Missouri last week became the last state in the nation to put a statewide prescription drug monitoring service in place as its new database went online.
Prescription drug monitoring programs allow health workers to compile patients’ drug history in an electronic database. Dentists, doctors, pharmacists and other professionals who dispense controlled substances now will be required to enter patient and prescription information into the database.
Those who prescribe or dispense drugs will be able to check the database to view a patient’s prescription drug use before giving out narcotics, stimulants, opioids or other controlled substances. Proponents of the program say it helps workers identify drug-seeking behavior and check for any potentially harmful interactions between medicines.
“This gives the providers a much better tool to see what's been going on — what kind of prescription history those patients have, so they can avoid those maybe unnecessary prescriptions,” said Dean Linneman, executive director of the state’s joint oversight task force for prescription drug monitoring. “Or in some cases, there may be other alternatives to offer patients rather than a new prescription or an additional prescription.”
States adapted prescription monitoring databases as more people across the country became addicted to prescription opioids and began overdosing. Missouri had been the only state in the country without a statewide prescription drug monitoring system. The Missouri legislaturevoted to install one in 2021.
Missouri dispensers will need to enter information into the database whenever they give out controlled substances — drugs the federal government has deemed especially addictive or harmful. Federal officials consider medicines with lower schedule designations — including oxycodone, methadone and fentanyl — as those with highest potential for abuse.
The programs “continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk,” Centers for Disease Control and Prevention officials note on the agency’s website. “Although findings are mixed, evaluations of PDMPs have illustrated changes in prescribing behaviors, use of multiple providers by patients, and decreased substance abuse treatment admissions.”
For years, dozens of jurisdictions in Missouri have participated in a prescription drug monitoring program operated by St. Louis County. The state has chosen the same vendor, Kentucky-based health IT company Bamboo Health, to operate the statewide database, so many providers and patients will not notice a difference in care after the switch, Linneman said.
Bamboo Health operates such databases in 40 other states and territories and can share data across state lines, according to the company.
Liz Chiarello, a St. Louis University sociology professor, is dubious.
States have operated PDMPs for years, Chiarello said, but overdose rates still increased.
“Taking away pills doesn’t mean people with addiction are cured,” she said. “If they’re cut off from prescriptions, they may seek out street drugs, which often contain dangerous levels of the potent opioid fentanyl.”
“I think we have to be clear that telling someone they can't have a prescription opioid doesn't suddenly make addiction go away,” she said. “They’re going to end up seeking that out somewhere. And we know exactly where they're going to go.”
They are a useful tool for providers, though, Chiarello said.
“You could imagine a world in which monitoring drugs was used in a way to benefit health care,” she said. “And I think if you talk to doctors or you talk to pharmacists, they love the PDMP. It really does help them do their work and helps them to be more efficient.”
Enforcing the programs leaves addicted people open to punishment from law enforcement, she said.
However, Linneman is adamant the data will only be used by health care professionals.
“This is not a law enforcement tool, it's a health care tool,” he said. “The statute that enables us to create the Missouri PDMP has a lot of limitations on who can view the information. So law enforcement is not allowed to view the information. Neither are like licensing boards or regulatory boards throughout the state or even at the central level.”
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