Holly Rehder – Missouri House of Representatives Newsroom

House vote sends statewide PDMP proposal to Governor

After roughly a decade of legislative consideration, the Missouri legislature has voted to create a statewide prescription drug monitoring program (PDMP).

Representative Travis Smith (Photo: Tim Bommel, Missouri House Communications)

The program would consolidate information on the prescription of controlled substances so that pharmacists and physicians can identify those who might be dealing with addiction. The House approved the bill, Senate Bill 63, 91-64, sending it to Governor Mike Parson (R). Parson has signaled support for a PDMP.

If SB 63 becomes law it would make Missouri the last state in the nation to enact a statewide PDMP. More than 80-percent of the state is covered by a PDMP that began in St. Louis County a number of years ago. This would replace that plan and have different requirements for the sharing of data.

PDMPs are intended to identify and flag the practice of “doctor shopping,” when individuals go to multiple doctors and multiple pharmacists seeking to accumulate a large supply of a drug in order to abuse or sell it. Supporters say the program will save lives and help get those with addictions into treatment.

“Every law enforcement person I talked to, every doctor says it will prevent deaths in the future, and if you can prevent just one person from dying I think that means something. I think this will prevent hundreds, if not thousands,” said Representative Travis Smith (R-Dora), who carried the bill in the House.

Opponents say PDMPs will create a database of Missourians’ private medical information which the government shouldn’t have. Lake St. Louis representative Justin Hill, a former undercover drug enforcement officer, said PDMPs haven’t worked in other states and the one based in St. Louis County isn’t working.

Representative Justin Hill speaks against the PDMP proposal as Senator Holly Rehder, its sponsor, watches debate. (Photo: Tim Bommel, Missouri House Communications)

“This has dire consequences. The death rate in St. Louis County has actually increased because people are pushed away from pharmacies to buy their narcotics, which they are addicted to, on the street. If you truly care about the lives of people that are addicted to these drugs then you want them to be discovered at the pharmacy. You want them to doctor shop,” said Hill. “You turn down that person at a doctor’s office or pharmacy, they’re still going to get their drug.”

Smith said he’s heard those concerns, and if the bill becomes law he intends to monitor the impact of a PDMP in Missouri. If it doesn’t work he will work to fix or eliminate it.

“My argument to those people is this: most heroin users did not start off as heroin users. They had some kind of prescription for the opioid. They get the opioid and because there wasn’t a monitoring program they got too much of it. They got addicted,” said Smith. “My idea is, if we can work with doctors and pharmacists and monitor it, we can catch it before it ever happens.”

The bill passed the House with mostly Democratic support, with around 30 Republicans voting in favor. Representative Tracy McCreery (D-St. Louis) has been in favor of a PDMP throughout her 8-year legislative career.

She credited Senator Holly Rehder (R-Sikeston), who has sponsored and pushed for passage of a program through most of her 8 years in the House, and was the sponsor of SB 63.

“I think that what her legislation is doing is truly putting a statewide PDMP forward, and to me that is something that is ultimately going to save lives.”

Proponents say under SB 63, Missourians’ medical information will only be available to doctors and pharmacists.

Missouri House endorses statewide prescription drug monitoring program

The Missouri House has given preliminary approval to a statewide monitoring program for prescription drugs. Supporters say it will combat abuse of prescription drugs. Opponents say it will lead to more people switching to heroin and other illegal drugs, and cause an increase in overdose deaths.

Representative Holly Rehder (Photo: Tim Bommel, Missouri House Communications)

Missouri is the only state in the nation without a statewide program, though a program started by St. Louis County encompasses roughly 87-percent of the state’s population.

House Bill 1693 would replace St. Louis County’s program with one that covers all of Missouri and puts additional protections in place for those whose data would be in the Monitoring program.

It would create an online database that doctors and pharmacists could use to record and monitor the purchases of pills and visits to pharmacies. For the seventh year, Representative Holly Rehder (R-Sikeston) is the proposal’s sponsor. She said it would help fight what has been called an “epidemic” of prescription drug use.

