Tag: House Bill 90 (2017)

House asks Senate to come to the table on proposed prescription drug monitoring program

The state House has asked the Senate to debate the changes it made to the House’s proposed prescription drug monitoring program (PDMP).

Representative Holly Rehder (photo; Tim Bommel, Missouri House Communications)
Representative Holly Rehder (photo; Tim Bommel, Missouri House Communications)

A PDMP aims to fight the abuse of prescription drugs by entering into a database information on people’s prescriptions to see who is getting large numbers of drugs that can be abused.  Backers say the program will help identify abusers and cut back on “doctor shopping,” or going to multiple doctors to get multiple prescriptions for drugs.

The House passed House Bill 90 earlier this month that would require pharmacists to report to the database in real time by 2020, require the Department of Health and Senior Services to notify law enforcement if it believes any law or professional standard has been broken, and keep submitted prescription information confidential except when there has been a breach.

The Senate proposed several changes to the House plan.  It would require that information only be kept on the database for 180 days; limit the database to opioids and benzodiazepines (the House proposed including all schedule II, III, and IV drugs); and mandate that doctors check the database before writing prescriptions for specified drugs.

The sponsor of HB 90, Sikeston Republican Holly Rehder, has been pushing for passage of a PDMP for years, driven in part by how drug abuse has affected her family.  She opposes some of those proposed changes and wants to see if the House and Senate can work out differences.

She said those in the medical field she has talked to say the database won’t be effective if information is only kept on it for 180 days.  They want it to be on there for at least two years.

“Typically when you’re looking at addiction, your first two years you have more relapses,” Rehder explained.  “Once you get past that two-year mark you’re doing pretty good.”

Rehder said limiting a PDMP to opioids and benzodiazepines wouldn’t go far enough.

“Ritalin – Adderall is one of the highest drugs of misuse and abuse, so we need to be sure that we have all schedule II through IV (drugs) in my opinion,” said Rehder.

Rehder said she would not fight the change that requires doctors to check the database before writing a prescription.

Representative Justin Hill (photo; Tim Bommel, Missouri House Communications)
Representative Justin Hill (photo; Tim Bommel, Missouri House Communications)

The Senate also proposed letting the legislature decide after six years whether to continue the PDMP, and requiring training for database users.

Lake St. Louis Republican Justin Hill opposes Rehder’s proposal and urged the body to deny her motion.  He said if Missouri is going to have a PDMP it should include the 180-day provision.

“I hope we keep the 180-days in because if we’re talking about addiction and pill shopping, then let’s try it.  Let’s see if it works with 180-days,” said Hill.

Hill would rather Missouri not have a PDMP.  He argues they haven’t worked in other states except to push more people from abusing prescription drugs to heroin.

“49 other states admit that this doesn’t work,” Hill told Rehder.

“No, no, tell me a state that admits it.  You can’t just throw things out like that on the House floor and not have anything to back you up,” Rehder responded.

The House passed Rehder’s motion to seek a conference with the Senate, and now awaits the Senate’s answer.  Fewer than four weeks remain in the legislative session for lawmakers to attempt to reach a compromise.

House perfects prescription drug monitoring program proposal

The Missouri House has given initial approval to a proposed tracking system for prescription drugs that backers hope will fight opioid abuse in Missouri.  Specifically it aims to help stop “doctor shopping;” the practice of going to multiple doctors seeking multiple prescriptions for valuable and addictive medications.

This is the fifth session in which Representative Holly Rehder has sponsored PDMP legislation. (photo; Tim Bommel, Missouri House Communications)
This is the fifth session in which Representative Holly Rehder has sponsored PDMP legislation. (photo; Tim Bommel, Missouri House Communications)

House Bill 90 would make Missouri the 50th state to enact a prescription drug monitoring program (PDMP).  The electronic registry would take information on those who prescribe, use, or dispense prescription drugs.

The bill had bipartisan support in a 109-40 vote.  West Plains Republican Shawn Rhoads, a former police detective, said it is an answer to opioid abuse in Missouri.

“There’s just so many times in a career [someone has] had to go to somebody’s house and tell them that their loved one has overdosed and died because somebody was doctor shopping, selling them drugs, and they’ve overdosed on them.  That is the worst thing that you will ever have to do in a career, and I’m telling you I never, ever, want to do it again,” said Rhoads.  “That’s why, Mr. Speaker, I urge the body to vote for this bill.”

The bill is sponsored by Sikeston Republican Holly Rehder, who has spoken publicly many times about her own family’s experience with addiction.

“I grew up in poverty.  One of my stepdads was a dealer.  My sister married a dealer at 16, was a main line user by the time she was 16,” said Rehder.  “I didn’t use drugs because I was afraid of them.  I saw what they did to those around me.”

Rehder said it was that fear that caused her to raise her children “differently,” but when her daughter was given a prescription for opioid painkillers after cutting her thumb at work, she became addicted.

“From that point forward we had 13 years of addiction,” said Rehder.

Rehder said addictions to opioid painkillers often begin with a legal prescription following an injury, such as when a high school athlete gets hurt.

“An athlete breaks a leg or whatever, they go to the doctor, they get an opiate to help with the pain, and then if that person is predisposed to addiction, they become addicted.”

Before giving the bill first-round approval, the House changed it so that by 2020, pharmacists will have to report information to the registry in real-time.

The sponsor of that change, Representative Lynn Morris (R-Nixa), owns a chain of pharmacies.

“By doing real-time, all my stores are connected real-time, and we know how much importance that is in trying to catch people that are drug shopping every day, and we catch them and we don’t fail to catch them,” said Morris.

Opponents say a PDMP creates a government database and poses a threat to the privacy of anyone using prescription drugs.

Representative Rick Brattin was among those Republicans who opposed the PDMP legislation filed by one of their fellow caucus members. (photo; Tim Bommel, Missouri House Communications)
Representative Rick Brattin questioned the PDMP legislation offered by a fellow Republican, but voted for the bill on perfection. (photo; Tim Bommel, Missouri House Communications)

Harrisonville Republican Rick Brattin also argued PDMPs must not be effective because they exist in all other states, yet President Donald Trump has launched a task force to fight opioid addiction.

“So that would lend to me that this sort of program does not work and it has no effect, and if it has we would not be issuing a task force for the entire country to tackle the overprescribing of opioids,” said Brattin.

Ash Grove Republican Mike Moon also maintains PDMPs are not effective, and urged his fellow lawmakers to consider whether Missouri should launch one.

“As of 2014 Missouri ranked 24th in the nation related to the number of deaths due to prescription drug overdose, and we’re not participating in the PDMP.  You’d think that Missouri would be number one in the abuse category, but we’re not,” said Moon

Brattin and others offered other changes to HB 90 saying it needed to be strengthened, in part because similar versions have stalled in the state Senate in past years.  Rehder urged legislators to reject them, saying that over the five years she’s handled the issue, stakeholders including law enforcement and medical experts have helped develop the language she’s proposing.  Those amendments were then rejected.

Another favorable vote would send the bill to the Senate, where in past years it has been stopped primarily by Senator Rob Schaaf (R-St. Joseph), who has his own PDMP proposal which cleared that chamber early this month.