PDMP – 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.

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:

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.

House champion of prescription drug monitoring praises governor’s program, says hers is still needed

Missouri now has a prescription drug monitoring program but it’s not the kind of program one state legislator has been proposing for years, and she says hers is still needed.

Representative Holly Rehder (R-Sikeston) calls the PDMP Governor Eric Greitens (R) launched Monday with an executive order, “outside the box thinking,” that will, “work really well.” She said Missouri counties should not, however, stop pursuing a program like the one she has promoted.

Prior to Monday, Missouri was the only state without a PDMP. Such programs aim to fight opioid addiction and “doctor shopping;” the visiting of multiple doctors while attempting to obtain as much as possible of drugs to be abused.

Greitens on Monday directed the Department of Health and Senior Services to track the prescribing and dispensing of schedule II-IV controlled substances. It will look for cases in which such drugs are being inappropriately prescribed or dispensed.

Unlike with Rehder’s proposed plan that data will not be available to doctors so they can look for signs of abuse and act to, among other things, offer help to abusers.

“It’s of the utmost importance, in order to treat addiction – which is at the core of this epidemic – for our medical professionals to be able to see this data. We need to be able to catch addiction on the front end and that’s what the traditional PDMP does,” said Rehder. “The executive order is phenomenal – very much outside the box thinking. I think we’re the only state doing this, which is going to be just an excellent cross check with the PDMP, and so I think with these two programs together we will have an extremely robust system focusing on the opioid epidemic, and so I’m very excited about it.”

Several counties in Missouri, St. Louis County being the first, have adopted their own monitoring programs that are more like those proposed by Rehder. She said since Monday she has been working to urge other counties not to back down from plans to adopt a program like St. Louis County’s.

“I’ve had to educate many on the fact that these are two very different programs,” said Rehder. “We had a couple of counties that said, ‘Hey, the state’s executive order gives us a statewide PDMP.’ One even cancelled a meeting for today that was going to approve an ordinance.”

Rehder said around 60-percent of Missouri’s population is already living in an area that has a monitoring program. She plans to keep urging counties to adopt one, and depending on the success of that effort, she might again propose legislation to create a statewide monitor when the legislature is in session in 2018.

House backer of prescription drug monitoring wants a special session to get program passed

The legislative session has ended without passage of a statewide prescription drug monitoring program (PDMP), but the top advocate for that issue hopes the legislature will be called back early to try again.

Representative Holly Rehder (R-Sikeston) has been pushing for a statewide PDMP for several years. Missouri is the only state that does not have one, though several of its counties are participating in a program based in St. Louis County.

She kept fighting until the final hours of the session on Friday for passage of a bill to create a program. Now she hopes Governor Eric Greitens (R) will call a special session of the legislature to focus on the issue.

“I think if there’s any hope of us getting a statewide [PDMP] passed it’s going to have to be a special [session] sooner than later, and I’m going to have to have help from [legislative] leadership,” said Rehder.

Backers of PDMPs say they help fight prescription drug abuse, particularly opioids. PDMPs 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 get as much as possible of drugs that are commonly abused.

Rehder came away from a conference between selected House and Senate members with a version of the program that would purge patient data after two years; would include reporting on all schedules II through IV drugs; and a mandate that all physicians would have to report to the system. She said she simply ran out of time Friday to educate fellow lawmakers on the measure to get it passed.

She said in order to get a statewide PDMP passed time is now of the essence, because with no program having been approved by the legislature, more counties will be looking to join St. Louis County’s system.

“We’ve kind of reached a tipping point with these counties,” said Rehder. “We can never get that type of a robust program out of both [chambers of the legislature], yet I need counties’ representatives’ votes to get it out of the House, and so … if we don’t get this out in something like a special session right away, the more counties that get added, just the more reps that are going to have to be against it.”

Rehder believes if the legislature is called back for a special session it will be able to come to agreement on a monitoring program, and she thinks it will look much like the bill that came out of the conference committee in the final days of the session.

Rehder said if a county-by-county PDMP is the only option, she’ll support that, but she still thinks it is important that a state-run PDMP be created.

“We shouldn’t be penalizing people’s safety because of their zip code,” said Rehder, saying anyone could drive until they are in a county that isn’t participating in a program.

She noted proposals for a state program would also prohibit authorities from using prescription data to prevent individuals from owning guns – a provision the St. Louis County program doesn’t have.