“I ask that you all hear me say that this is not a silver bullet. I have said that now for eight years, but as all states have said, this is a cornerstone in their fight against the epidemic,” said Rehder.

Representative Justin Hill (R-Lake St. Louis) has opposed creation of a Prescription Drug Monitoring Program (PDMP) each year he has been in the House. He argues that such programs have not worked, and said by taking away pharmacies as places abusers can get prescription drugs the state would be pushing abusers to illicit drugs. He said after St. Louis County’s PDMP was implemented the rate of drug overdose deaths increased in areas it covered.

“We’re okay with maybe putting another tool in the toolbox but at the expense of more lives. I’m not okay with that,” said Hill.

Rehder acknowledged the increase in overdose deaths but maintained PDMPs are effective tools in detecting and stemming addiction before it worsens.

Representative Justin Hill (Photo: Tim Bommel, Missouri House Communications)

“What we’re trying to do is to stop band-aiding this epidemic. We’re trying to work on the root of the problem, so we want to stop people from getting to that point,” said Rehder.

“As a grandmother who got my grandbaby out of a meth lab, who was living in one, there is no way that I would have the passion for this bill if I did not know from researching the data that this gets to the underlying problem,” said Rehder. “We must stop addiction on the front end. We must allow our providers to see it.”

Representative Glen Kolkmeyer (R-Odessa) said he backs the bill because not having a PDMP statewide means people can simply go to counties that do not have it to keep getting drugs to abuse or sell.

“My issue is … when we’re doing it patch quilted together is … if you’re from one county [which has PDMP] you’ll go to another county that doesn’t have it,” said Kolkmeyer. “That’s why we need it statewide.”

Rehder said her bill includes protections against information in the PDMP database being used to take away Missourians’ rights under the 2^nd and 4^th Amendments. She said those protections do not exist in the St. Louis County program.

Several proposed amendments to HB 1693 were voted down, including one that would have removed the bill from law if overdose deaths increase after its passage.

The bill was perfected by a roll call vote of 95-56. Another favorable vote would send it to the Senate.

House committee approves bill to legalize syringe exchange programs for IV drug abusers

A House Committee has endorsed continued operation of programs that offer clean needles to drug abusers.

Those programs aim to get drug users into treatment by introducing them to medical professionals who can consult with them while providing them clean needles. They also fight the spread of diseases like HIV and Hepatitis C, which are often transmitted through the use of dirty needles.

Representative Holly Rehder (R-Sikeston) is carrying the legislation for a third straight year. She said such programs operate in Missouri now, including one in St. Louis County and one that has been operating for decades in Kansas City, but they are technically in violation of state laws against distributing drug paraphernalia.

“The cities look the other way. It’s kind of a gray area because the cities want them there because they are helping so much with harm reduction,” said Rehder.

“We do not want to create a scenario of increasing drug use. In fact, syringe access programs have been found to cause a 13-percent reduction in use. They play a very large role in the referral for treatment. They’ve also been found to decrease needle sharing by 20-percent,” Rehder told the House Committee on Health and Mental Health Policy.

“[Drug abusers] are already using needles for their addiction. No one starts using the needle because they can get a free one,” said Rehder.

The top Democrat on the committee, Representative Doug Clemens (D-St. Ann), said he is enthusiastic about House Bill 1486, and the finding that users who take advantage of needle exchanges are five times more likely to enter a drug treatment program.

“I appreciate legislation like this which actually works to solve a problem instead of punishing people arbitrarily for a disease. Addiction is a disease and it’s something that we in Missouri are struggling with every day,” said Clemens.

Chad Sabora has testified to House committees on this proposal for several years. He runs a needle exchange program in Missouri. He is also a former Chicago prosecuting attorney who has been clean from a heroin addiction since 2011. He said the way society treats drug abusers now could be described as, “negligence and malpractice.”

“The message has been call me when you’re ready for help. The message has been when they get arrested they’ll get help, when they show up at a church basement for an AA meeting they’ll get help, when they make that phone call to treatment they’ll get help. One hundred thousand people died last year because that’s our philosophy. Our philosophy needs to change,” said Soborra.

