Will Missouri remain the only state without a prescription drug monitoring program?

For nearly a decade, the Missouri House has passed legislation establishing a statewide program for doctors to monitor prescriptions and prescription drug abuse. And for nearly a decade, the measure has died in the Senate.

Despite support from many Republicans and Gov. Mike Parson last year, the PDMP bill didn’t even get time on the Senate floor. The conservative caucus – a bloc of six Republican senators – effectively killed it last session, citing what they contend are privacy issues posed by a database of people’s prescriptions.

On Monday, the latest version of a bill to create a prescription drug monitoring program (PDMP), HB 1693, passed the Senate Judiciary Committee. Once again, its fate is uncertain,and Missouri could retain its status as the only one of the fifty states without a PDMP.

Beyond the privacy concerns, opponents pointed Monday to data showing that Missouri falls toward the middle in a ranking of nationwide opioid deaths, ahead of numerous states that have established the monitoring programs.

Sen. Bob Onder, R-Lake St. Louis, highlighted this ranking and what he described as the potential “unintentional consequences” of a statewide PDMP. These consequences, he said, could be more people switching from prescription drugs to street drugs like heroin and fentanyl.

The proposed statewide PDMP would not address heroin or fentanyl, which PDMP opponents argue cause the highest number of opioid deaths. It focuses only on prescription drugs.

Roughly 85% of Missourians are currently covered by the St. Louis County PDMP, which counties and municipalities can opt into. Jackson County joined the St. Louis County PDMP in 2016.

The House bill would replace that patchwork system and would be managed under the Department of Health and Senior Services. Opponents still cite privacy concerns as a reason for not supporting it.

“I’m opposed to a traditional PDMP because it’s the government tracking something they shouldn’t be tracking, it’s a violation of the Fourth Amendment,” Sen. Andrew Koenig, R-Manchester, said.

The bill contains some provisions aimed at addressing privacy issues. It says that the PDMP cannot be used to prevent someone from obtaining a firearm or as evidence to issue an arrest warrant.

“I also think it’s important to note that all the prescribers who would have access to the database are already governed by HIPAA, so they’re under federal law subject to federal privacy laws, as well,” said Sen. Tony Luetkemeyer, R-Parkville, who chairs the Senate Judiciary Committee and sponsors the Senate companion to the House PDMP bill. “So, I think the privacy concerns are well taken care of.”

Critics also contend that a PDMP will make it harder for chronic pain patients to get necessary prescriptions.

Those concerns are unfounded and the PDMP changes nothing about the doctor-patient relationship, proponents say.

“This is not saying that doctors cannot prescribe more opioids to somebody who’s a chronic pain patient.. It just says the doctor should have the knowledge and the information that they need to make the best possible decision for their individual patient,” Luetkemeyer said.

Koenig proposed a bill this session that looks to address some of the concerns with the opioid crisis without fully establishing a PDMP.

His bill, SB 706, allows people to participate in a “Prescription Abuse Registry.” Unlike the PDMP proposals, Koenig’s registry is entirely optional.

“Almost every drug addict I’ve known has at some point in time not wanted to be a drug addict,” Koenig said. “So, this would kind of work the same way as 1-800-BETS-OFF where people can put themselves on the registry, so that way a doctor could see it and know that they have a drug problem – a prescription drug problem.

1-800-BETS-OFF is a hotline that is part of the Missouri Alliance to Curb Problem Gambling.

Koenig admitted that his registry might not be as effective as a statewide PDMP, but he said “it’s more beneficial in the sense that you’ll actually know whether or not someone has a problem.”

Proponents of PDMP disagreed.

“I think it’s a do-nothing piece of legislation, frankly,” Luetkemeyer said. “People who are drug addicts, who have addiction problems, are not going to voluntarily turn themselves in. I think that that’s a pipe dream.”

Luetkemeyer said last week the goal with the PDMP this year is to get it to the floor early in the session.

“If you’re going to have a serious shot at getting it passed, it needs to come on the floor early so that we have a sufficiently long runway to give it the time that it needs and deserves to have a chance for passage,” he said.

Now that the bill has passed committee, it can go to the Senate floor. The timeline for that is up to Senate Majority Floor Leader Caleb Rowden, Luetkemeyer said. Rowden has previously supported a statewide PDMP.