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long-running battle to establish a database to monitor for prescription drug abuse in Missouri — the only state without one — is about to hit a boiling point.

On one side is Republican state Senator Rob Schaaf, who once said that when people die of overdoses that “just removes them from the gene pool.”

Schaaf, who is a physician, has squashed legislation in the past six sessions to establish a prescription drug monitoring program, or PDMP. But sensing urgency that the legislation might pass this session, Schaaf introduced his own bill to set up a PDMP that’s unlike those in any other state — a proposal that medical experts have called a “sham.”

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In a surprise move, the state Senate passed it in late February.

Now, the House is considering Schaaf’s proposal. At the same time, the Senate and House are both considering another bill, introduced by Representative Holly Rehder and Senator Dave Schatz, both Republicans. Their previous efforts have been filibustered by Schaaf.

“Our medical community all over the state is begging for a way to help address the opiate epidemic,” said Rehder.

But with conflicting pieces of legislation vying for approval, a PDMP may again elude Missouri this year.

Why doesn’t Missouri already have a PDMP?

Efforts to establish a PDMP have been repeatedly crushed by a small group of legislators led by Schaaf. The senator filibustered a measure in 2012 and has threatened to do so in other sessions in the past six years. Even that threat, Rehder said, is enough to keep a bill from being brought up in the Legislature.

Every other state has a drug monitoring program. The power of those programs varies, but they all require doctors and pharmacists to enter prescriptions into a database. The programs are designed to stop patients from being able to “doctor shop,” bouncing from one prescriber to the next to get painkillers.

Doctors in the region say such a database is needed; there were 1,066 overdose deaths in Missouri last year. Even Mallinckrodt Pharmaceuticals — which manufactures oxycodone and is based in St. Louis — has expressed support for the legislation introduced by Schatz and Rehder.

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“This is definitely something that our doctors here in my district, and parents of addicted children, and families, are just clamoring to have,” said Rehder. “It’s extremely frustrating that Dr. Schaaf continues to filibuster.”

Counties in Missouri, frustrated by a lack of legislative action, have started efforts to launch regional drug monitoring programs. St. Louis County established its own PDMP in 2016.

What’s the issue with Schaaf’s bill?

Schaaf’s bill wouldn’t set up a PDMP like others around the country, which give registered medical professionals direct access to a patient’s narcotic history.

Rather, Schaaf’s proposal would force doctors to send to the state health department the names of each patient they’re considering prescribing painkillers. The state PDMP would automatically alert the prescriber to any troubling patterns in that patient’s prescription history. Then, it would be up to the prescriber to make a decision about whether to dole out the medication.

“It’s unlike anything any other state has done,” said Jeff Howell, the director of government affairs at the Missouri State Medical Association. “In other states, a physician or prescriber can just get on and see what the prescribing history has been.”

The association has sharply criticized Schaaf’s proposal, and supports the legislation introduced by Rehder and Schatz.

Howell said he is concerned that having a vastly different system will make it all but impossible for the Missouri database to be used in tandem with the databases of surrounding states. With two of the state’s biggest cities — Kansas City and St. Louis — sharing a border with other states, it’s crucial that the systems be able to communicate, Howell said.

Schaaf did not respond to requests for comment. In the past, he has said his objection to PDMPs stem from patient privacy concerns.

“They don’t work. And it’s an infringement upon people’s privacy,” Schaaf said in an October 2016 interview with local television station KSHB. “Most people don’t want the government to have that information and have it on a database in which many people can get it.”

Schaaf has cited a 2009 case in Virginia in which a hacker claimed to have accessed 35 million prescription records through the state’s drug database.

But others argue his bill will put what should be a medical decision — determining whether a patient is at risk of abuse — out of a doctor’s hands.

“You are charging [the bureau] with making a medical decision and that doesn’t make any sense to me,” Larry Pinson, who serves on the board of the National Association of State Controlled Substances Authorities.

“How are they going to know if there is a true medical reason for that patient to need a narcotic?” said Pinson, who also serves on the Nevada State Board of Pharmacy, which controls the state’s PDMP.

What comes next?

The House is now considering both Schaaf’s measure and Rehder’s legislation. Rehder is confident her bill can get support in the House, which has passed it in two previous sessions.