Bill Kraemer of St. Genevieve testified in favor of the bill. He told of finding his daughter dead on a basement floor of an overdose. He managed to revive her and she recovered, and today is 2.5 years clean and just had a baby girl.

He said he learned through his experience with her that drug users will resort to dirty needles if they must.

“A person who needs to inject, sometimes they are so in need that they let their inhibitions down. They need to shoot up so they will use a dirty needle. My daughter was always meticulous in not using a dirty needle, always, but she found herself a couple times in need to inject and she used somebody else’s needle, and out of the three times that she used a dirty needle she got Hep C,” said Kraemer.

Kraemer and representatives on the Committee said they hope needle exchanges will spread to rural parts of the state, because it is needed there at least as much as in Missouri’s urban centers.

Rehder and other proponents of the programs say their ability to combat the spread of diseases is particularly important now. Missouri is on the verge of a crisis in the spread of HIV and Hepatitis-C, mostly among drug users who are sharing needles.

“Right now in Missouri we have 13 counties on the CDC’s top five percent watch list … across the U.S. of counties that are on the verge or at risk of Hep C and/or HIV outbreaks,” said Rehder.

The proposed change would cost Missouri nothing as these programs are privately funded. Rehder said the legislation could actually save the state some of the cost it has expended to treat drug abusers.

In each of the last two sessions the House has passed needle exchange legislation by sizable, bipartisan votes, but it has stalled in the Senate. HB 1486 has been approved by one House committee and is awaiting a hearing by a second.

VIDEO House proposals would address HIV spread and stigma, abuse of IV and prescription drugs

The Missouri House again will weigh bills aimed at fighting intravenous and prescription drug abuse, as well as a bipartisan effort to fight a stigma against those infected with HIV.

Representative Holly Rehder (R-Sikeston) has prefiled legislation to legalize programs that give drug abusers clean needles, and for the seventh consecutive year has filed legislation to make statewide a monitoring program for drug prescriptions. She and Representative Tracy McCreery (D-St. Louis) have also filed bills to change Missouri law that criminalizes exposing someone to HIV.

Supporters say needle exchange programs have been operating in the state for years, and don’t entice people to start abusing intravenous drugs. Rather, they say, they ensure abusers aren’t transmitting diseases through dirty needles and it puts them in contact with medical providers who can facilitate getting them into treatment.

Several such programs already operate in Missouri, though they are doing so against the letter of the law. House Bill 1486 would exempt those programs from the crime of “unlawful delivery of drug paraphernalia.”

House Bill 1693, dubbed the “Narcotics Control Act,” would make statewide a prescription drug monitoring program (PDMP) like that maintained by the St. Louis County Health Department. That program covers about 87-percent of Missouri’s population, in just over half its counties. Rehder said that program has had great results but the whole state must be covered.

A PDMP is a database that physicians and pharmacists could use to track pill purchases and pharmacy visits, in an effort to find those who are potentially filling multiple prescriptions to support abuse. Such proposals have met stiff opposition in past years, generally from those who say creating such a database would put sensitive medical information in danger of being breached.

House Bills 1691 (Rehder) and 1692 (McCreery) would reduce or eliminate the penalties for knowingly exposing someone with HIV. Backers say the current penalties are too steep – the punishment for knowingly exposing to HIV someone who contracts the disease is on par with those for murder, rape, and forcible kidnapping.

Supporters say the harsh penalties are actually helping the spread of HIV by discouraging people from getting tested.

Both bills have been filed for the session that begins January 8.

Reps. Rehder and McCreery and advocates discuss the legislation in the video below:

House votes to clear needle exchange programs to fight IV drug use, disease

The Missouri House has passed a bill that would legalize programs already operating in the state that give drug abusers clean needles. Supporters say those fight the spread of intravenous diseases and expose drug users to treatment options.

Those running needle exchanges in Missouri now could be charged with violating the state’s drug paraphernalia law. They are protected only by handshake agreements with local law enforcement who recognize the benefit of the programs.

House Bill 168 would exempt from that law needle exchange programs that are registered with the Department of Health and Senior Services.

