A prescription drug monitoring program won’t stop Missouri’s opioid crisis. This can

When it comes to the opioid crisis, Missouri is an outlier. It is the only state that has failed to adopt a statewide prescription drug monitoring program, or PDMP. These systems are surveillance tools that track all of the opioids dispensed in a state. In most states, if you went to a pharmacy to fill your opioid prescription, that prescription would become part of your record. Physicians and pharmacists could use your record to ensure that you did not receive opioids elsewhere. They gained popularity between 2000 and 2015, when most overdose deaths involved prescription opioids such as OxyContin and Vicodin. The idea was this: If PDMPs could reduce opioid prescribing, states would see a reduction in opioid overdose deaths.

Missouri’s lack of tracking system is not for lack of trying. Legislators proposed 15 bills from 2005 to 2019. They all failed to pass. This legislative failure might be embarrassing for our state, but what is more embarrassing is our leaders’ failure to acknowledge the real drivers of overdose death: illicit opioids such as heroin and synthetic fentanyl, which PDMPs cannot track. By focusing on prescription drugs, Missouri legislators have missed critical opportunities to save lives. The most effective way to help Missourians is by expanding evidence-based care, not fortifying surveillance capacity.

The gold standard for addiction treatment is “medication for addiction” treatment, using drugs such as buprenorphine, Suboxone and methadone, which mimic other opioids’ behavior in the body. This treatment reduces overdoses as well as the cravings and withdrawal symptoms that plague people who have opioid use disorders, creating stability where there once was chaos, and offering a powerful pathway to recovery. Many patients would benefit from this therapy, but most physicians cannot prescribe it and most insurance does not cover it. This is seriously troubling because these medications are so effective that if patients use them alone without other treatment, their overdose risk goes down.

So we have the tools to treat opioid use disorder — but we are not using them. How would a PDMP enhance care? It wouldn’t. PDMPs are surveillance tools, not treatment devices. At best, they are ineffective at preventing overdose deaths. And at worst, they result in more lives lost.

A recent study published in The Annals of Internal Medicine found that not only did PDMPs fail to reduce fatal and non-fatal overdoses, but heroin overdose deaths increased after states implemented PDMPs. In 2017, 299 Missourians died of heroin overdoses and 618 died from synthetic fentanyl. With a PDMP, we stand to lose even more of our friends, neighbors and family members.

And saying that Missouri has no prescription monitoring system at all is simply not true. We might lack a statewide program, but Saint Louis County currently runs one that covers 85% of residents and 94% of physicians by combining data from municipalities across the state. A statewide PDMP might remove our outlier status, but it is unlikely to be more effective than our existing system.

Missouri is an outlier in another sense as well: It is one of only 14 states that have failed to expand Medicaid under the Affordable Care Act. This matters for opioid overdoses because the ACA requires insurance companies to cover mental health and substance use treatment for people with addiction. States that have expanded Medicaid have fared well in their efforts to fight the opioid crisis. An article published in The Journal of the American Medical Association last month found that states with Medicaid expansion had a 6% lower overall rate of overdose deaths compared to states without expansion. This included a 11% lower rate of deaths involving heroin and a 10% lower rate of deaths involving synthetic opioids like fentanyl. Expanding Medicaid works because it covers more people and creates new opportunities for treatment.

Expanding Medicaid would not only help patients — it would help care providers, too. Right now, physicians are better equipped to police patients than to treat them. Doctors routinely test patients’ urine for illicit drugs, and physicians and pharmacists use the PDMP to surveil patients. Providers are oriented toward refusal: saying no and turning patients away. But these providers are ill-equipped to treat addiction like the disease it is by connecting patients to care. Providers who attempt to help their patients face a disjointed, poorly-funded mental health and substance abuse treatment system. We do not need better surveillance tools. We need a better treatment plan.

By failing to expand Medicaid, legislators have shortchanged Missourians, leaving us with anemic mental health and substance use treatment systems at a time when we need help the most. There is a lot of hand-wringing in Jefferson City about why the state can’t manage to pass a PDMP. It makes sense — no one wants to be an outlier. However, if lawmakers really care about saving Missourians’ lives, they should devote themselves to expanding Medicaid and increasing treatment opportunities instead of trying to pass PDMP legislation yet again.

Liz Chiarello is an associate professor of sociology at Saint Louis University.

This story was originally published March 8, 2020 at 5:00 AM.