This story is part of a Daily Citizen series on Springfield’s opioid crisis.
Remember when Missouri was the last of the fifty states to implement a Prescription Drug Monitoring Program? Me neither, because it hasn’t happened yet.
But we’re close.
A Prescription Drug Monitoring Program, otherwise known as a PDMP, is an electronic database that allows health care providers and pharmacies access to data about patients’ prescription history. They use that information to make decisions about whether or not to prescribe certain medications, notably opioids.
Now, as Missouri’s opioid addiction crisis intensifies, there is pressure to develop a PDMP that is not only informative but effective. A final push is being made to get a statewide program out the door by early next year.
Up to this point, large swaths of the state were covered in a PDMP of a smaller scale, widely based off the St. Louis County model, but the lack of a statewide program contributed to inconsistencies and left pockets of the state without any prescription monitoring. Ultimately, these cracks in the system have the potential to put people at risk for opioid addiction.
It’s been quite the journey for Missouri’s PDMP. In 2017, after a stalemate in the state legislature, then-Gov. Eric Greitens took it upon himself to establish the statewide program via executive order. However, access to prescription data was more regulatory in nature by equipping law enforcement agencies with prescriber information rather than public health focused.
Additionally, both Democrats and Republicans in the Missouri General Assembly felt Greitens overstepped by taking executive action. However, it did not last long. Less than a year later, the state Senate’s Appropriations Committee cut funding to the program.
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How we got here
It appeared Missouri was doomed to remain the only state without a statewide PDMP. That was until 2021, when state Sen. Holly Rehder (R-District 27) sponsored legislation to establish the statewide program. On June 8, 2021, Gov. Mike Parson signed SB 63 into law, which established the Joint Oversight Task Force of Prescription Drug Monitoring.
“Establishing a statewide prescription drug monitoring program has been a top priority for my administration, and I want to thank Sen. Rehder and Rep. Travis Smith for working to get this landmark legislation across the finish line,” Parson said in a news release. “SB 63 will help provide necessary information to health care professionals and empower them to make decisions that better serve their patients and assist in fighting the opioid epidemic in Missouri.”
The task force is composed of six individuals from the Board of Nursing, the Board of Pharmacy, the Board of Registration for the Healing Arts and the Dental Board, all of which are within the Missouri Division of Professional Registration.
Dean Linneman, the former director of the Division of Regulation and Licensure in the Missouri Department of Health and Senior Services, was selected to serve as executive director of the task force. In this role, Linneman will assist the task force in picking a vendor via a bidding process, who will be responsible for storing and using the prescription data collected.
Key points of opposition tied to privacy, effectiveness
A recurring concern among opponents of PDMPs is privacy. To quell those fears, Linneman emphasized the standards to which the vendors will be held.
“This is going to be a major concern in the bid process when we’re selecting vendors,” Linneman said. “How they will be able to ensure us they will be able to protect the data submitted to them through the PDMP.”
Thus far, PDMPs’ effectiveness in lowering opioid-related consequences has been limited and with mixed results.
A study from George Washington School of Medicine and Health Sciences suggests that while results remain limited, it is difficult to determine the full scope of their impact.
“A study analyzing ED physician utilization of PDMPs in Wisconsin found that 97 percent of users reported that it was helpful in identifying patients with patterns of drug abuse and 90 percent of providers prescribed fewer opioids as a result,” the study read. “However, 36 percent of physicians from the sample size did not use the program, with commonly reported barriers being limited knowledge on the registration process or not obtaining a DEA number.”
Results can also be mixed due to the varying characteristics of PDMPs from state to state, as they are established by each state’s government.
“PDMPs are going to be as effective as the statutes that created them,” Linneman said.
Linneman is hopeful that Missouri can use lessons learned from both failures and successes in other states to make Missouri’s program as effective as possible. He thinks equipping prescribers with access to a statewide PDMP will lead to less overall prescriptions and ultimately fewer opioids in the hands of those who may be at risk of misusing them.
Missouri District 30 Sen. Lincoln Hough was supportive of Rehder’s legislation and thinks having a statewide PDMP is a good first step in tackling the opioid epidemic.
“There’s probably no perfect solution for this, and there’s always going to be someone who can say there’s a boogeyman here that is an unintended consequence,” Hough said. “It’s a tool, it’s something that I believe in. Trust the professionals on this. If you make a difference in a few lives, that’s what we’re tasked with doing.”
Between the vendor bidding process and promulgation, Linneman is expecting Missouri’s statewide PDMP will be up and running sometime in the first quarter of 2023.