“Syringe access programs have been found to cause a 13-percent reduction in use. They play a very large role in referral for treatment, and they’ve also been found to decrease needle sharing by 20-percent,” said Sikeston Republican Holly Rehder, the bill’s sponsor.

She said the CDC has identified 13 counties in Missouri as ripe for an outbreak of Hepatitis C and HIV. She said preventing an outbreak would save lives and save the state money.

“In 2016 the cost to the state for Hep-C and HIV treatment was $70-million. In 2017 it was $63-million, and in 2018 it was $80-million,” said Rehder.

Missouri has plenty of examples in other states to look to, to see how needle exchange programs have run and what results they’ve had.

“We’ve had over 30 states enact legislation to allow these to take place,” said Columbia Democrat Martha Stevens.

Supporters say in places with needle exchange programs, drug users are five times more likely to enter treatment. That’s because when users go to get needles, they’re getting them from a health care professional who can tell them about treatment options.

“This could be the entryway into someone getting treatment. This could be the first healthcare professional that one of these IV drug users ever meets,” said Lee’s Summit Republican Jonathan Patterson.

“So often people who are using, once they get to using needles, they don’t have anyone in their life that knows how to get them help, that knows how to get them plugged in when they reach out for help,” said Rehder. “Having this person who meets them where they’re at, becomes their friend, and becomes that medical professional with the knowledge to get them plugged in, and that’s who they go to reach out to when they’re ready for help.”

The House’s 124-27 vote sends the bill to the Senate, where it stalled last year. Rehder has said she has assurances from members of that chamber that it will be supported this year.

Earlier stories:

House Committee considers legalizing needle exchange programs to fight disease, addiction

Missouri House asked again to revamp HIV infection laws, endorse needle exchange programs

Missouri House votes to support needle exchange programs to fight IV drug abuse, disease

Missouri House sends prescription drug monitoring proposal to the Senate

The Missouri House has voted to create a statewide monitoring program for drug prescriptions. Backers hope such a law would combat the abuse of prescription drugs and help prevent conflicts between medications. Opponents say it would violate Missourians’ constitutional right to privacy.

Sikeston Republican Holly Rehder, who has pushed for a prescription drug monitoring program for years in response to her own family’s struggles with prescription drug abuse, hopes this is the year PDMP legislation is finally sent to the governor. (photo; Tim Bommel, Missouri House Communications)

House Bill 188 would create an online database that physicians and pharmacists could use to track pill purchases and pharmacy visits. Missouri is the only state in the U.S. without such a system, statewide. A program launched in the St. Louis region several years ago now covers 67 of the state’s 114 counties, encompassing about 87-percent of its population.

The bill cleared the House 103-53. Republicans who opposed it were very vocal about fears that the program would create a government database that would jeopardize Missourians’ medical information.

Backers say no other PDMP database has ever been successfully hacked and say this would fall under Health Insurance Portability and Accountability Act privacy protections. Blue Springs Republican Dan Stacy remained critical, and said that to say databases won’t get hacked is, “probably somewhat naïve.”

“The bigger the database, the bigger the target, and when we, as a body decide to put all of the State of Missouri – all of these records into one database – that is helping create a large target, and that is a place in which we can get a lot of data hacked because it’s a target,” said Stacy.

Eureka Republican Dottie Bailey said she remembered being a concealed carry permit holder when, under the administration of Governor Jay Nixon, information about those permit holders was shared with the Department of Homeland Security.

“Nothing has happened to that administration since that occurred other than my name is with the federal government as a firearms owner, or permitted, so right now, not a big deal, right? But what happens when another administration gets in that wants to weaponize those databases? And this is where I worry, this is where my constituents worry,” said Bailey. “This bill is very difficult because yes, something needs to be done, but an overwhelming, sweeping government program has never, ever done what we think it’s going to do and then we usually end up regretting it.”

Proponents said concerns over privacy were being overblown, and paled in comparison to the bill’s goal of saving lives by fighting prescription drug abuse.

