Missouri is the only state in the country without a statewide program that tracks and allows doctors and pharmacists to look at prescriptions.
For nearly a decade, efforts to install a statewide prescription drug monitoring program (PDMP) have passed the Missouri House to only fail in the Senate, where Republicans citing privacy concerns have kept the bill from coming to a vote through filibusters.
While 85 percent of the population falls under a PDMP run by St. Louis County, many Missouri jurisdictions still have no system for monitoring use — and possible abuse — of opioids.
Advocates had hoped this year would be different. Term limits forced the departure of the statewide PDMP’s longstanding opponent, St. Joseph Republican Rob Schaaf. His successor, freshman state Sen. Tony Luetkemeyer, is the legislation’s sponsor this year.
But while Schaaf has left office, fresh Senate opposition has emerged, within a coalition of Republicans called the Conservative Caucus. Like Schaaf, they contend that a statewide database of residents with prescriptions for certain drugs is an unwarranted violation of privacy.
One attempted deal has already fallen through. Supporters had hoped to lure caucus members to allow a vote on PDMP by signing on to one of their top priorities: further cuts in the state’s income tax rate coupled with methods to improve the collection of a use tax on internet sales.
With the legislation set to hit the Missouri Senate this week, a path forward on the bill is unclear and conversations surrounding concessions have yet to yield to a compromise.
While Caucus members are united in their opposition, what each member wants — or could live with — differs.
Freshman state Sen. Cindy O’Laughlin, R-Shelbina, said she wants to narrow the focus of the program solely to track of opioid prescriptions, rather than most prescription drugs. She also wanted some kind of assurance that chronic pain patients would still be able to easily access their medication.
“It’s going to take a huge change,” O’Laughlin said. “As I said, I’m willing to listen to people.”
Two years into his opposition, state Sen. Andrew Koenig, R-Manchester, said that among other changes, he wanted the program to be coupled with a ban on county-level ordinances that require prescriptions for pseudoephedrine, an anti-meth production measure.
“I think there’s a chance I’d sit down on the bill,” Koenig said. “I don’t think there is a chance I would vote for it. I always keep my options open.”
State Sen. Bill Eigel, who has opposed the bill since he was first elected in 2016, said he wanted to see more conversations on data security and a sunset clause, which would require the legislature to renew the program.
“I’m at a point on the current bill, I think that would engender a lot of resistance,” Eigel, R-St. Charles, said.
Finding the balance between the demands of Conservative Caucus members and Democrats is tricky, according to Senate President Pro-Tem Dave Schatz.
“If we don’t make it palatable enough, some people — the St. Louis County folks — will say we are watering it down, why would we vote for it? They won’t vote for it,” Schatz, who sponsored the bill in previous years, said. “We can’t go down that path.”
Luetkemeyer said his winning strategy included being open-minded to changes Caucus members may offer and not hold out for “perfect legislation.”
“I’m a realist,” Luetkemeyer said. “I knew whenever we set on this journey that the version of PDMP that was introduced, if we pass it, was not going to be the version that was introduced.”
Luetkemeyer said the goal of the program is to avoid “inadvertent overdoses” caused by the mixing of opioids with other drugs, which is why the program would track a wider schedule of drugs.
“As long as it is done correctly, it’s not a ‘kill bill’ amendment,” Luetkemeyer said, of paring down the tracked drugs.
Luetkemeyer said the statewide PDMP would be “more conservative” than St. Louis County PDMP. It includes information that can’t be accessed by law enforcement without a warrant and provides that data be purged every three years.
“At some point, we are going to have nearly 100 percent of the state under a PDMP that the state has no control over and that is a patchwork system created by municipalities and counties across the state,” Luetkemeyer said.
The county created a PDMP in April of 2017. Counties and cities, including Kansas City and St. Joseph, have voted to chip in and join the effort. The districts of several of the senators opposed to statewide PDMPs are covered by the St. Louis County program.
Both O’Laughlin and Eigel don’t buy the argument that the St. Louis County PDMP would pressure them to vote for a statewide program.
“The one part of the bill I do like is that it eliminates all the local PDMPs,” Eigel said. “Just because I don’t like the local PDMPs doesn’t mean I’m going to take a less worse bill than what’s before us, and opening the door to a statewide program is something I’m not comfortable with.”