Monitoring prescription drugs: Missouri likely to remain only state without program

Gary Henson of Kansas City was in the middle of a celebratory dinner in New York when he got the call.

His 20-year-old son, Garrett, had died from a drug overdose in Colorado.

Garrett had been in and out of rehab for months. Henson said his son got hooked on opioid drugs during high school.

Since Garrett’s death in 2015, Henson has sat on the board of Shatterproof, a nonprofit that aims to get a prescription drug monitoring program passed in Missouri — the only state that doesn’t have one.

Advocates say such a program is needed to prevent “doctor shopping” — going to numerous doctors to get multiple prescriptions — and to curtail rising opioid addiction. According to a Centers for Disease Control and Prevention study, 1,067 people died from opioid overdose in Missouri in 2014.

Two versions of prescription drug monitoring bills have once again been proposed in the General Assembly. One, sponsored by Sen. Rob Schaaf, a longtime opponent of a drug monitoring program, focuses on privacy protection. It won Senate approval Thursday.

The other is sponsored by Rep. Holly Rehder, a longtime champion of the idea, and focuses on giving physicians access to information. Her proposal is similar to the program that Kansas has had since 2008.

Schaaf, a St. Joseph Republican, has come ready for a compromise. Rehder, a Sikeston Republican, has come ready for a fight. Unless they can reach an agreement, the idea is likely doomed for another year.

While Henson said he’s unsure whether a monitoring program could have saved his son, he thinks a drug monitoring system would save the lives of others. Drug monitoring, he said, “is a step in the right direction of reducing the opioid abuse in our country.”

Schaaf doesn’t buy the argument that drug monitoring programs save lives.

“If you look at the death rate from opioids and the addiction rate, they continue to go up across the nation in spite of having 49 states with” drug monitoring, he said. “That gross measure in and of itself shows that they don’t work.”

He acknowledged that drug monitoring does help catch doctor shoppers. But he said most drug abuse doesn’t arise from that practice.

“Most of the diversion is really people not lying about seeing other doctors but lying about having pain,” Schaaf said. “You can catch them lying about seeing other doctors with a (monitoring program), but you can’t catch them lying about pain.”

Under his bill, Missouri’s drug monitoring program would rely on a computer system to flag possible abuse.

A physician would log in with a username and password, and then enter the medication he or she wants to prescribe to the patient. If the patient had received multiple prescriptions, the system would prompt the physician to enter his or her own Social Security number. Only doctors would have access to the full medical history of patients flagged by the system, and information about a prescription would be purged after 180 days.

“I’m trying to find something that protects our liberty and our privacy,” Schaaf said. “And I think I’ve come up with a way to do that.”

House version

To Henson, Schaaf’s bill is “a complete farce.”

Henson said prescription drug monitoring is about more than catching doctor shoppers. He thinks drug monitoring programs do save lives when they allow doctors to prescribe medications with more knowledge.

His son died from a combination of Xanax and opioids, which is why he thinks it’s essential that physicians always have access to a full list of their patients’ medications.

“In my mind, a (monitoring program) is a better practitioner tool,” Henson said.

Rehder agrees.

Her bill, which has not yet been debated this year in the House, would give physicians and pharmacists access to the full prescription history of any of their patients.

Henson said this access would allow caregivers to make more informed choices when prescribing medications that could negatively interact with one another.

Under Rehder’s bill, physicians and other prescribers would enter prescription information into a database. That database would be accessible to other physicians who care for that patient.

“That’s going to give the best patient care,” Rehder said. “... That’s how you tell addiction; you catch it on the front end.”

Critics argue that Rehder’s bill would put patient privacy at risk.

Compromise unlikely

Though Missouri does not have a statewide program, it does have a county system that includes some of the largest counties and cities in the state, among them Jackson County, Kansas City, Independence, St. Louis and St. Louis County.

Each time a new county or city joins, its information will be combined with that of other members.

The county network system is set to roll out April 1. When it does, it will cover about 35 percent of Missourians.

Schaaf’s bill would dismantle the county system once the new state system is fully operational. Rehder’s bill mirrors the language that the county system is based on, so the county system would simply be rolled into the new statewide program.

Schaaf said his bill would protect Missourians from the privacy-infringing measures that the county systems allow.

“Already we have political subdivisions that are creating (monitoring programs), so it would be better to have a statewide one that protects their liberty than multiple ones that don’t,” he said.

Rehder counters: “We don’t want to take a step back and circumvent the good work that the counties are doing.”

She has pushed her version for years, narrowly winning House support in 2016 but never getting it through the Senate.

On Thursday, Schaaf proposed changes to his bill in the House that would cause the monitoring system to flag physicians if their patients had been prescribed monitored drugs by any other physician.

“I’ve been trying to compromise for years,” he said. “You would think that a version that would ... give physicians all of the information they would need would be worth having and that (Rehder) wouldn’t reject it just because it protects the privacy of Missouri citizens better.”

Rehder is not ready to back down. If she had to pick between Schaaf’s bill and not having a statewide program, she said the better option is “not having one.”

This story was originally published March 3, 2017 at 2:28 PM with the headline "Monitoring prescription drugs: Missouri likely to remain only state without program."