“Hacking is a real concern, I know, for all of us,” said Representative Sheila Solon (R-St. Joseph), “however we can’t let that worry consume us or we would never use a credit card to go to a restaurant or to go shopping or go to the gas station. We’d never use a credit card or do any shopping online.”

Other lawmakers expressed frustration that all attempts to amend the bill were rejected. Among those amendments were proposals to require physicians and pharmacists to participate in the database – the bill would make that optional – and to create penalties for failure to participate.

Representatives Justin Hill, Jack Bondon, and Jason Chipman were among those Republicans who opposed HB 188 to create a PDMP. Chipman offered an amendment to require all physicians and pharmacists in the state to participate in the program the bill would create, but it and all amendments to HB 188 were rejected. (photo; Tim Bommel, Missouri House Communications)

“No penalties; no requirement to participate; no protection for chronic pain patients, and that is unfathomable. I just don’t get it, why we are punishing those who actually need the help,” said Ash Grove Republican Mike Moon.

Bill sponsor Holly Rehder (R-Sikeston) responded to those critics, saying, “I disagree with those who said that we didn’t do our job because this bill hasn’t been amended. Mr. Speaker this bill has been massaged for years on this floor. We started this year with where we had left off with the things we had agreed with. The ones who wanted to amend it wanted to kill it.”

Rehder, who has proposed PDMP legislation for several consecutive sessions, told opponents that one way or another Missouri will have a monitoring program.

“Over half of our counties have passed this locally. The current program will be statewide at some point and that program does not have legislative oversight; it doesn’t have a purge; it doesn’t protect our ability to purchase or have ownership of guns. Do you need to pick which program you want?” said Rehder.

HB 188 now goes to the Senate, where past years’ versions have run into opposition and stalled out. While the senator who led that opposition is no longer in that chamber due to term limits, last week the Senate version of Rehder’s bill stalled in a tie committee vote.

Rehder and other backers note that all members of that committee were present for the vote, and she believes that outcome isn’t representative of the chances of passing a PDMP bill this year.

House Committee advances prescription drug monitoring proposal

The Missouri House is again being asked to consider creating a statewide prescription drug monitoring program (PDMP), with the aim of battling the abuse of opioids and other prescription medication.

Representative Holly Rehder presents to a committee House Bill 188, which would create a statewide prescription drug monitoring program in Missouri. Behind her, Senator Tony Leutkemeyer (R-Parkville) listens to the discussion. Luetkemeyer is sponsoring identical legislation in the Senate. (photo; Tim Bommel, Missouri House Communications)

House Bill 188 is sponsored by Sikeston Republican Holly Rehder, who has proposed a statewide PDMP for several years. Such legislation has passed out of the House several times but was held up in the Senate.

Rehder has been a strong proponent of PDMPs largely because of her family’s experience with opioid and drug abuse. One of her step-fathers was a drug dealer. Her daughter, Raychel, became addicted to pain relievers after an emergency room visit when she was 17. She went on to abuse other substances including methamphetamine before becoming drug-free more than 5-years ago. Rehder says other members of her family have also struggled with abuse issues.

“I know this issue inside and out, as a parent, as a kid who grew up in it, and it doesn’t matter what your background is, it doesn’t matter how you grow up or how you raise your children. It’s not a moral failing. Addiction is a disease,” Rehder told the House Committee on Insurance Policy.

Missouri is the only state in the nation without a PDMP. Such programs collect and monitor drug prescription and dispensing data to look for, among other things, “doctor shopping;” the visiting of multiple doctors in an attempt to obtain drugs that are commonly abused.

Rehder and other supporters say they don’t view PDMPs as a “silver bullet,” that will end the abuse of opioids and other prescription drugs, but as a tool that will help fight such abuse.

“A PDMP allows providers to see concerning trends in their patients’ narcotic history. That physician can intervene with options for that patient: alternative care treatment, medication-assisted treatment – we have many options available now with excellent outcomes, but we need our medical professionals seeing their patients’ history before they get too far down the road,” said Rehder.

Opponents of PDMPs argue that they violate citizens’ rights by collecting personal data and putting it into a government database that, they say, could then be jeopardized by hacking or other breaches.

