the statistics, mandatory programs are without a doubt more effective. The Pew Charitable Trusts performed a study to measure this.⁷ In New York, for example, use of the database increased 100-fold in the 6 months following the mandate’s effective date. In addition, opioid prescriptions dropped by 8.7%, and buprenorphine prescriptions rose by approximately 12.8%. Missouri’s St Louis County is offering a voluntary PDMP. Although this is not ideal, the program does cover a large portion of the state’s population, despite the lack of a statewide program.

Many Missouri representatives and senators do support this important health care initiative.

Missouri State Representative Holly Rehder calls it a “lifesaving tool,” saying: “They’re collecting less information than [they are] in your electronic records. This is a medical process that we should be ashamed in Missouri that we have held…up.”⁶

A timely issue somewhat parallel to this is the debate rooted in the coronavirus disease 2019 (COVID-19) pandemic and the resulting mandates by some levels of government that masks be worn in public. Such tension between protecting the health of the public collectively and the rights of the individual will come to the forefront with a variety of public health-related issues. It is unfortunate that health-related topics or issues often focus a spotlight on this conflict or tension between the best interests of the collective public and the rights of the individual. A PDMP mandate can present an identical issue.

It is a continuing battle, and hopefully, one that will soon be resolved. Pharmacists in Missouri can reach out to local representatives and senators to inform them of the tremendous benefits that a PDMP can bring. We hope that representatives and senators realize the great potential in such a statewide program and vote to implement one soon.

REFERENCES

• Prescription drug monitoring programs (PDMPs). CDC. Updated June 10, 2020. Accessed October 19, 2020. cdc.gov/drugoverdose/pdmp/states.html.
• Technical Assistance Guide: history of prescription drug monitoring programs. Prescription Drug Monitoring Program Training and Technical Assistance Center. March 2018. Accessed October 19, 2020. pdmpassist.org/pdf/PDMP_admin/TAG_History_PDMPs_final_20180314.pdf
• Weber L. Why Missouri’s the last holdout on a statewide Rx monitoring program. KHN. May 20, 2019. Accessed October 19, 2020. khn.org/news/why-missouris-the-last-holdout-on-a-statewide-rx-monitoring-program/.
• Missouri opioid data factsheet. Missouri Department of Health & Senior Services. 2017. Accessed October 19, 2020. health.mo.gov/safety/ems/more/pdf/opioid-data-fact-sheet.pdf.
• Missouri: opioid-involved deaths and related harms. National Institute on Drug Abuse. April 3, 2020. Accessed October 19, 2020. drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/missouri-opioid-involved-deaths-related-harms.
• Kennedy W. Opioid abuse epidemic catching attention of Missouri politicians, law enforcement. Springfield News-Leader. February 7, 2016. Accessed October 19, 2020. news-leader.com/story/news/local/ozarks/2016/02/07/opioid-abuse-epidemic-catching-attention-missouri-politicians-law-enforcement/79983090/.
• Prescription drug monitoring programs. The Pew Charitable Trusts. December 2016. Accessed October 19, 2020. pewtrusts.org/~/media/assets/2016/12/prescription_drug_monitoring_programs.pdf.