Missouri is the only state not monitoring prescription drug use. Will it finally create a database?

A long-running battle to establish a database to monitor for prescription drug abuse in Missouri — the only state without one — is about to hit a boiling point.

On one side is Republican state Senator Rob Schaaf, who once said that when people die of overdoses that “just removes them from the gene pool.”

Schaaf, who is a physician, has squashed legislation in the past six sessions to establish a prescription drug monitoring program, or PDMP. But sensing urgency that the legislation might pass this session, Schaaf introduced his own bill to set up a PDMP that’s unlike those in any other state — a proposal that medical experts have called a “sham.”

In a surprise move, the state Senate passed it in late February.

Now, the House is considering Schaaf’s proposal. At the same time, the Senate and House are both considering another bill, introduced by Representative Holly Rehder and Senator Dave Schatz, both Republicans. Their previous efforts have been filibustered by Schaaf.

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“Our medical community all over the state is begging for a way to help address the opiate epidemic,” said Rehder.

But with conflicting pieces of legislation vying for approval, a PDMP may again elude Missouri this year.

Why doesn’t Missouri already have a PDMP?

Efforts to establish a PDMP have been repeatedly crushed by a small group of legislators led by Schaaf. The senator filibustered a measure in 2012 and has threatened to do so in other sessions in the past six years. Even that threat, Rehder said, is enough to keep a bill from being brought up in the Legislature.

Every other state has a drug monitoring program. The power of those programs varies, but they all require doctors and pharmacists to enter prescriptions into a database. The programs are designed to stop patients from being able to “doctor shop,” bouncing from one prescriber to the next to get painkillers.

Doctors in the region say such a database is needed; there were 1,066 overdose deaths in Missouri last year. Even Mallinckrodt Pharmaceuticals — which manufactures oxycodone and is based in St. Louis — has expressed support for the legislation introduced by Schatz and Rehder.

“This is definitely something that our doctors here in my district, and parents of addicted children, and families, are just clamoring to have,” said Rehder. “It’s extremely frustrating that Dr. Schaaf continues to filibuster.”

Counties in Missouri, frustrated by a lack of legislative action, have started efforts to launch regional drug monitoring programs. St. Louis County established its own PDMP in 2016.

What’s the issue with Schaaf’s bill?

Schaaf’s bill wouldn’t set up a PDMP like others around the country, which give registered medical professionals direct access to a patient’s narcotic history.

Rather, Schaaf’s proposal would force doctors to send to the state health department the names of each patient they’re considering prescribing painkillers. The state PDMP would automatically alert the prescriber to any troubling patterns in that patient’s prescription history. Then, it would be up to the prescriber to make a decision about whether to dole out the medication.

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“It’s unlike anything any other state has done,” said Jeff Howell, the director of government affairs at the Missouri State Medical Association. “In other states, a physician or prescriber can just get on and see what the prescribing history has been.”

The association has sharply criticized Schaaf’s proposal, and supports the legislation introduced by Rehder and Schatz.

Howell said he is concerned that having a vastly different system will make it all but impossible for the Missouri database to be used in tandem with the databases of surrounding states. With two of the state’s biggest cities — Kansas City and St. Louis — sharing a border with other states, it’s crucial that the systems be able to communicate, Howell said.

Schaaf did not respond to requests for comment. In the past, he has said his objection to PDMPs stem from patient privacy concerns.

“They don’t work. And it’s an infringement upon people’s privacy,” Schaaf said in an October 2016 interview with local television station KSHB. “Most people don’t want the government to have that information and have it on a database in which many people can get it.”

Schaaf has cited a 2009 case in Virginia in which a hacker claimed to have accessed 35 million prescription records through the state’s drug database.

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But others argue his bill will put what should be a medical decision — determining whether a patient is at risk of abuse — out of a doctor’s hands.

“You are charging [the bureau] with making a medical decision and that doesn’t make any sense to me,” Larry Pinson, who serves on the board of the National Association of State Controlled Substances Authorities.

“How are they going to know if there is a true medical reason for that patient to need a narcotic?” said Pinson, who also serves on the Nevada State Board of Pharmacy, which controls the state’s PDMP.

What comes next?

The House is now considering both Schaaf’s measure and Rehder’s legislation. Rehder is confident her bill can get support in the House, which has passed it in two previous sessions.

But Schaaf told the St. Louis Post-Dispatch that he intends to filibuster that version of the legislation if it makes it to the Senate floor. “I’d just as soon not have a PDMP. Would they rather have a database that protects privacy or no database at all?” Schaaf said in a recent interview.

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The senator said he has already compromised on setting up a PDMP at all, and is calling on Rehder and Schatz to compromise, too — by supporting his legislation.

“I appreciate the momentum. I appreciate him agreeing that there’s a problem,” Rehder said. But she made clear she will not back down from her opposition to Schaaf’s bill.

“The most important part of being able to spot addiction is on the front end,” she said. “Without physicians having that access, it’s really just putting a Band-Aid on it.”