Doctor John Lilly of Springfield told lawmakers they should put privacy concerns above all others in considering PDMP legislation.

“Your job is not to make my job easier. Your job is to protect the liberty of the citizens of this state,” said Dr. Lilly. “I am a U.S. citizen first and a doctor second. I care about the liberty of these citizens of Missouri.”

Lilly and others speaking against HB 188 argued that data show PDMPs in other states have not been effective in fighting opioid abuse.

Monroe County Commissioner Ron Staggs asked the committee, “After you see the data from 49 states and a death rate that continues to climb why would you want to enact the same thing?”

Proponents say a PDMP wouldn’t just address drug abuse in Missouri. It could also help pharmacists spot cases in which patients might be prescribed unsafe combinations of medications.

Anne Eisenbeis works at a pharmacy in Moberly. She told the committee of one such instance that she caught by chance, that a PDMP would have ensured was flagged.

“I had a patient and a friend – a young man – bring in two prescriptions from two different doctors for two almost identical narcotics … had he not brought both physical prescriptions into my store, because in Moberly we don’t have access to the PDMP … he would’ve easily overdosed. There would’ve been an interaction with these two medications,” said Eisenbeis. “With a PDMP this would help me prevent this kind of medication error accident. I would’ve been able to see that he was given another prescription had he gone to another pharmacy.”

In previous years one of the proponents of a PDMP in the Senate has been Senator Dave Schatz (R-Sullivan), who is now the President Pro-Tem of the Senate. Rehder said she and Schatz worked in past years on compromises that have been worked into HB 188, and having him in Senate leadership bolsters the chance PDMP will become law this year.

The committee voted 13-3 to pass HB 188. It goes next to another House committee, which could vote on whether to send it to the full chamber for consideration.

Missouri House asked again to revamp HIV infection laws, endorse needle exchange programs

Missouri lawmakers will again consider a bipartisan effort to reduce exposure to and the transmission of HIV in the session that begins in January.

Representative Holly Rehder will again in 2019 sponsor legislation that would change Missouri laws to allow needle exchange programs; and to encourage people to be tested for HIV. (photo; Tim Bommel, Missouri House Communications)

Representatives Holly Rehder (R-Sikeston) and Tracy McCreery (D-St. Louis) have filed legislation that would change Missouri laws that criminalize exposing individuals to HIV. Rehder will also file a bill that would let organizations give clean needles to users of illegal intravenous drugs. Both proposals were also filed last session.

Rehder’s House Bill 168 would relax state laws against delivery of drug paraphernalia. Programs that offer clean needles to users could register with the Department of Health and Senior Services and be allowed to continue operating.

Supporters say the offer of clean needles could reduce the spread among IV drug abusers of diseases like HIV and Hepatitis C. Representative Rehder said it also make s users 5-times more likely to enter drug treatment because the needle exchange programs put them in direct contact with medical professionals.

“You want that person who is using a syringe to go get a clean one so then they have that contact with someone who is medically educated, who has the information on how to get treatment, where to get help, for when that time comes that they do reach out for help,” said Rehder.

Rehder refutes opponents who have argued that needle exchange programs simply enable the abuse of IV drugs.

“A free syringe isn’t going to provoke a non-IV user to start using, nor will a free syringe cause an IV user to increase their use,” said Rehder.

Last session’s needle exchange legislation, House Bill 1620, was passed out of the House 135-13, but stalled in the Senate.

House Bills 166 and 167, filed by Reps. McCreery and Rehder, respectively, both aim to change Missouri laws that criminalize the act of knowingly exposing a person to HIV.

Representative Tracy McCreery is again sponsoring legislation meant to encourage people to get tested for HIV by easing Missouri’s law regarding knowingly exposing others to the disease. (photo; Tim Bommel, Missouri House Communications)

Both bills would expand those laws to criminalize knowingly exposing a person to any serious infectious or communicable diseases. Both would also specify that individuals who attempt to prevent transmission, including through the use of a condom or through medical treatment that reduces the risk of transmission, are not knowingly exposing others to a disease.

McCreery and other supporters said those laws have actually discouraged people from getting tested and, if necessary, treated for HIV.

