Frustrated by the Missouri Legislature’s failure to enact a statewide prescription drug plan, Jackson County this week joined St. Louis and St. Louis County in enacting its own plan, hoping it will cut down on painkiller abuse and addiction.
Missouri is the lone state in the nation without a prescription drug database, a tool used to track patients who abuse prescription painkillers and to prevent “doctor shopping” by individuals seeking prescriptions from multiple physicians.
Missouri’s efforts to adopt a prescription drug monitoring program, or PDMP, have been stymied by a small group of lawmakers led by Sen. Rob Schaaf, a St. Joseph Republican and family physician, who says it would infringe on individuals’ privacy.
In exasperation, St. Louis and St. Louis County adopted their own plans earlier this year. On Monday, Jackson County legislators unanimously approved their own PDMP, although they did not set a date for its implementation.
“We see it as a step in the right direction,” said Jackson County Legislator Crystal Williams, one of the driving forces behind the ordinance. “Obviously a patchwork approach is not the most effective, but it’s certainly more effective than having nothing.”
Whether, in the absence of a statewide program, the local plans will have a measurable impact on opioid and prescription drug abuse is an open question.
“I’m certainly pleased to see the work of St. Louis County and the city of St. Louis and now Jackson County considering countywide monitoring programs,” U.S. Agriculture Secretary Tom Vilsack, who oversees an interagency task force charged with combating the opioid epidemic, said in a phone interview Wednesday. “But the reality is we really do need a statewide program in Missouri.
“It’s too easy for people to shop around and get multiple prescriptions, then they sell those prescriptions perhaps on the street or they use them to feed an addiction.”
The Jackson County plan excludes the two largest cities in the county, Kansas City and Independence, unless they agree to be included in the plan.
Williams said the ordinance was drafted that way because both cities, unlike other Jackson County municipalities, have their own health departments. But she said she was confident Kansas City and Independence would sign on.
“Both the Independence and Kansas City health departments have been at the table since the beginning of the discussion,” she said.
The plan requires dispensers of controlled substances to electronically submit information on drug purchases within seven days or face a maximum fine of $500 and/or 90 days in jail per violation.
The information would be accessible to authorized prescribers or sellers of controlled substances, individuals seeking their own dispensation information, the Missouri State Board of Pharmacy, law enforcement officials and prosecutors, among others.
Patrick Knue, director of the PDMP Training and Technical Assistance Center at Brandeis University, said the St. Louis County plan calls for the participation of neighboring counties, which could make it an effective tool.
“Then the data from all those county pharmacies would be in a central database for anyone who is signed up to use it,” he said.
But he said even a database limited to drug dispensers in Jackson County could still be effective.
“It’s more than they have now,” he said. “Certainly it would give an idea of the prescription history for honest, legitimate patients.”
Williams estimated the cost of the Jackson County program at $150,000, which she said was a bargain compared with what the county would get in return.
“We’re not calling it a stopgap measure because we do know it will have efficacy,” she said. “But obviously statewide is by far the best solution.”
The Centers for Disease Control and Prevention says statewide prescription drug monitoring programs are “among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.”
Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR. You can reach him on Twitter @DanMargolies.