After months of debate, Missouri remains the only state in the country without a prescription drug monitoring program.
Chances dwindled Tuesday when the legislation’s sponsor, Republican Rep. Holly Rehder of Sikeston, asked to set it aside rather than take a vote on a significantly amended version that would have threatened existing county monitoring systems.
Rehder on Thursday requested a conference with the Senate to try to reach a compromise. But nothing came of it, and when the session ended Friday, the bill was dead for another year.
“We came closer this year than we ever have,” Rehder said in a statement to a Cape Girardeau TV station. “(Two) people overdose every day in MO. I’m not going to give up.”
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In April, Rehder got House colleagues to approve her bill 102-54. It would have allowed physicians to access a patient’s full medical record, with a goal of reducing “doctor shopping” and prescription drug abuse.
But the Senate tacked on amendments that would purge the data after six months; another would mandate that doctors use the drug monitoring system or face possible criminal penalties; and a third would limit the monitored drugs to benzodiazepines and opioids.
The proposed Senate changes, if passed, would have superseded the ever-growing system of county drug monitoring programs that will be active in at least 20 counties and several cities by June 1. Many supporters of the House bill balked at passing a Senate version that would have replaced tough county-based systems with a weakened statewide system.
“To pass a watered-down program that takes away the ability for counties to do this in a more effective way I think does harm to my district and to many folks in the state,” said Rep. Peter Merideth, a St. Louis City Democrat.
Rehder, who has been fighting for drug monitoring for years, had long said she would rather have no drug monitoring program than a monitoring program that follows the guidelines set by the Senate.
But Tuesday evening, she urged colleagues to approve the Senate version. Lawmakers could fix any problem down the road, she said, because it would take 18 to 24 months to roll out the system.
“This gives us a statewide framework to build upon,” Rehder said Tuesday. “It’s not as robust, but it is a good statewide framework that really covers the most abused and misused drugs.”
But a history of fierce resistance in the Senate left some, like Republican Rep. Keith Frederick of Rolla, doubtful.
“This is a triumph of hope over reason,” Frederick said. “You think it would work, you hope it would work, you want it to work. But really, when you peel back the onion and look at this issue, you will become convinced that it will not work, it has not worked and it won’t meet what the future problem is.”
The bill needed significant Democratic support to pass the House in April. But that support collapsed Tuesday, especially among those who represent counties that already have drug monitoring programs.
Jackson County passed a drug monitoring program in 2016. Kansas City signed on shortly thereafter.
The Senate version “would ultimately be better for folks in the state whose counties have not joined in the county-by-county state program,” Merideth said. “But it might actually hurt those of us who have joined into the state program.”
Some Republicans also struggled to swallow the Senate amendments, taking issue not with the changes to the county system but with the amendment that would make it mandatory for all physicians to use the system.
“This will diminish access to your physicians,” Frederick said.
But the mandatory-use requirement made it into the bill well before the Senate took it up and passed it, at the hands of Sen. Rob Schaaf, a St. Joseph Republican.
Schaaf has long been the state’s largest opponent of drug monitoring. He opposed the bill on privacy grounds. But last month, he announced he would no longer block the bill as long as it included a mandatory use requirement.
Rehder said she would be willing to oblige Schaaf’s request, but opponents of the idea argued Tuesday that Schaaf’s amendment was a poison pill.
“This is another thing that’s going to make it harder for physicians to do what they do, which is to treat patients,” said Rep. Bill White, a Joplin Republican. “This was put in across the rotunda because it was meant to kill this bill.”
Schaaf was once thought to be the only major hurdle to the implementation of a drug monitoring system. But as soon as Schaaf sat down, new Senate opponents made themselves known.
Sen. Will Kraus, a Lee’s Summit Republican, was responsible for the amendment that implemented a six-month data purge. Freshman Republican Sen. Bill Eigel of St. Charles County also jumped to fight the bill, expressing privacy concerns similar to the rhetoric once employed by Schaaf.
Still, things could be worse for proponents of a drug monitoring system.
Earlier in the session, Rehder told The Star that a fall back on the county system could still create positive results.
“I think the conversation has switched from being able to stop Missouri from passing a (drug monitoring program) because that’s no longer possible. The conversation is now what version is going to be the best.”