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Drug monitoring in Missouri: It takes two

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Drug Monitoring Missouri

Missouri Gov. Eric Greitens speaks to reporters in St. Louis on July 17, 2017, after signing an executive order establishing a prescription drug monitoring program. Missouri was the last state without a PDMP. (AP Photo/Jim Salter)

Last year in the St. Louis area alone, more than 700 lives were lost to fatal opioid overdoses. This is a breathtaking number. We lost 712 fathers, sons, mothers, daughters, sisters and friends, and as the death toll climbed, the Missouri Legislature again failed to pass a statewide prescription drug monitoring program.

Such a program is a proven asset. It enables doctors and pharmacists to see what drugs a patient is currently being prescribed. This helps prevent “doctor shopping,” or obtaining multiple prescriptions for a drug from multiple doctors. The program also improves health outcomes, especially among elderly patients who are seeing several different specialists for different conditions, because it enables their doctors to see all the medications they’re taking and gives them a tool to prevent adverse drug interactions.

For these reasons it’s important that doctors and pharmacists have access to a prescription drug monitoring database. We are all quite accustomed to sharing this kind of information with our doctor or pharmacist.

A prescription drug monitoring program is an effective way of reducing drug diversion and the harms of drug dependence. Every other state (even Puerto Rico and Guam) has one. But — largely due to the misguided efforts of Rob Schaaf, a senator from St. Joseph who believes that a program violates our right to personal privacy — Missouri stands alone on the wrong side of history.

Thankfully, last February, something innovative happened: St. Louis County stepped in and created the nation’s only local prescription drug monitoring program. Now, the only benefit of Missouri’s being last to adopt a drug monitoring program is that St. Louis County had 49 other programs to examine. Along with consultation with the Brandeis University’s Center for Excellence, it was able to develop a state-of-the-art program, built on best practices, and capable of being scaled up. This ingenious workaround would make it possible to bring this database, county-by-county, to the entire state.

Almost immediately, St. Charles County joined, then St. Louis city. Others followed, and one by one, counties signed up for the program, and as of today, 58 percent of Missouri citizens are protected and 74 percent of providers are joined to this database. The system isn’t perfect because it isn’t statewide, but it’s a start, and it grows larger and more complete every week.

On July 17, Gov. Eric Greitens signed an executive order. And though he refers to his executive order as a statewide prescription drug monitoring program, that’s a bit misleading. It is, in fact, a brilliant and unique adjunct to the local program that began in St. Louis County.

Greitens’ plan has received some criticism from the Missouri Foundation for Health, the Missouri State Medical Association and U.S. Sen. Claire McCaskill. This is understandable because, on its own, the governor’s plan is insufficient. Doctors and pharmacists are denied access to the data; and while this might please those in the Legislature who worry about such programs posing a risk to personal privacy, the lack of patient data is an enormous deficiency.

On its own, the governor’s plan will do nothing to help patients avoid dangerous drug interactions, it will do nothing to improve health outcomes, and it will do nothing to stop addicts and dealers from “doctor shopping” for opioids or other addictive drugs.

But the governor’s executive order was clearly not intended to create a stand-alone prescription drug monitoring program. We believe it was intentionally designed to complement the program that began in St. Louis County.

Together, the governor’s and St. Louis County’s prescription drug monitoring program give Missourians all the protection they require and take Missouri from last aboard to first in class. But only if they are used together.

We urge all counties to join the prescription drug monitoring program that began in St. Louis County. Do not settle for only the governor’s necessary-but-insufficient plan. Give your people the benefit of both because, together, they set a new standard for what works.

Now, if we commit to additional measures like making treatment more available and more affordable, and expanding universal, school-based substance-use prevention for all kids in all schools in all grades, we can rein in this epidemic and prevent the next one from arising.

Howard Weissman is the executive director of the National Council on Alcoholism and Drug Abuse-St. Louis.

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Missourians are fortunate that county-level prescription drug monitoring programs cover more than 60 percent of the population because the plan launched by Gov. Eric Greitens does little other than rid the state of its embarrassing status as the only one in the nation without a plan.

Greitens gets credit for bucking the Missouri Legislature, which hemmed and hawed for years and failed to pass a plan. But his plan isn’t like those in any other state, falling short of the model by focusing on law enforcement and not health care.

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