Prescription drug addiction and abuse have exploded in the St. Louis region over the past decade. Heroin use continues to grow, with some emergency departments seeing heroin overdose and naloxone rescue on a daily basis. Four of five heroin users start with prescription medications.
A Prescription Drug Monitoring Program (PDMP) is the backbone of a community effort to battle opioid and heroin addiction. It was first discussed in the Missouri Legislature in the 2004 session. During each session from 2004 to 2008, I sponsored a PDMP bill, with some success moving it through the legislative
process. Unfortunately, it never received final passage.
Over the past 12 years, every state has adopted this program except Missouri. We remain the only state in the union that does not have this program in place through state legislative action. Missouri remains in the top five states for opioid consumption per capita and prescribes more opioid medications than any other state in the Midwest, earning the reputation as “America’s Drug Store.”
In the spring of this year, I successfully sponsored a bill in St. Louis County to create our own PDMP, with an option to allow other county and large city jurisdiction to subscribe for a nominal cost of $7 per prescriber or pharmacy. St. Louis County Executive Steve Stenger has been a strong supporter of this legislation. His nephew struggled with prescription drug and heroin addiction before losing his life to a fatal overdose in 2014.
Our program was built on the PDMP Center of Excellence at Brandeis University—the resource for all state-run PDMPs. Physicians, dentists and anyone licensed to prescribe scheduled medications will soon have the opportunity to access this database for patients under their care.
To date, St. Louis City, St. Charles County and Jackson County have passed bills to join our program. Kansas City,
Independence and Columbia are in the process of joining as well. In October representatives of 11 rural southeastern Missouri counties attended a meeting with St. Louis County public health leaders to discuss joining the program. For other jurisdictions to join, it only requires passing of an enabling bill and then signing a user agreement with St. Louis County. The system will be HIPAA compliant and is subject to all local, state and federal privacy laws and regulations. Sharing with other states is built into the structure of this program and is a second-step function that will be added once the program is operational for a few months.
How the Program Will Work
St. Louis County has contracted with Appriss, the PDMP vendor in 25 states. The PDMP concept has a long multi-state track record of privacy and security in the other 49 states where it functions. St. Louis County hopes to begin the data collection phase in January, and be available for use by physicians (and all other prescribers) and pharmacists in April.
Some PDMPs are built as a law enforcement tool, and some are built as a public health tool— in reality an extension of an electronic medical record. The St. Louis County PDMP (with optional statewide participation) is a public health tool. Law enforcement access is granted with a court order for an ongoing
investigation of a specific prescriber or patient. Prescribing patterns that generate concern, by standards set by the PDMP technical advisory committee, will be referred to the appropriate licensing board for investigation by that body. Patients may also request a copy of their own prescribing history. De-identified data will be made available for community reporting and research purposes.
The PDMP database is populated by automated transmittal of Schedule II though IV prescription information as a copy of information sent to third party payers when a prescription is filled. The pharmacist does not manually enter additional data. In the 25 states where Appriss provides PDMP operational services, no additional switch fees are charged to participating pharmacies.
Some states have made physician participation in PDMP mandatory. In St. Louis County we do not require physicians to check the PDMP prior to writing a controlled substance, but referring to this database is prudent, especially in light of medical liability associated with scheduled medication. Physicians do not enter data into the PDMP. Only filled prescription data from a pharmacy is automatically reported to the PDMP.
The best answer continues to be a PDMP that covers the entire state of Missouri, through state legislative action. State
Rep. Holly Rehder (R-Sikeston), the sponsor of state legislation to create a PDMP for Missouri, will continue to pursue this legislation and should continue to receive medical community support. House and Senate leadership have indicated continued support for this solution as well.
The unique approach taken by St. Louis County to affiliate with each county in Missouri is cumbersome, but unfortunately the only way to accomplish the task at hand in the current legislative environment. We have concerns that patients with addiction disorders or drug-seeking behavior will migrate from the participating urban areas to nonparticipating and non-reporting counties.
Once passed, the state program will require two to three years to become functional, depending on appropriation of adequate funding and development of supporting regulations. When the state finally passes a PDMP built on best practices that are equal to or greater to the St. Louis County PDMP, our intention is to roll our county collaborative system into the statewide program.
Please email your questions and suggestions to me at spage@ stlouisco.com. As this program is adopted we hope to give physicians another tool in the fight against opioid addiction, diversion and abuse. This is a work in progress and we will depend on the active engagement
and participation of the members of the St. Louis Metropolitan Medical Society.
Sam Page, MD, is a physician anesthesiologist at Mercy Hospital St. Louis and a SLMMS member since 1996. He is a member of the St. Louis County Council representing the 2nd District. He served in the Missouri House of Representatives from 2003-2009.
Reprinted with permission from St. Louis Metropolitan Medicine