“Because of the way Missouri laws are written there is no motivation for people to know, and in fact not only is there no motivation but you can actually be charged with a more severe crime if you do know your HIV status,” said McCreery.

LaTrischa Miles, treatment adherence supervisor with KC Care Health Center, said in the time since Missouri’s and other states’ HIV exposure laws were written treatments have advanced so that people who might be in violation of those laws aren’t actually exposing anyone to a risk of HIV infection.

LaTrischa Miles with KC Care Health Center, which says Missouri’s HIV transmission laws are outdated and actually discourage people from getting tested and treated for HIV. (photo; Tim Bommel, Missouri House Communications)

“Most do not account for prevention measures that reduce HIV transmission risk such as condom use; antiretroviral therapy; preexposure, which is prep; or the fact that if the virus is maximally suppressed to undetectable levels, the person living with HIV has a zero risk of transmission,” said Miles.

“If people are doing things that pose no risk of transmission then that act should not be criminalized,” said McCreery. “Right now there are things in our laws that say if somebody commits a certain action, even if they absolutely pose no risk of transmission, they can still be charged with a crime.”

Rehder agreed with McCreery in saying that it’s time for Missouri to update its laws regarding HIV exposure and transmission, which were written in the 1990s.

“It’s important for our statutes to be updated as we become better educated and as technology and medicine advance. Bottom line is we want people to get tested, know their status, and get treatment,” said Rehder. “The Department of Justice along with many other national health organizations called for states to reform their HIV-specific laws many years ago because they run counter to many public health best practices.”

Last session’s versions of the HIV transmission laws legislation, House Bills 2675 (McCreery) and 2674 (Rehder) were subject to a hearing by the House Committee on Health and Mental Health Services. The hearing was in the final days of the session so the bills did not advance, but the committee encouraged McCreery and Rehder to reintroduce the bills for 2019.

These three bills were among dozens filed by lawmakers on Monday, the first day legislation could be prefiled for the session that begins in January.

Missouri House votes to support needle exchange programs to fight IV drug abuse, disease

The Missouri House has proposed easing state law to allow organizations to give clean needles to users of illegal intravenous drugs. Backers say the bill will help combat a potential outbreak in diseases like HIV and Hepatitis C caused by the sharing of used needles, and will get more people into drug treatment, but not all lawmakers are convinced.

Needle exchange or syringe access programs already exist in the St. Louis and Kansas City areas. Representative Holly Rehder (R-Sikeston) said those programs are operating in violation of state law regarding drug paraphernalia, but local jurisdictions allow them to operate because of the impact they have.

Legislation sponsored by Rehder, House Bill 1620, would relax state law to allow those programs to operate and to expand to other regions in the state.

Rehder said people who use those programs to get needles are 5-times more likely to get into drug treatment because the programs put them in contact with medical professionals.

“That becomes the medical professional in their life, so they go and they get a ten-cent needle but they get so much more than that,” said Rehder. “They get educational material explaining the harm of what they’re doing. They get a person who’s greeting them where they’re at in life who’s explaining there are options for you. We have places for you to go that we can get you into to help get you past this addiction, and so that becomes a relationship.”

Lake St. Louis Republican Justin Hill said as a former police officer and drug task force detective he supports the legislation. He said law enforcement officers are always conscious, when dealing with individuals abusing intravenous drugs, to look out for needles.

“Use extreme caution because you don’t want to be pricked by what? A dirty needle. We want clean needles on the street because of the instances where if an officer gets pricked they don’t want to have to take tests for the next two years of their lives every month – go get tested for HIV, go get tested for AIDS, go get tested for Hep C,” said Hill.

Some Republicans who are former law enforcement officers oppose Rehder’s bill. Cedar Hill representative Shane Roden, a reserve deputy sheriff, called the idea “stupid.”

“We’re not fixing the problem. We’re just creating Band-Aids. We’re not actually coming down with any solutions,” said Roden.

Representative Shane Roden (photo; Tim Bommel, Missouri House Communications)

Roden argued that with HB 1620, “We’re literally going to put the needle in their arm.”