But Schaaf told the St. Louis Post-Dispatch that he intends to filibuster that version of the legislation if it makes it to the Senate floor. “I’d just as soon not have a PDMP. Would they rather have a database that protects privacy or no database at all?” Schaaf said in a recent interview.

The senator said he has already compromised on setting up a PDMP at all, and is calling on Rehder and Schatz to compromise, too — by supporting his legislation.

“I appreciate the momentum. I appreciate him agreeing that there’s a problem,” Rehder said. But she made clear she will not back down from her opposition to Schaaf’s bill.

“The most important part of being able to spot addiction is on the front end,” she said. “Without physicians having that access, it’s really just putting a Band-Aid on it.”

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  • As a Nurse Practitioner myself and prescriber of potentially addictive substances, I can say I am really glad I’m not a prescriber nor reside in Missouri. I am originally from Alabama and am used to the being at the top or the bottom of all kinds of lists. I am really glad Missouri is taking some heat at this time. Y’all, this guy is a fool. Addiction is a real disease (named by the medicine in the late 50’s) and should be treated like a disease. Doctors like this guy should not be practicing. Everyone wants somebody or entity to be at fault. Some people are more likely to develop diabetes or cancer or heart disease. Addiction is the same – you don’t have to agree or like that comment – it is just the truth – backed up by study after study. They need help just like everyone will need help by the health care system(s) someday. The PDMP is a tool I use daily. Not with all patients but some who exhibit clinical s/s of addictive behavior. I also use other tools backed by medicine including urine drug testing, pain contracts, etc. This guy’s approach is not medicine. It is not science. It is not backed up by any study and frankly most prescribers. His contribution ends up becoming a delay of care to someone slipping into a disease that kills more people by far than heart disease (~1.5 million Americans yearly). Death from addiction to drugs, alcohol, food, and cigarettes is nearly 3 times that of heart disease. Yet, we don’t want to have this conversation. The stigma is just to painful. So we would rather bury our heads in the sand and say heart disease is the number one killer. The truth is there is not a single person on this thread (I bet Dr. Dummy himself) that has not felt the sting of this disease in some way. There are people on this thread that couldn’t go a couple of hours without their smartphone. It’s addiction. It is the same behavior that brings people down this ugly path. We need to talk about this problem. We need to get rid of fools such as Dr. Dummy above. We need to try harder to have compassion for these people. Next time you get a chance, google famous alcoholics and addicts. The list will surprise you.

  • It seems disingenuous to have so many concerned physicians when they are the ones that overprescribed in the first place. Now they have addicts who need a new (expensive and usually not covered by insurance) drug to treat their addiction- suboxone. So they can control their patients at every stage, and keep them coming back indefinitely. And even fearful of exposure…

  • WHY is the government so hell bent to save drug addicts from themselves? Why are they so willing to destroy the lives of those living in pain and taking actions to deny lifesaving analgesics, and drive them to suicide, heroin, street drugs and illegal activity? What NO one knows is these monitoring programs are allowing PHARMACY staff to easily divert others drugs ! We found a patient in California who was being fired from pain clinic after pain clinic without reason. HE couldn’t access his own state monitoring records so he had no idea that pharmacists were using him for narcotic identify theft ! He’d fill his rx for 150 percodan at one CVS, the interestingly within 3 days, his “CURES” report would indicate he’d filled small rx’s for more percocet in surrounding CVS pharmacies ! ONLY CVS could be responsible, because THEIR PHARMACIST should be checking when every rx is filled and would see the same individuals name day after day. ETHICAL pharmacies would have pulled the plug, but this would have alerted the patient to his identity theft by CVS ! MONITORING program data must be available to all, otherwise it just shields victims from discovering they’re identity is being used, and they can’t report the pharmacies. WE HAVE GOT TO STOP this salvaging of drug addicts and forcing others to illegal activity and need for street drugs

  • I am a resident of Cedar Hill Mo. I lost my Son to a Heroin overdose… Persprition Drugs lead to His addiction addition… Keep me updated on meeting in my location

  • Fundraisers: trot out children-get lots of $
    Drug laws: trot out privacy concerns.
    As health care providers, we are very concerned about privacy (and children) but it has become a very convenient political inaction tool.

