The stroke of a pen more than a thousand miles away has made Missouri the only state in the nation yet to authorize collection of pharmacy data to crack down on prescription drug abuse.
Missouri earned the distinction last week when Gov. John Lynch signed legislation creating a prescription drug monitoring program in New Hampshire, prompting one national expert to warn that Missouri could become a haven for the illicit trafficking of prescription drugs.
“What Missouri has undoubtedly accomplished in this process,” said John Eadie, director of the Prescription Monitoring Program Center of Excellence at Brandeis University in Waltham, Mass., “is setting itself up as the mecca for drug dealers.”
A primary purpose of the prescription drug monitoring programs, through which states collect sales data from pharmacists, is to reduce what the U.S. Centers for Disease Control and Prevention has called the “growing, deadly epidemic of prescription painkiller abuse.” Prescription painkiller overdoses killed nearly 15,000 people in the United States in 2008, according to the CDC. That is more than three times the number of people killed by those drugs in 1999.
These centralized databases, which track individual drug purchases, give pharmacists, doctors and regulators a tool to see a patient’s complete pharmaceutical record. The aim is to prevent so-called “doctor shopping,” when addicts obtain prescriptions from a number of physicians and fill them at various pharmacies.
Supporters also argue that monitoring can reduce Medicare and Medicaid fraud, but privacy advocates contend the programs intrude into what should be a patient’s confidential medical record.
Privacy concerns scuttled efforts to pass the Prescription Drug Monitoring Act in this year’s session of the Missouri General Assembly.
In an eight-hour filibuster May 3 led by Sen. Rob Schaaf, a St. Joseph Republican, opponents outlasted supporters of a Senate measure and a companion bill, which passed the House of Representatives in March by a vote of 143-6.
The stalemate finally ended, the Associated Press reported, when the Senate gave initial approval to a watered-down version with the understanding that leaders would not bring it up for a final vote before the General Assembly adjourned May 18.
The database would have applied to cash transactions only, because that’s the payment method addicts and traffickers use to fly under the radar of insurers. It also would have tracked the sales of only certain classes of controlled substances, including pain relievers like oxycodone.
Privacy “kind of rings hollow as an argument,” said Bob Twillman, director of policy and advocacy for the Sonora, Calif.-based American Academy of Pain Management, considering the vast amount of personally identifiable medical data already maintained by public health agencies and insurers.
He is also chairman of the advisory committee overseeing the prescription drug monitoring program in Kansas, which launched in April 2011.
Officials with the Kansas program said their data suggest some spillover problems from Missouri.
They alert doctors and pharmacists with a “threshold letter” when a patient exceeds a certain number of prescriptions in a quarter. The threshold is confidential so as not to alert potential abusers, said Program Director Christina Morris.
In the first quarter of this year, she said, nearly two-thirds of 171 letters sent involved patients who lived in Missouri or in bordering Kansas counties, including Johnson and Wyandotte.
As a primary care physician, Schaaf’s stance puts him at odds with the Missouri State Medical Association. At its spring conference, a majority of the attendees agreed to support establishment of a prescription drug monitoring program.
Of the supporters, he said, “They were thinking with their doctor hats on, which is OK, because on the one hand there would be some utility of having the drug database.”
But, he added, “I have to wear my senator hat, and on the other hand, there would be a severe infringement on our liberty.”
Schaaf also noted that in many states legislators have authorized programs, but they are not operating.
According to the Center of Excellence at Brandeis, the programs are up and running in 40 states. Eadie said they are proving useful as early warning systems.
“If you know where doctor shopping is beginning to crop up,” he said, “then you will have the capacity to inform those communities immediately.
“Because we know now from the data that we have looked at that there is a close association between overdoses and deaths and doctor shopping.”