Rob Schaaf could see the writing on the wall.
The Republican state senator from St. Joseph has done more than anyone else in recent years to block a statewide prescription drug monitoring program in Missouri.
Every other state in the country has such a program, a government database aimed at stopping people from getting prescriptions from multiple physicians to feed an addiction or to sell, a practice known as “doctor shopping.”
Schaaf and other critics argue that these programs are an infringement on personal liberty and an invasion of privacy that do little to actually curtail rising opioid addiction. And he’s proud Missouri is the only state without one.
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But on Tuesday, he laid down his sword. Schaaf publicly agreed not to filibuster a prescription drug monitoring bill that has cleared the Missouri House and passed a Senate committee.
His long fight was over, and he says his reason is quite simple: A rising tide of support, coupled with term limits pushing him from office after next year, meant he no longer had the power to stop it.
“My term is up at the end of next year,” Schaaf said. “Both U.S. Sens. (Roy) Blunt and (Claire) McCaskill want the (monitoring program). Gov. (Eric) Greitens does. The speaker of the House pushed it. The president pro-tem of the Senate pushed it. More than half of the House Republicans and more than half of the Senate Republicans voted for (it), and none filibustered it.”
Schaaf’s about-face caught nearly everyone by surprise.
“I’m speechless,” state Rep. Holly Rehder, a Sikeston Republican who has sponsored drug monitoring legislation for years, said after Schaaf’s announcement.
Under Rehder’s bill, physicians would enter prescription information for their patients into a database. That database would be accessible to other physicians who care for that patient.
But before proponents celebrate, they must sort out how to accommodate Schaaf’s only stipulation: The bill must include provisions making it mandatory that doctors use the database.
“I’m cautiously optimistic,” Rehder said. “I think we can definitely get to a consensus here.”
According to a study by Pew Charitable Trusts, 18 states require doctors who prescribe controlled substances to check databases that show whether their patients are getting drugs elsewhere. Usage of the databases in those states has risen while opioid prescriptions have dropped.
In New York, for example, the Pew study found use of the database increased from an average of 11,000 inquiries per month to 1.2 million in the six months after the mandate went into effect. Opioid prescriptions dropped by 8.7 percent, and prescriptions for buprenorphine, a drug used to treat opioid dependence, rose 12.8 percent.
But the idea of legally requiring doctors to use the database has drawn the ire of the Missouri State Medical Association, which has historically been one of the biggest supporters of a drug monitoring program.
Jeff Howell, the group’s lobbyist, told the St. Louis Post-Dispatch he worries doctors will be exposed to an increase in malpractice lawsuits if mandatory use is put into law. He also argued that clinical decisions should be left to medical professionals.
The potential showdown between Schaaf and the Missouri State Medical Association has ginned up the statehouse rumor mill. Just two days before Schaaf announced he was ending his opposition to a drug monitoring bill, he lost out on his bid to become president-elect of the medical association.
Some worry his capitulation on the monitoring program is just a stick in the eye of the association, forcing them to swallow an amendment they don’t like or kill the bill they’ve long sought.
The idea that he has some ulterior motives for standing down on this issue is absurd, Schaaf said.
“If I wanted to kill it, I would filibuster it,” Schaaf said. “I have a bit of a record on filibustering. If I wanted to kill the (bill), I would just kill it. But I feel like it’s a losing battle for me, and so therefore I’m just saying, ‘I give.’ ”
Losing out on a leadership role in the medical association had nothing to do with his decision, Schaaf said. He’d been thinking about the issue for weeks, eventually coming to the conclusion that even if he managed to stop it this year, passage of a monitoring program was inevitable, so he might as well try to make the best of the situation.
“The worst case would be to let a bill pass that doesn’t even require doctors to use it,” he said, “because that would be the taking of our liberty for nothing.”
It’s true, Rehder said, that “states have much better outcomes when the physicians have been required to use the program.” But she added, “The devil is in the details.”
She said she will work with the bill’s Senate sponsor, Republican Dave Schatz of Sullivan, to try to meet Schaaf’s demand without losing any of the bill’s longtime supporters.
Schaaf said he’s ready to put the issue behind him.
“There’s going to be (a database), it’s just a matter of degree of severity of badness,” Schaaf said. “So let (Rehder) have her database, and let’s just make sure that it gets used and that it saves lives.”