Gov. Eric Greitens' administration said Monday it was cracking down on 8,000 Missouri doctors who aren't following best practices for prescribing opioids within the state's Medicaid program.
Greitens, in a prepared statement, said those doctors may be "manipulating the system and creating or feeding dangerous habits."
"Last year, there were more than 1.2 million opioid prescriptions in our Medicaid system alone—sometimes destroying the lives and families of our neighbors," said Greitens, who has spoken publicly about his cousin's death by heroin overdose.
Jeff Howell, a government relation specialist with the Missouri State Medical Association, said the physicians group is seeking more information about what the state intends to do.
“If they’re indeed looking for outlier physicians that are prescribing just crazy amounts of opioids, obviously we don’t have a problem with that type of program," Howell said. "If they’re just doing a witch hunt on doctors we would have a problem with that.”
Missouri Medicaid's program, MO HealthNet, covers almost 1 million people. Most of them are low-income children, pregnant women, the elderly and people with disabilities.
Last year about 10 percent of them got prescriptions for opioids. Greitens said the majority of the state's doctors prescribed them safely.
But the 8,000 flagged still represents a significant portion of the state's 19,000 practicing physicians.
They were flagged for not adhering to Centers for Disease Control guidelines that discourage keeping patients on opioids for more than three months, in most cases.
Opioid pain pills used to be a standard long-term treatment for severe chronic pain. But the new guidelines were developed after research showed that their pain relieving effect wanes as patients become accustomed to them, while the potential for abuse and overdose increases.
Under new regulations that begin Tuesday, MO HealthNet recipients will have to get prior authorization from the state to fill opioid prescriptions past 60 days of use.
Officials in the Greitens administration said they will also send notices to the 8,000 doctors instructing them to change their prescribing patterns and consider referring people on long-term opioids to addiction programs.
Those who don't respond could face professional sanctions.
Steve Corsi, the director of the Missouri Department of Social Services, said the state will begin forwarding the information to the state's medical licensing board and the Bureau of Narcotics and Dangerous Drugs, which holds their permits to prescribe controlled substances.
He said his department and other state agencies are able to provide training and advice to doctors who want to get in compliance.
Monday's announcement was the latest in a series of anti-opioid efforts Greitens has started since taking office.
He established a limited statewide prescription drug monitoring program by executive order last year after legislative efforts to join every other state in establishing one fizzled. He's also started filling several vacancies on the medical licensing board with physicians who say they're willing to get tough on colleagues who contribute to the opioid crisis.
Monday's announcement drew praise from lawmakers of both parties who said the state has been too lax for too long when it comes to problem prescribers.
"Dr. Corsi and his passion to fight opioid abuse and misuse is a breath of fresh air," said Rep. Holly Rehder, a Republican from southeast Missouri. "This will make a real difference in people’s lives who struggle with addiction.”