A 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.”


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.

“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.”

Leave a Comment

Please enter your name.
Please enter a comment.

  • As a physician, I totally disagree with Rob Schaff, MD.. We are so busy in the office that just checking the PDMP takes time out of seeing patients. It is necessary, but has to be done efficiently in order to continue to see other patients. If doctors were asked to submit a name to the state and wait for a response that would hold up a lot of prescriptions and time and energy of doctors and staff. It is actually ridiculous. In order to help people, we need to be able to quickly access whether patients are drug seekers or not. Those who are in true pain and need relief, need it now, not after a state reviews it.

  • Government FDA and dea have been a major cause of death and suffering to people who have verafiable diseases and accidents. Darvon products were recalled instead of being blaccke boxed warning due to lobbying by Ralf nadars org. FDA then Published to Dr to go right to oxies. Instead of milder ones.now the la5est findings disputed by some in cdc that the recommendation has no fact basis,yet some states have made the recommendation law and stats show that most patients don’t abuse,and some get addicted and Dr quickly detox them and the rest were drug seekers and previous addicts.and in deaths most are herion and fynantol and average one has 5 different drugs in system. And some have committed suiside over the inability gto receive the meds in dosage necessary. And the pain centers have become legal extortion in some cases excessive charges wanting to do invasive procedures. A large profit center now.to the point my mother 96 fell hurt back and x-ray showed possible trade but was she sent to a Ortho or nuro doctor no all they wanted to do is have her see pain clinic.she was gjiven 7 days tramadol and used about half.and fortunately the X-ray showed her older injury.but why they would not let her see a back doctor is very disturbing. A year earlier she broke her wrist was operated on and again about 4 days of meds were enough.government run healthcare is a very scary thing and we’re getting pushed toward total government dictates on health we all need to worry. Or the USA might try the Liverpool protocol England got caught doing .look that up.

  • What is the ANSWER or SOLUTION for Legitimate Pain Patients? Those of us
    who were ABLE to maintain normal, active lives BECAUSE we were on a
    daily (and conservative) regimen of a particular pain killing OPIOID… We have NOW been “thrown under the bus” because of irresponsible drug addicts who had no legitimate need for Opioids to begin with.
    This entire scenario is outrageously UNFAIR. Where do we turn for help?
    Our Texas State physicians have their hands tied due to PDMP regulations
    prohibiting them from prescribing (even conservatively) ANY kind of OPIOID
    pain medication. As a result, I (for one) have been reduced to a sedentary,
    semi-invalid existence BECAUSE of non-stop, chronic, acute pain (from
    Degenerative Disc Disease) which was dealt with, for ten years, thanks to my
    pain-killing OPIOID (Oxycodone) prescription; now, NOTHING is offered
    to deal with my pain….and NO, I am not amenable to Steroid Shots, Surgery,
    or “Pain Psychology”? Where do we turn for HELP?

    Barbara Van Camp

  • I applaud Senator Rob Schaaf‘s position and his resolve. It would be wonderful if more elected officials would stand up for the rights of the citizens they represent. It is appalling how easily the majority of elected officials feel it is their right to take away my rights just because a drunk driver crushed a vertebra in my spine, and it didn’t heal completely because of ruptured disk material mixing with bone shards. So I have pain every day. My pain is manageable with medication, but in order to have medication I am cohersed into signing a pain contract and my doctor puts my personal medial info in a data base that is accessible to many including doctors, pharmacists, law enforcement, child protective services, etc. What about my HIPPAA rights? Did I give them away when the drunk driver injured me? It’s funny because, even though he left the scene and was not financially or otherwise responsible, he was in the wrong. He broke the law. But I’m the one who loses my right. I did nothing wrong and I not only suffer at his hands, but I am forced to suffer even further from our government. This is wrong. I ask someone, an attorney or someone in power to stand up for us like this senator is doing. He should be celebrated not condemned.

  • Bobby Rich and was told my script was way too much for my need so now im going to go back to my way of dealing with the pain which will most likely do more damage than the pills says:

    I’m on opid painkillers have been since 2010 with each passing year its increased but now I’m being told I’m an possible addic and not allowed to have what I need to keep me able to have a normal day to day activicty without pain so what am I to do stop living since I need these drugs that I’m being told that I don’t go back to drinking moonshine everyday just to cope with the pain …. pls answer I would like to know what to do Bobby

    • I agree with you Bobby. I have been on opioids since 93. But with me my dose is only 4 a day. And never had to go up. Thank god. I live in CO. And here they are not following the guide lines from the CDC. they are not reviewing your records completely. And just refilling scripts. I was told if I did not sign this contract that I would not get my meds. In the begining of the contract. Looks really good warnings and things but when you get 3 pages in. It talks about how they are the only ones that can prescribe to you. And random UA’s, pill conunts you name it. I have never Dr. Shopped, been convicted of any crimes or anything. That recorder thing here is broken and taking the rights away from other Dr.s and yourself. I stand with your Rep that say no…… His way I feel is better. But honestly no one is going to stop the drug abusers. Never have never will. All this monitor thing is doing is mske good honest folks out on the streets looking for something that would help them. Turning them into addicts. Thumbs up for your state Rep.

Sign up for our Daily Recap newsletter

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy