Scare tactics skew the conversation about monitoring prescription drugs in Missouri

Members of the conservative caucuses in both chambers of the Missouri General Assembly cite multiple reasons for their opposition to the proposed state prescription drug monitoring program, or PDMP. However, none of these reasons justifies blocking this potentially lifesaving tool.

They often point to a report noting a rise in opioid related deaths in the St. Louis region, which has its own PDMP, as evidence that the program is ineffective.

It should be noted that this report from the National Council on Alcoholism and Drug Abuse-St. Louis Area did not distinguish between deaths caused by prescription opioids and drugs such as fentanyl and heroin obtained illegally. Therefore, using this data as evidence of ineffectiveness of the PDMP is not valid.

Another reason some lawmakers oppose a PDMP is a poorly-supported claim that these programs have not been proven to work in other states. This stance may come from a much cited article from The American Journal of Managed Care that used a review from The Annals of Internal Medicine to support this claim. Closer scrutiny of this review, however, reveals that its authors 2did not conclude that PDMPs do not work, but that the evidence available could not determine the success or failure of the program due to limitations such as risk of bias, the small number of studies available and the lack of regulatory consistency among states. However, it did conclude that features such as data sharing among states, mandatory doctor reviews of PDMPs before prescribing and updating the database weekly are associated with fewer opioid overdoses.

An enduring objection by the Missouri Senate conservative caucus centers on questions about patient privacy, and the risk that the government database may be hacked. (Some have suggested that this concern may be designed to protect individuals who are at risk of having their guns confiscated due to felony conviction from fraudulently obtaining an opioid prescription.) Whether there are secondary motives, the privacy issue is overblown, as there are already multiple databases — both required by and maintained by the state — that contain this very patient and prescription information.

In addition, Missouri permits insurance companies operating within the state to maintain exactly these types of databases to share with prescribing doctors, in an effort to recognize fraudulent misrepresentation by patients. Considering all these factors, legislators who use privacy concerns as a reason to block passage of the PDMP are either ignorant of current Missouri law and regulations, or they have other motives in obstructing an avenue to identify patients and prescribers that may be harmful to themselves or others.

Prescription opioids remain a major contributor to overdose deaths and may serve as an entry point for later addiction. A study of injection drug users found that 86% had used opioid pain relievers non-medically before using heroin. These people’s initiation into nonmedical use of opioids was characterized by three main sources they obtained the drugs from: family, friends or their own prescriptions.

The American Medical Association and the Missouri State Medical Association, societies that represent the physicians who are authorities on opioid prescriptions, support creating a PDMP. That — along with recognizing the fact that 75 Missouri jurisdictions, along with 95% of health care providers, voluntarily participate in the St. Louis County PDMP — should convince the conservative caucuses that Missouri must not remain the only state without a monitoring program.

It stands to reason that PDMPs alone would not markedly reduce overdoses. We must pursue efforts to address other opioids such as heroin and fentanyl, as well as illegal drug supplies, in our initiatives to engage patients in drug treatment programs. But a robust monitoring program — one that incorporates features that have worked to reduce overdoses in other states — would move Missouri in the right direction.

This story was originally published January 21, 2020 at 5:00 AM with the headline "Scare tactics skew the conversation about monitoring prescription drugs in Missouri."