Guest Commentary

Missouri has new tools in the fight against opioid abuse

Missouri is taking action to fight the No. 1 public health crisis in the state, writes Randall W. Williams, director of the Missouri Department of Health and Senior Services.
Missouri is taking action to fight the No. 1 public health crisis in the state, writes Randall W. Williams, director of the Missouri Department of Health and Senior Services.

The opioid crisis in Missouri has reached epidemic portions. It is the No. 1 public health crisis that we face. In 2016, there were 908 opioid- or heroin-related deaths in the state, a 35 percent increase over 2015. Every day, two babies are born in Missouri addicted to opioids. And the numbers are rising.

Gov. Eric Greitens is leading the Missouri government in the fight against this modern-day plague. Two recent actions stand out as being innovative in our efforts to save lives.

First, we are mobilizing the resources of all 16 executive departments in our Cabinet to help families combat this crisis where it’s happening.

Second, the governor authorized the Department of Health and Senior Services to create Missouri’s Prescription Drug Monitoring Program with a new, first-in-the nation approach that starts with innovative partnerships with pharmacy benefit managers. These partnerships will enable us to use sophisticated data analytics from the private sector to effectively and efficiently stop the sources of opioids that are misused, abused or diverted here in Missouri by providers and dispensers that perpetuate this crisis.

We will shift from being dependent on investigators combing through records or relying on tips on more than 30,000 providers and over 1,200 dispensers. Instead, they will analyze data from this group to filter, evaluate and immediately identify those who warrant further investigation. These tools also allow us to separate out oncologists, hospice providers and others whose prescribing practices are consistent with their patient population.

We will be able to identify those providers and dispensers that are frequented by “doctor shoppers,” as well. People with addictions are adept at finding providers that will prescribe in large quantities. By identifying these patterns, we will be able to reduce the 89,000 narcotics prescriptions written for every 100,000 Missourians through professional board action, administrative response, educational efforts or law enforcement.

I’ve had the privilege of taking care of patients for 30 years as an OB-GYN. I’ve used a physician-based component of a prescription drug monitoring program and I understand the value of providers having access to real-time prescription data. We agree with my fellow members of the Missouri State Medical Association and continue to support the voluntary reporting programs that counties and municipalities are considering or already have established. We think the two approaches — the innovative approach of leveraging analytics combined with the physician-based approach — are complementary and work well in parallel.

From my conversations with thought leaders and policymakers from around the country, I believe that data analytics have great potential for those programs that make patient data available to providers. I am sensitive to the fact that physicians spend two hours administratively for every one hour they see patients. Prescription drug monitoring programs can be inefficient because providers have to stop what they are doing and look at the prescription history of thousands of patients who are not abusing narcotics.

In many states with voluntary monitoring programs, it has been shown that only 13-50 percent of doctors use them. For that reason, the Centers for Disease Control and Prevention support mandatory provider usage of these programs. If Missouri providers use them at the same rates as the rest of the country, then it is unlikely these plans can create the outcomes we need to protect our residents.

Our plan does not give the Missouri government access to individual data, but providers around the country who have access to patient data have expressed an interest in the ability of these same analytical tools to identify patients at risk before they become addicted.

Our commitment to the people of Missouri is that everyone in state government will work together in a comprehensive, integrated and innovative way. We acknowledge this will be a protracted fight that requires tenacity. We need you to help us and each other on the front lines of this battle.

I want to be able to say to my good friend — who has lost both his daughter and brother to this crisis — that we are doing everything possible to prevent another family from suffering such tragedies. Every life saved is victory in this fight.

Randall W. Williams, MD, is director of the Missouri Department of Health and Senior Services.

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