In order for a bill to pass the House, Rehder would likely need to regain the support of urban Democrats whose districts are covered by the St. Louis County program. Many voted against the final proposal to come before the House, viewing the program it would create as less robust than the county’s.

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).

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.

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)

House Bill 90 would make Missouri the 50^th 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 24^th 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.

With Senate prescription monitoring plan close to passage, House remains focused on its member’s version

The Missouri Senate appears prepared to endorse a prescription drug monitoring program. The House, however, remains focused on a plan proposed by one of its members who said the Senate bill won’t do the job.

Representative Holly Rehder has proposed for several years the creation of a prescription drug monitoring program in Missouri. (photo; Tim Bommel, Missouri House Communications)

Backers of PDMPs say they help fight prescription drug abuse. They are intended to catch people in the act of “doctor shopping;” visiting multiple doctors in an attempt to get their hands on as much as they can of prescriptions commonly abused.

The Senate has given initial approval to a Senate Bill 74 sponsored by Senator Rob Schaaf (R-St. Joseph), meaning another vote could send it to the House for consideration. Schaaf has blocked advancement of earlier PDMP bills saying they would invade Missourians’ privacy by creating a database of their prescriptions.

His plan would let doctors submit a patient’s name to the Bureau of Narcotics and Dangerous Drugs. It would then give that doctor access to the patient’s medical records only if the Bureau determined the patient is a potential abuser.

Sikeston Representative Holly Rehder (R) has sponsored PDMP legislation in the House for several years. She said neither her nor Schaaf are willing to budge on their approaches to a plan.

“He would allow physicians to see what their patient is doing if a red light comes back. Well, you know, that’s after a problem has already been discovered and we’re already down that road,” said Rehder. “Physicians need to be able to have full understanding of what their patients are on and what they’re doing so that they can make those best clinical decisions. I’m not able to give on that point because to me that’s the most important part to help this epidemic that we are in. That’s the way to decrease overdoses. That’s the cornerstone of this legislation.”

Missouri is the only state without a PDMP. Other states allow doctors to access their patients’ prescription information through a secured database. Rehder said such a database gives doctors quick access to information they are already authorized to view.

“They just have to call around and get it from kind of doing the phone tree – calling the pharmacies and other doctors,” said Rehder. “This just allows a one spot place that the physicians can go, that pharmacists can go to make sure that they’re not prescribing something that’s harmful, that’s going to counteract with other medications … this a huge opportunity for physicians to be able to spot the signs of addiction early and to help get that person on a manageable path back to a healthy lifestyle.”

As for Schaaf’s concerns about privacy, Rehder said the prescription drug database would be encrypted.

“If somebody were to get this information they wouldn’t be able to read it,” said Rehder. “[Health Insurance Portability and Accountability Act] laws – our federal laws – really cover this area very well, which is why we have electronic medical records, and this is just another portion of that.”

Rehder says Schaaf’s bill is also so expensive it might never be implemented. Legislative researchers estimate that if passed, SB 74 would cost more than $1-million dollars in Fiscal Year ’18 – similar to the projected year one cost of Rehder’s legislation – but in Fiscal Years ’19 and ’20, Schaaf’s bill’s projected cost each year is greater than $6.5-million.

Rehder believes the actual cost of her bill would be less than $1-million dollars, and said with grants and other funding sources it would pose less of a challenge to fund.

Rehder took up the PDMP issue in response to her own family’s issues with prescription drug abuse. Her daughter, Raychel, became addicted to an opioid pain reliever after an emergency room visit when she was 17. She went on to abuse other substances including methamphetamine, but has been clean for going on two years. Other members of Rehder’s family have also struggled with abuse issues.

Rehder’s PDMP legislation in past sessions has passed out of the House with overwhelming support only to be stalled in the Senate, where opposition was largely led by Schaaf. House Speaker Todd Richardson (R-Poplar Bluff) said even with Schaaf’s bill close to coming to his chamber, the focus of the House is going to remain on Rehder’s efforts.

“Representative Rehder has been the thought leader on prescription drug monitoring here in the House for some time and for good reason,” said Richardson. “We’ll continue to allow Representative Rehder to stay in the driver’s seat on that bill and we’ll see if we can work through the differences with the Senate.”

Rehder’s legislation, House Bill 90, is nearly ready for debate by the full House.