Missouri is the only state in the nation without a prescription drug monitoring program.
Opposition to changing that, at least among Missouri lawmakers, appears to be gaining steam.
A bill creating a prescription drug monitoring program passed the Missouri House in 2014 by a 112-32 vote. It passed again last year 107-48, but both times it died in the Senate.
It was supposed to be debated in the House this past week, and was expected to smoothly sail out of the chamber once again. But increased opposition has put the idea’s fate in doubt, said Rep. Holly Rehder, a Sikeston Republican who is sponsoring the measure.
While she still expects the bill to pass, Rehder said that if a vote were held today, “it could be close.”
“I need more time to educate my colleagues on the reality of this bill,” she said, “and dispel a lot of the misinformation that’s being spread.”
The legislation would allow the state Department of Health and Senior Services to start a database that would track opioid prescriptions. Proponents of the idea say it would help prevent doctor shopping, by which people get medicine from multiple physicians to feed an addiction, or to sell.
Forty-nine other states use a similar program to identify people who acquire excess prescriptions for addictive painkillers and tranquilizers, as well as the physicians who overprescribe them. Not having a database, Rehder said, has hampered Missouri’s ability to combat prescription drug abuse.
To critics, however, a prescription drug database represents an infringement on personal liberty and a possible invasion of privacy.
In the last year, those critics have picked up momentum.
“This is a classic case where for a long time this was a bill that flew under the radar,” said Ryan Johnson, president of the conservative nonprofit Missouri Alliance for Freedom. “Grass-roots activists weren’t really aware.”
That changed last year, Johnson said, as his organization worked to raise the profile of the issue and the concerns his organization has.
“Republicans that support a (prescription drug monitoring program) would go to the mat and race to the television cameras if we were talking about a registry for guns,” Johnson said. “Frankly, supporting this database by Republicans is pure hypocrisy.”
Rep. Keith Frederick, a Rolla Republican and a physician, sponsored legislation for two years that would have created a prescription drug monitoring program.
Now he’s become one of the idea’s most outspoken critics.
“I was of the belief that the benefits outweighed the risks,” he said. “But I came to realize that isn’t true. We’re not doing much good with it at all, but we’re subjecting our citizens to a complete overreach of government power. I became distrustful that the government was going to handle this data in a responsible manner.”
Frederick said the database “could be hacked. It could be purposefully abused. It could be repurposed by government. I worry about all three of them.”
Those who prescribe and dispense drugs already have access to the information in the database, Rehder said, and the federal Health Insurance Portability and Accountability Act prohibits them from disclosing any patient information.
Additionally, Rehder’s bill would make disclosure a felony.
The privacy issue cited by opponents, Rehder said, is “ just a red herring.”
According to the Centers for Disease Control and Prevention, painkiller prescriptions in the U.S. have nearly quadrupled from 1999 to 2013, and overdose deaths have quadrupled in lockstep.
The CDC says New York saw a 75 percent drop in patients who were seeing multiple prescribers to obtain the same drugs after prescribers were mandated to check the state’s drug monitoring program.
Missouri falls somewhere in the middle in terms of number of painkiller prescriptions per 100 people.
In terms of the effectiveness of monitoring programs, detractors point to a study published in 2014 that found databases did not reduce drug overdoses in most states from 1999 to 2008.
Rehder said election year politics have complicated the issue, pointing to efforts by the Missouri Alliance for Freedom to increase opposition to the bill. She said she has been instructed by legislative leaders to reach out to fellow Republican lawmakers to try to address any issues.
“There’s lots of questions and confusion about the bill right now,” she said. “I’m going to take some time and address the concerns. But fear is hard to fight.”
House Speaker Todd Richardson, a Poplar Bluff Republican, said he wants to allow lawmakers a chance to study the issue further.
“The House’s position on prescription drug monitoring has been consistent for the last several years, and I don’t expect anything to change on that,” he said. “I always voted for it, and I intend to vote for it again.”
Even if the bill gets out of the House this year, it still probably runs into a buzz saw of opposition in the Senate. Opponents filibustered in previous years to kill the legislation and are widely expected to do the same this year.