Doctors in every state but Missouri have the ability to check prescription drug information, but Missouri doctors are in the dark. However, pending legislation could change that.
Two bills have been filed this session, one in the House and one in the Senate, regarding a Missouri prescription drug monitoring program. Programs in other states help doctors identify if a patient may be struggling with prescription drug addiction. Prescriptions for controlled substances are loaded into a statewide database that doctors have access to, showing if a patient is “doctor shopping,” getting legitimate prescriptions for pain killers or opioids from multiple doctors.
Missouri already uses a statewide program to track pseudoephedrine cold medication purchases to curb the production of methamphetamine.
Rep. Holly Rehder, R-Sikeston, has introduced legislation for a monitoring program five times, only to be filibustered once the bill reached the Senate. Rehder is trying yet again with Sen. Dave Schatz, R-Sullivan, and one of the program’s biggest opponents, Sen. Rob Schaaf, R-St. Joseph, introduced his own version this session. Schaaf’s bill passed 20-13 in the Senate this week and Rehder’s bill is on the House calendar.
Privacy becomes roadblock
When someone gets a prescription filled at a pharmacy, it pings the insurance company, and with a PDMP it would also be entered into the statewide database.
“It allows (doctors) to prevent harmful combinations — if they see a patient has gotten some medications that are essentially lethal with a narcotic, the physician wouldn’t want to write you a narcotic prescription,” Rehder explained. “It give physicians more information about their patients to make an informed decision. It also allows them to recognize early signs of addiction, patients going to multiple doctors and getting multiple prescriptions.”
Schaaf, whose constant complaint about Rehder’s PDMP bill is privacy issues, has helped filibuster it each time it reached the Senate. He said he and another opponent polled their districts, finding constituents were “solidly opposed” to such a program. Schaaf cited the passage of the Missouri Electronic Data Protection, Amendment 9, in the 2014 primary election as “a big clue about what Missourians think” when it comes to privacy.
In Schaaf’s recently revised bill, a doctor can log onto the statewide database with a username and password, then look up a patient’s name. The database would screen all entries of drugs dispensed to the patient, and if all prescriptions were prescribed by that doctor, no further information would be made available. If the prescriptions were made by a doctor other than the one looking, it would prompt the doctor to enter the last four digits of their Social Security number. Once that is verified, all prescription data is made available. The data is purged after six months.
“The reason I would do this, the username and password is the easiest way to hack. Most hacking is an inside job, someone who works in the office,” Schaaf explained. “If someone had stolen my username, they’re not going to see any information because you’ve only seen me. If you’ve seen someone else, it isn’t very likely (the hacker) will also know my Social Security number.”
‘Recreating the wheel’
Rehder’s bill requires a username and password and all information about a patient’s prescriptions is made available right away, not after multiple security steps, just like other states’ programs.
Rehder said Schaaf’s bill is “recreating the wheel,” as it is unlike any other state PDMP, so it’s not proven if it will be successful or not. She also said his privacy fears are unfounded, as the program wouldn’t be showing doctors any information they don’t already have access to as a medical provider. With the program, doctors would only be able to look up information for their patient, not for others, as it would be a HIPPA violation.
“They already have authorization. When you make an appointment, you’re giving them access to your medical data,” Rehder said. “A physician can call a pharmacist and ask if a patient has been there. This is not authorizing anyone to have your medical information that isn’t authorized to have it right now, just puts it in a more available format for the physician or pharmacist.”
Rehder noted that if Schaaf’s concern is privacy, he should be in favor of a statewide PDMP rather than a county system. Several Missouri counties started their own PDMP last year.
“Counties passing it on the county level has been helpful,” Rehder said. “The question is no longer can Sen. Schaaf stop this, it’s are we going to do the responsible thing, help this be the best state ever, or do you want it piece-mealed throughout the state with counties and they deal with the burden?”
While Schaaf is hearing negative feedback, Rehder said citizens she’s heard from are “very much in favor of it.” She talked with families of those who have died of a heroin overdose, including Debbie Williams, whose daughter, Jessica Williams, died last February of a heroin overdose in her father Wayne Williams’ Sedalia home. Debbie said she’s been talking with Rehder about the bill and has encouraged everyone she knows to contact their legislators to get the bill passed, everywhere from social media to Jessica’s vigil last month.
Police in favor
Sedalia Police Officer Kevin Klein, of the STING Unit, said officers frequently encounter prescription drugs when serving drug-related search warrants in Sedalia, but it can be hard to make a case against the suspect because they typically have a legitimate prescription.
“There’s a lot of people who do distribute pills around here, as far as we know in most cases they have legitimate prescriptions, they’re doctor shopping,” Klein said. “They go to different areas to get prescriptions filled then they’re coming back here and selling. (A PDMP) would help monitor as far as I know.”
Kip Bartlett, of the Mid-Missouri Drug Task Force, which covers Miller, Morgan, Moniteau, Benton, St. Clair and Laclede counties, said PDMP legislation is “a great law” and something Missouri has needed for a long time.
“You have people with six, seven, eight doctors,” Bartlett said. “When we’re doing a search warrant on a house, we may find five or six doctor-prescribed medications, the same medication. Networking those doctors is extremely important.”
Doctors see benefits
While Schaaf, a family physician since 1985, has been opposed to a PDMP, local medical officials say they see the benefits. Dr. Phillip Fracica, Chief Medical Officer at Bothwell Regional Health Center, has worked in other states with a program and he said it gives doctors a “comprehensive picture” of a patient’s medications.
He said a PDMP would not only identify addiction, but help give proper dosages to those patients who really do need pain medication.
“We have no way of knowing (in Missouri) when a patient sees us Thursday if they saw another doctor Wednesday or what other medications they already have,” Fracica said. “It doesn’t even have to be a patient trying to abuse it, sometimes they’re legitimately in pain and trying to get relief, but going on higher doses turns out not to work well, a characteristic of those drugs.”
Fracica is a member of the Missouri Hospital Association Physician Executive Group and he said a state program is frequently discussed.
“It is the unanimous opinion of that group that a drug registry is the right thing to do to advance the health and welfare of our citizens and that it is truly unfortunate that physicians in Missouri do not have access to this important resource,” Fracica said.
The Missouri State Medical Association is also opposed to Schaaf’s bill, tweeting last week, “The fake #PDMP bill is bad for #Missouri patients.”