JEFFERSON CITY • Calling painkiller abuse a “modern plague,” Missouri Gov. Eric Greitens sidestepped the Legislature on Monday to create his own version of a prescription drug monitoring program.
In issuing an executive order to try to bring Missouri in line with the rest of the nation, the Republican governor launched a weeklong series of events designed to focus on opioid abuse and drug trafficking.
Greitens said he was moving forward on the database without the GOP-led House and Senate’s endorsement because opioid abuse must be addressed.
“There are too many families that have had to deal with this,” Greitens said during an event at St. Louis-based Express Scripts, a pharmacy benefits manager. “We have to look this problem square in the eye.”
His plan differs significantly from what has been debated in the Legislature and what is in place in other states and in more than 26 counties and jurisdictions across Missouri.
While most monitoring programs track when patients are prescribed an opioid painkiller, Greitens’ plan would focus the data collection effort by the Department of Health and Senior Services on those who prescribe and distribute addictive drugs like Vicodin, OxyContin and Percocet.
Greitens said he wants the program to target “pill mills” that pump out prescription drugs at “dangerous and unlawful levels.”
St. Louis County Executive Steve Stenger issued a statement saying the county-level program, which was launched in St. Louis and now covers 58 percent of Missouri’s population, will continue to operate “with the hope that whatever the governor proposes does nothing to hinder our progress.”
How Greitens’ program might affect the county program remains unclear, Stenger spokeswoman Allison Blood said.
“The executive order was really vague, so we don’t know right now,” Blood said.
Patrick Knue, project director for the Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University in Massachusetts, said Missouri’s monitoring system would be different from every other state’s because it would not allow doctors or pharmacists to access the data. The systems in other states are primarily used as a health care tool.
“For the most part across the country the primary focus is helping the health care professionals do proper treatment for their patients, to make sure they’re not prescribing something that has a bad interaction, to make sure the patient is not at risk of overdose,” Knue said. “It’s moving Missouri along, but the health care professionals is a piece that’s missing in this executive order.”
Missouri is the only state without a way to track opioid abuse. A measure that would have created a database failed to win approval before the legislative session adjourned in May.
The Senate approved a prescription drug monitoring program that attempted to address privacy concerns. It would have required patients’ medical information be purged after 180 days and included restrictions on what kinds of drugs can be tracked.
But some members of the House balked, saying the data should be kept for a longer period of time. They also said the Senate version would allow highly addictive drugs such as Adderall to go unpoliced.
The lead sponsor of the legislation in the House, Rep. Holly Rehder, R-Cape Girardeau, said she was “overjoyed” the governor is weighing in on the opioid epidemic but signaled his solution does not go far enough.
Without a legislative solution on the horizon, Rehder is pushing for all counties in the state to join the system already in place.
“Now, more than ever, we should continue to push for a statewide program. Right now we have over 60 percent of Missouri’s population covered by a PDMP that allows our medical professionals to see the important narcotic history of their patients. We will continue to work across this great state to bring that number to 100 percent,” Rehder said in a statement.
Sen. Dave Schatz, R-Sullivan, who sponsored legislation in the Senate, declined to comment because he had not yet been briefed on the order.
The governor’s maneuver rankled some lawmakers. On Twitter, Rep. Shamed Dogan, R-Ballwin, wrote, “Governing by executive order because you couldn’t get a bill passed was wrong under Obama and it’s wrong today.”
Greitens has issued 18 executive orders since taking office in January.
In a release, U.S. Department of Health and Human Services Secretary Tom Price praised the governor.
“I commend Missouri Governor Eric Greitens for taking a strong step in fighting the opioid epidemic by joining other states in establishing a Prescription Drug Monitoring Program,” Price wrote.
U.S. Sen. Claire McCaskill, D-Mo., who earlier called on Greitens to schedule a special session on the opioid epidemic, said she wasn’t confident his plan would work.
“While I certainly welcome the governor’s attention to this crisis, I have serious questions about how meaningful this action will be if doctors writing prescriptions — and pharmacists filling those prescriptions — don’t have access to this database,” McCaskill noted.
The executive order specifies that prescription and dispensation information received by the Missouri Department of Health and Senior Services will be confidential.
State Sen. Will Kraus, R-Lee’s Summit, said he likes the idea of not creating a database on Missouri citizens.
“This executive order focuses on the prescribers and distributors of medications, such as doctors and pharmacists, who are already regulated by the state,” Kraus said.
Amy Tiemeier, an associate professor of pharmacy practice at St. Louis College of Pharmacy, said the existing county-level monitoring program has been useful since it went live in April. Doctors and pharmacists can access the prescription database to check whether patients are getting inappropriate amounts of opioids.
“When medications are being used and there are negative consequences, there is a clear role for pharmacists to be involved based on their knowledge of the drugs, how they work and being able to provide insight into the appropriateness of therapy and potential therapies that might be less harmful,” Tiemeier said.
Doctors nationwide have reduced the number of prescriptions they write for painkillers, from 81 to 71 prescriptions per 100 people between 2012 and 2015, according to a recent report from the Centers for Disease Control and Prevention. St. Louis has the lowest prescription rate in the region, while Franklin County has the highest. Other prescription hot spots around the state include the Bootheel region and the areas around Springfield and Joplin.
The monitoring program is “a step in the right direction, but we have a long ways to go,” said Percy Menzies of St. Louis-based Assisted Recovery Centers of America.
Menzies said the bigger concern is the increase in people who switch to heroin after having difficulty obtaining prescription opioids.
Attorney General Josh Hawley, a fellow Republican who earlier filed a lawsuit against three opioid manufacturers, applauded Greitens.
“Today’s first step toward a prescription drug monitoring program in Missouri is long overdue,” Hawley said. “I brought suit against major opioid manufacturers last month to start the fight to end the opioid epidemic in our state. A prescription drug monitoring database is critical to that effort.”
Monday’s announcement marks the first of a week’s worth of focus on drugs and drug abuse by the first-year governor. On Tuesday Greitens will be in St. Louis discussing ways to prevent overdose deaths. He will be in Cape Girardeau and Springfield later in the week to outline plans for combating drug traffickers and treating addiction in rural Missouri.