Missouri, Behind All Other States

The New York Times came out with an article on July 20, 2014, reporting Missouri is currently the only state without a prescription drug monitoring program.1 A prescription drug monitoring program (PDMP), according to the National Alliance for Model State Drug Laws (NAMSDL), “is a statewide electronic database which collects designated data on substances dispensed in the state.”2 These programs can have many advantages, for example, to help prevent prescription drug abuse, misuse, and addiction.2PDMP stats

According to the Centers for Disease Control and Prevention (CDC), Missouri has an overdose death rate of 17 per 100,000 population in 2010 when compared to the national rate of 12.4 per 100,000 population.5 This means Missouri is the seventh highest ranked state in drug overdose mortality rate.7 Drug overdose mortality rates for Missouri have tripled during the time of 1999 to 2010.7 Trust for America’s Health (TFAH) states “prescription drug related deaths now outnumber those from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington D.C.”7 Another devastating statistic reported is an estimated $53.4 billion a year is spent due to lost productivity, medical costs, and criminal justice costs.7 The CDC identifies possible solutions to decrease the overdose death rate by adding a state pain clinic law and a prescription drug monitoring program.5 Another concern with Missouri not having a PDMP is prescription drug abusers in neighboring states come to Missouri to fill prescriptions because we do not monitor prescription drug use.1

TFAH has identified indicators to help prevent prescription drug abuse and they are listed below.7 Missouri scored three out of the 10 indicators.7 Our state has doctor shopping laws, physical exam requirement, and lock-in programs.7 The highest scorer was New Mexico and Vermont with a 10 out of 10 score and the lowest scorer was South Dakota with a two out of 10 score.7

  • Existence of Prescription Drug Monitoring Program (PDMP): Has an active program”7
  • PDMP: Requires mandatory utilization by prescribers”7
  • Doctor Shopping Laws: Has a law specifying that patients are prohibited from withholding information about prior prescriptions from their healthcare provider”7
  • Support for Substance Abuse Treatment Services: Participating in Medicaid Expansion, which helps expand coverage of substance abuse services and treatment”7
  • Prescriber Education Required or Recommended7
  • Good Samaritan Laws: Has a law to provide a degree of immunity or mitigation of sentencing for individuals seeking to help themselves or others experiencing an overdose”7
  • Rescue Drug Laws: Has a law to expand access to, and use of naloxone, a prescription drug that can help counteract an overdose, by laypeople”7
  • Physical Exam Requirement: Has a law requiring healthcare providers to physically examine patients or have a bona fide patient-physician relationship before prescribing a controlled substance”7
  • ID Requirement: Has a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance”7
  • Lock-In Programs: Has a pharmacy lock-in program under the state’s Medicaid plan where individuals suspected in misusing controlled substances must use a single prescriber and pharmacy”7

Recently the National Association of Boards of Pharmacy (NABP) released an article about Florida having a drastic drop in prescription drug overdose and death.3 Florida was able to reduce their prescription drug overdose death rate by 23 percent from 2010 to 2012 and closed 250 rogue pain clinics by 2013.3 Florida adopted a state prescription drug monitoring program that required pain clinics to register with the state and for dispensers to report prescription drug usage.3 These numbers indicate that Florida has been very successful in reducing prescription drug overdose and abuse by implementing new laws, including a prescription drug monitoring program.

The NAMSDL has released a document that lists components of a strong prescription monitoring program that states could use to implement a well-designed program.6 The ten items listed are discussed below 6

  • Drugs Monitored – The state should decide which medications would be best to monitor, but it is suggested to “include federal controlled substances, additional specified controlled substances regulated by the state, and drugs of concern documented to demonstrate a potential for abuse, particularly those identified by law enforcement and addiction treatment professionals.”6
  • Unsolicited and Proactive Disclosure – The state should decide who is allowed to view the information, but it is suggested to “provide data to prescribers, dispensers, law enforcement and occupational licensing individuals.”6
  • Disclosure of De-Identified Information – It is suggested that “the PMP Administrator to disclose de-identified data for statistical, public research, public policy or educational purposes.”6
  • Authorized Users – The state should decide who is allowed to request information to be used to “enhance patient safety and patient care.”6
  • Education, Training, or Instruction for Authorized Users – It is suggested that persons using the information “should demonstrate that they have the education, training or instruction necessary to responsibly and properly use the information that they receive from the program.”6
  • Standards and Procedures for Access to and Use of PMP – It is suggested that states “establish standards and procedures for their licensees regarding access to and use of PMP data.”6
  • Linkage to Addiction Treatment Professionals – States should establish a connection from the PMP information provided to an addiction treatment professional with a statute, regulation, rule, or policy.6
  • Interstate Sharing of PMP Data – States should establish a method in “sharing of PMP data by statue, regulation or interstate agreement.”6
  • Confidentiality Protections – States should make sure information is not released for public viewing and establish “penalties for knowingly disclosing, using or obtaining information other than as authorized by law.”6
  • Evaluation Component – “An evaluation component is critical to identifying cost benefits of the PMP, impacts of the use of PMP data on the practices of authorized users, any recommended operational improvements and other information relevant to policy, research and education involving controlled substances and drugs of concern monitored by the PMP.”6

The NABP has a new program, NABP PMP InterConnect®, which allows 25 states to share their PDMP information in a secure manner.3 This new program could even further help prevent prescription drug abuse, misuse, and addiction. Missouri has been working on a prescription drug monitoring program.4 During the 2014 Legislative Session, the House of Representatives approved House Bill 1133, but the bill died in the Senate after being referred to the Senate Governmental Accountability and Fiscal Oversight Committee. We need to push this issue through the Missouri Legislature during the 2015 Legislative Session.

I will leave you with this alarming statistic that TFAH reported from Andrea Gielen, Director of the Johns Hopkins Center for Injury Research and Policy, “50 Americans die a day from prescription drug overdoses, and more than 6 million suffer from prescription drug abuse disorders.”7

Ashley Buehler
UMKC School of Pharmacy at MU
PharmD Candidate 2015
MPA Rotation Student, July 2014

Resources

1Schwarz, A. (2014, July 20). Missouri alone in resisting prescription drug database. Retrieved from http://www.nytimes.com/2014/07/21/us/missouri-alone-in-resisting-prescription-drug-database.html

2State prescription drug monitoring programs. (2011, October). Retrieved from http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm

3Florida sees dramatic drop in prescription drug overdose deaths. (2014, July 9). Retrieved from http://www.nabp.net/news/florida-sees-dramatic-drop-in-prescription-drug-overdose-deaths

4Missouri legislature considers bill to establish a PMP. (2014, February 19). Retrieved from http://www.nabp.net/news/missouri-legislature-considers-bill-to-establish-a-pmp                                                                                                                                                       

5Prevention status report. (2013). Retrieved from http://www.cdc.gov/stltpublichealth/psr/prescriptiondrug/2013/MO-pdo.pdf

6Components of a strong prescription monitoring program. (2012, June). Retrieved from http://www.namsdl.org/library/85740FEB-19B9-E1C5-31AA3E9A59034388

7Reports. (2013, October 7). Retrieved from http://healthyamericans.org/reports/drugabuse2013/release.php?stateid=MO

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