Still the proposal has broad support including from Democrats. St. Louis City representative Peter Merideth followed-up Rowden’s statements by asking Rehder, “Do you expect this to cure the problem of opioid addiction in Missouri?”

“No, and no one other than that gentlemen has even insinuated that this is a fix for the problem. We all, that have stood up, have said it’s a tool in our toolbox,” Rehder replied.

Backers also say the bill will save the state money in costs to Medicaid of treating people who contract conditions like HIV and Hepatitis C by sharing needles.

The House voted 135-13 to send the legislation to the Senate. In previous years one similar proposal was voted out of one House committee but moved no further through the process.

Bill would add info on consent, violence, & harassment to sex education in Missouri high schools

A Missouri representative is proposing that high school students learn about sexual harassment, violence, and consent as part of sexual education. Her legislation will be heard Tuesday night by the House Committee on Children and Families.

Sikeston Republican Holly Rehder said the idea behind House Bill 2234 was brought to her by students at the University of Missouri who said they wish they had received such an education. They believe teaching high school students about those subjects could prevent situations that can cause life-changing harm, and Rehder agrees.

“What was so fascinating to me was you have these college students – two girls, is who initially brought it to me – that said, ‘We wish we would’ve had this,’” said Rehder. “’We don’t know how they were in high school or what their reputation is back home and then we all get lumped in together and we’re at a party, or we’re at an event, or walking to the car, or whatever … you need to know how to speak up for yourself, set those boundaries, and you also need to know how to not cross them.’”

Numerous cases have put sexual harassment, sexual violence, and consent in the public spotlight. One of those is the case of long-time USA Gymnastics team doctor Larry Nassar. He was sentenced late last month to up to 175 years in prison for abusing young female gymnasts. At least one of the women who gave a victim impact statement before his sentencing has written a letter in support of HB 2234.

Amanda Thomashow tells lawmakers she realized many of those Nassar assaulted didn’t know they were being abused, at least not at first, and trusted the doctor.

She writes, “more than anything I keep coming back to one particular question: How can we prevent such a tragedy from happening ever again? I have repeated this question in my head, over and over, searching for a way to save others from similar evils. I know there are many answers and I know there is no easy solution when it comes to sexual assault. However, I also know one thing with absolute certainty; we must add consent and sexual violence to basic sexual education curriculum. We need to equip young people with knowledge to protect and empower them, and House Bill 2234 does just that.”

HB 2234 would expand Missouri law on what must be included in sex education materials so that they cover sexual harassment, sexual violence, and consent. It would also seek to define those terms in relation to sex education.

It would define “consent” as, “a freely given agreement to the conduct at issue by a competent person. An expression of lack of consent through words or conduct means there is no consent. Lack of verbal or physical resistance or submission resulting from the use of force, threat of force, or placing another person in fear does not constitute consent. A current or previous dating or social or sexual relationship by itself or the manner of dress of the person involved with the accused in the conduct at issue shall not constitute consent.”

HB 2234 defines “sexual harassment” as, “uninvited and unwelcome verbal or physical behavior of a sexual nature, especially by a person in authority toward a subordinate,” and defines “sexual violence” as, “causing or attempting to cause another to engage involuntarily in any sexual act by force, threat of force, duress, or without that person’s consent.”

Missouri school districts are not required to have sexual education as part of their curriculum. The bill would require that these new areas be included for those that do.

Rehder said she looks at the issue not just as a legislator but as a mother of three.

“I think that’s the prism that we need to look at it through – what would we want for our children? What do we want them to know and be prepared for before they go into college,” said Rehder. “Or not college – before they go into the workplace and you have people over you. I think that these are just very important things to know before you’re thrown out into the world.”

The hearing on HB 2234 is Tuesday at 5 p.m. in House Hearing Room 7 in the Missouri State Capitol basement.

Additional audio:

Representative Rehder said she wants students to learn how to protect themselves and to respect others:

“I want them to know some clear cut signals and how to make those clear cut signals. I think it makes a lot of sense. I think it’s a small – doesn’t cost the state anything but could do a world of good.”