In the Missouri capitol building in Jefferson City, Representative Holly Rehder, R-Sikeston, has been trying for half a decade to get Missouri to establish a PDMP, or Prescription Drug Monitoring Program.
That’s an electronic records database that would allow prescribers—doctors, dentists, nurse practitioners, and anyone who can prescribe narcotics—to pull up on a screen in the exam room that shows what medicines that patient has been prescribed, and when.
Missouri is the only state where medical professionals don’t have the option of using such a database.
“They are authorized to have the information now, to have their patient’s medical history. However, they have to go about it in very archaic ways. They have to call the pharmacies, call the doctors in town, find out if their patient has been anywhere else –where the PDMP gives them that instant look at, ‘Okay, my patient has been on this,’” Rehder said.
That allows prescribers to spot prescription drug addiction on the front end, Rehder said, and treat it before it destroys a life. It’s a prevention tool in the war against opioid addiction.
On a visit to Tennessee, she says she met with a doctor who showed her how the PDMP there works.
“And he didn’t show me any private information. But he said, ‘Right now, I have my patient who comes in every month for a refill of his pain medication. He’s a veteran. He was injured in the war. He has true pain.’ And he said, ‘I checked the PDMP. I finished our appointment. He’s out in the waiting room, waiting for me to finish up his paperwork. I checked the PDMP, saw that he was at the VA two weeks ago getting medication for the same thing.’ He said, ‘So now, I’ve got a call into his VA doctor. And so then what we will do is, as his physicians, we will work together to get him back to a manageable solution that’s not overmedicating,” Rehder said.
Rehder has faced fierce opposition from a small group of Senators concerned primarily about privacy. But this year, she feels the PDMP legislation is gaining support.
“What has really been new wind in our sail is the push from the counties. You know, the counties have decided, ‘Look, we can’t endure this health epidemic any longer and do nothing’,” Rehder said.
Greene County is one of those considering joining others across Missouri that have established their own local PDMPs.
These local programs are using the same technology that Rehder is proposing the whole state eventually use.
At the March 20 City Council meeting, the Springfield-Greene County Health Department asked Council to pass a resolution allowing it to jump on board with St. Louis County for its grant application for PDMP money from the US Department of Justice.
At that meeting, one of the speakers in favor of a local PDMP was Ron Pregner, Senior Vice President and Chief Hospital Officer for CoxHealth.
“I’ll leave you, really, with only one number. I went back and looked: from 2007 to 2016, we have had 180 newborns with drug withdrawal syndrome. 26 in the last year,” Pregner said.
Pregner said as long as Missouri does not have a drug prescription monitoring database, it becomes a destination for drug abusers.
Council voted to support the resolution—that’s different than an ordinance that would formally establish the PDMP here.
Rehder's bill in Jefferson City, HB 90, is about five pages long, and you can read the full text here.
It identifies which criteria would be mandatory for prescribers and pharmacies to enter into the database. Those include the patient's date of birth, driver's license or government-issued ID number, and the date the patient received the prescription. It also includes the unique identifying number for the pharmacy and prescriber involved, which is the DEA (Drug Enforcement Administration) number or NPI (National Provider Identifier) number.
Page three of the bill, in Section 195.456, states that the Missouri Department of Health and Senior Services "shall review the dispensation information and, if there is reasonable cause to believe a violation of law or breach of professional standards may have occurred, the department shall notify the appropriate law enforcement or professional licensing, certification, or regulatory agency or entity, and provide any dispensation information required for an investigation."
Back in Jeff City, Rehder’s bill was perfected and ordered printed late Wednesday afternoon. It now has one more House vote before heading to the Senate, where Sen. Rob Schaaf has been the main opposition for several years, citing privacy concerns.
Schaaf did not respond to our multiple requests for an interview for this series. Rehder’s office expects Schaaf to filibuster the bill when it comes up for debate, which could be as early as next week.