Tag: prescription drug monitoring program

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.

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)
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.