__PDMPs__

Amid a national state of emergency regarding the opioid epidemic, and a quadrupled overdose rate in the United States since 1999, there is only one state in the union without a reactive statewide prescription drug monitoring program (PDMP) — Missouri.

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A prescription drug monitoring program is an electronic database that tracks controlled substance prescriptions in a state. According to the Center for Disease Control and Prevention (CDC), PDMPs can provide health authorities timeless information about prescribing and patient behaviors that contribute to the epidemic and facilitate a nimble and targeted response.

PDMPs apply to the approximately one million medicaid users in Missouri, and track an individual's prescription medicine activity across all medical denominations and inputs the information into a database for physicians and pharmacists.

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Evaluations conducted by the CDC concluded that PDMPs have illustrated changes in prescribing behaviors, use of multiple providers by patients, and decreased substance abuse treatment admissions.

Rep. Holly Rehder (R-Sikeston) has introduced a house bill for the past six years to the Missouri House of Representatives to bring a statewide reactive PDMP to the state, however the bill has never passed.

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As for why it hasn’t passed, Rehder said some legislators are simply dragging their feet.

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“Every medical professional in the state is for [PDMPs], yet it’s the sixth year going through legislature,” Rehder said. “This is information they are allowed to have already, we are just making it difficult for them to access it.”

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In lieu of the 99th General Assembly’s failure to pass the required legislation to instate a reactive PDMP, Gov. Eric Greitens signed an executive order for the Department of Health and Senior Services to implement a multi-phase PDMP.

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In it’s reasoning, the executive order read: “Missouri’s Opioid Public Health Crisis necessitates the marshalling of all appropriate resources to combat the harmful effects of opioids on Missouri families and communities.”

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The executive order, however, only allows for a proactive PDMP, which allows personnel to access and investigate overprescribing practices, however does not send patient data straight to the prescribing physician as a reactive PDMP would.

Dr. Joe Leckie, specialist in emergency medicine at Saint Francis Healthcare System, says he’s happy the governor instated the PMDP he did, however in the future he would like to see the two forms working together.

With a proactive PMDP, providers have the option to register, it’s not an automatic database in every hospital computer systems. Also, it’s not reliable across counties and state lines.

“A lot of the providers still have not registered to get into [the PDMP]. We have a lot of patients that come from Illinois, so we can’t get their information from across the river, so you have to use your best judgement,” Leckie said.

Leckie said as a physician, he’s always had cyber access to medicaid information that shows what a PDMP would show. The PMDP would just supply the information immediately during patient visits.

Although PDMP’s would certainly help with monitoring prescription drug distribution, Leckie said people always find a way to get around the system.

“We’ve had medicaid and medicare, and had cyber access for a long time, which shows how they’re getting these meds filled, but the addicts realized if they pay with cash, it won’t go on my medicaid number,” Leckie said.

Despite the legislature’s denial for a reactive PDMP, Rehder said she has been focused on implementing PDMPs county by county. According to her, approximately 70 percent of the state’s population is covered by county PDMPs, mostly in urban areas.

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Director of the Missouri Department of Health and Senior Services Randall Williams said the county by county PDMPs originated in St. Louis, and started making its way around the state. Williams said his department supports county PDMPs; however, they are not recommended by the CDC because only 15 percent of doctors around the country use them, reporting the programs as cumbersome.

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The Southeast Missouri region has successfully implemented PDMPs in every county in the region, with Dunklin County being the last to implement the registry.

“We just think very fervently that to have a robust and disciplinary process is best for everybody — it’s best for our patients, our doctors and best for the profession.” Williams said.