  • The Prescription Drug Monitoring Program is communistic and fasicism at its best. It is evil to the core.
    It makes pharmacists and physicians look at patients as criminals. It breaks the federal Hippa law.
    It is an invasion of privacy.
    As a physician, I can only pray that those people that instituted this program some how find their way
    out of the path to HELL.
    I have run a methadone program, an inhouse detox program and had the suboxone license for maximum
    patients.
    I have NEVER met a drug addict. I have met many, many people with health care and mental health issues
    of which are now viewed as CRIMINALS because of the PMP. The problem is BLACK MARKET CRIME.
    The problem is not patients with health care issues.
    The problem is not innanimate objects such as drugs.
    The PROBLEM IS BLACK MARKET. When searching for answers, I discovered that all of the people in
    authoritarian positions that say ILLEGAL DRUGS MUST BE ILLEGAL, I have found that it is these
    people that are involved with the illegal manufacturing of street drugs, and they are making lots of
    money. THE PMP is a method so that black market can thrive and nothing else.
    I have found the manufacturers and dealers to be authoritarian figures, Police, Mayors, Senators,
    Congressmen, Governors, ANd at least 3 of our Presidents.

    It is evil beyond evil an anyone that supports the PMP is involved with the illegal drug trade making
    money, Or they are just useful idiots, that drank the kool-aide.

    • You sound crazier than a meth addict, and I have seen a few in Missouri. The tenuous fact that you claim to be a physician simply baffles me. The thought that you have never met a addict is a hasty generalization. Your statement misrepresents the real opioid epidemic we have in the country not to mention Missouri

    • You are a physician? You know posing as a licensed health care provider is a crime right?

      I am an ARNP in a neighboring state. I have met many alcoholics and addicts. As a matter of fact, I am an alcoholic myself – been in recovery for 5 years. I can speak very intelligently on this subject.

      My professional opinion in regards to prescription pain drugs is not that we have a drug problem necessarily, we have a quantity problem. If it were up to me, all prescribers would only be allowed to write for up to 30 days worth of drugs. After 30 days, the patient MUST be seen by a pain clinic. Pain clinic prescribers MUST be trained in addiction medicine. This is my policy in my clinic. I do not write for any pain drug past 30 days in a 3 month period or for the same diagnosis. HOWEVER, it is very important to note that every attempt that has been made to control Rx drugs has only exacerbated the heroine epidemic. Example: Hydrocodone being a scheduled II drug. Did it help? Nope. We have a real health crisis on our hands and it will take a real approach. Lack of empathy or saying ugly things about this patient population has never worked. I just read the other day that people are taking Immodiam AD to get high! That is illness.

      Folks, please don’t pose as a prescriber. It is illegal and just stupid. Those of us who are prescribers can rat you out because you sound so ignorant.

  • How on earth do these people get away with this kind of thing? This guy, who probably should be investigated by whoever polices prescription drug profiteering by physicians, and that little coterie of Republicans whose intransigence on Real ID is causing Missouri to have unacceptable state IDs for travel by air. It’s terrible that those districts clearly don’t have any good other choices for representation, or they’d elect someone better.

    • Real ID is a terrible idea that unnecessarily infringes on privacy. This is different because only medical professionals who need it have access. BTW… Even the American Civil Liberties Union opposed Real ID. They are far from a Republican leaning organization.

  • Thanks for covering this important issue. I’m embarrassed to say I live in the state without a drug monitoring program AND the lowest cigarette tax in the country. Missouri is not a healthy state and the Republican controlled legislature and governor aren’t likely to change that.

    • Gregg? You think that the Government should have the power to say how much pain you live in? Well good for you! But any Gov. that thinks they have the power to dictate by guideline the amount of physical pain you, me, your parents, Grand parents and children live in, is confused beyond reason! Go look up the Government, NIDA and other medical agencies, ASAM and you will find that the Governments own figures don’t even support what they are saying! According to NIDA and ASAM, less than 1% of Americans have abused prescription medications and that includes those taking other peoples medications and that is an epidemic. Yet 7.2% of Americans abuse alcohol and it isn’t an epidemic. Were being played and the Governor of Missouri is right to stop this crap! Here is another way to look at it! NIDA – “While drinking alcohol is itself not necessarily a problem—drinking too much can cause a range of consequences, and increase your risk for a variety of problems.” NIDA on “drugs” – “What is drug addiction?

      Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.† It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse drugs.” The Governments own agency on “drug addiction” can’t get it’s facts straight, why would we allow these people to control our lives over a “brain disease” that only applies to “Drugs” of the Governments choice!

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