Missouri: Time to monitor prescription drugs



One might guess that being the only state without something may not be a good distinction to have. In the case of the map to the left they would be correct. Missouri, highlighted here, is the only state to not have a prescription drug monitoring program or PDMP. PDMPs are tools used by doctors to look up what narcotic and potentially addictive drugs like opioid medications a patient receives in the hopes of stopping those that are abusing them or selling them. Deaths due to opioid and heroin have reached epidemic proportions; Missouri needs a PDMP.

The Centers for Disease Control and Prevention estimate that approximately 91 Americans die every day from an opioid overdose and since 1999 the amount of pain medication sold has quadrupled! On its website the CDC even recognizes how important PDMPs can be to reducing prescription drug deaths.

Countless other organizations such as mental health groups, drug policy think-tanks and physician groups, including the nation’s largest doctor group, the American Medical Association, have come out in support of states establishing these databases. One scientific study showed that using PDMP reduced the supply and abuse of opioid medications.

Why then does Missouri not have one? The answer lies with political action groups and conservative statesman that have blocked legislative efforts that create PDMPs. United for Missouri and Missouri Alliance for Freedom both believe that legislation like this erodes a citizen’s right to privacy and constitutes government over-regulation. Their biggest ally, State Senator Robert Schaaf, has gone so far as to filibuster bills that introduce them.

The truth is the people of Missouri must establish programs that have decreased opioid deaths. Senator Schaaf should stand down and the legislature should join the rest of the nation in establishing a prescription drug monitoring program




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6 Responses to “Missouri: Time to monitor prescription drugs”

  1. earnestrebecca Says:

    I completely agree that Missouri needs a prescription drug monitoring program (PDMP), and would also go one step further and advocate for tackling prescription opioid abuse from two angles: the supply and the demand side. As has been done with tobacco and alcohol previously, strategies to curtail the easy supply of prescription opioids, including PDMPs, can help to reduce the number of substance abusers, or at least help public health officials to better understand the scope of the problem. However, it’s also important to pair these strategies with ones that address the demand side of prescription opioid abuse like medication-assisted and behavioral therapy treatment and attempting to address some of the underlying factors behind abuse (e.g., socioeconomic depression). Tobacco and alcohol don’t really have illegal markets in the United States, so markets can be easily monitored and regulated, enabling supply-side strategies to have a substantial impact in reducing the associated negative health effects, Prescription opioids are different however in that they do have a thriving illegal market where heroin and other illicit opioids are sold. The issue with supply-side only strategies is that they can drive prescription opioid abusers to turn to cheaper and more readily available illegal opioids like heroin, which can have an even worse health effect given the lack of regulation in what it contains (e.g., fentanyl-laced heroin has caused a recent surge in opioid deaths) and how it pushes substance abusers even further away from the health system given its illegal nature. So, to conclude, I think this is an excellent blog about one of the big supply-side issues, but it will be important for Missouri to pair this with demand-side strategies like increased access to treatment.

  2. mariew90 Says:

    I agree with you 100% that Missouri needs a prescription drug monitoring program. Abuse of addicting prescription drugs is a national problem. I am from Florida and the issue of pain clinics and the overprescription of pain medications has been a hot issue recently. People with genuine medical issues that should have been addressed for root causes and not just symptoms, were being over prescribed pain medication to the point of addiction. Thankfully, many of these pain clinics have been shut down. What happened in Florida is not an isolated case, but is an example of dangerous over use of prescription drugs can be.

  3. shawngul Says:

    Great post! I enjoyed the effective attention-grabber with the opening sentence, and the simple picture was also useful in illustrating your message. Given the effectiveness of a PDMP in other states, it is amazing that Missouri has not followed suit. I completely agree with your argument, and this posting argues it well. The essential theme of this post is to ask the famous public health question – is the public willing to make a small sacrifice regarding privacy in order to enjoy health benefits?

    In the case of Missouri, it appears that conservative leadership in the state have weighted privacy greater than the health benefit. This is unfortunate given (1) the widespread problem of opioid overuse in America, and (2) the “loss” of privacy with PDMPs seems to be overstated. Regarding the second point, in looking at other states, it does not seem as though clinical access to this information betrays the public’s privacy. In any case, I enjoyed your post. It was concise, straightforward, and well argued. Nice job!

  4. csalmero Says:

    Great topic, although i’m inclined to side a bit with caution. I believe that it is imperative that citizens maintain their rights to privacy, particularly when it comes to medical history. That being said, I do think that Missouri residents have the right to request monitoring be done in a safe responsible manner, that in no way puts their prescription history at risk of scrutiny, or external use outside of the mission of the program. Instances of such abuse of power have already called into question the nature of the monitoring program and the right to privacy; in 2014, the ACLU along with residents sued the DEA for violation of the right to privacy in the state of Oregon, when the DEA attempted to forego warrants and demanded information collected by the database purely by administrative subpoena. In this instance they were successful, but I can imagine where in other situations, such as the current political climate surrounding immigration, where information may be used against the exact populations they set out to protect. While I agree that PDMPs are effectively preventing drug abuse deaths, I think it is important that safeguards to any program be put in place and the policy to protect those rights be explicitly laid out before databases begin to collect private information of a sensitive nature.

  5. shkhaiat Says:

    First off, I was shocked to hear there is still a state that doesn’t have a monitoring program to look over drug prescription. Especially when drug overdose deaths are increasing every year. This post prompted me to read more about the PDMP program and its limitations. I believe that PDMP has some real flaws and there is still a need for a better approach to monitor drug use and prevent drug abuse. Patients can easily deceive this system by crossing the borders to another state and giving false information when they register in hospitals and clinics. I also agree that the patients have the right to their privacy and keeping their medical history confidential. Also, sometimes the medical histories are not recorded accurately or may have missing data that can cause it to be interpreted in a wrong way. These records are also not readily accessible 100% of the times and that could slow down the health care services. I am still surprised and disappointed that this state is neglecting this important issue but I also believe that PDMP is absolutely imperfect and controversial and they need a comprehensive program to approach the problem of drug abuse.

  6. nidhi0912 Says:

    Thank you for sharing this interesting blog! I completely agree that the state of Missouri needs to adopt a Prescription Drug Monitoring System (PDMP) to check for high-risk prescribing and patient behaviors. PDMPs are statewide electronic databases that track the prescribing and dispensing of controlled substances to the patients, particularly important in cases of patients who might be seeking prescriptions of multiple providers. Studies have shown the success of implementing PDMPs in other states to curtail the epidemic of prescription drug overdose, especially prescription opioids. One study published in Health Affairs showed that a state’s implementation of the program was associated with an average reduction of 1.12 opioid-related overdose deaths per 100,000 population in the year after implementation (http://content.healthaffairs.org/content/early/2016/06/16/hlthaff.2015.1496). PDMPs are certainly a good resource for practitioners, however are not perfect. An important point to consider here is that about 7% of prescriptions are filled in a pharmacy outside the state, which go undetected by PDMPs limited to the state pharmacies. Additional strategies and support is needed to make the PDMPs more robust so we can track such prescriptions filled outside of the state. The PDMPs can be made more comprehensive and inclusive of nearby states. Legislators are certainly key stakeholders for these policy reforms. Additionally, besides PDMPs, limiting the prescription for opioid pain relievers when treating acute pain to about 7 days, especially by the emergency room physicians is another strategy to curtail the epidemic of prescription opioids misuse and overdose.

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