Proposed legislation seeks to enact statewide prescription drug monitoring program

Missouri is the only state in the country without a statewide prescription drug monitoring program (PDMP), an electronic database that tracks prescriptions for controlled substances.

New legislation proposed in the Missouri House of Representatives would establish a statewide PDMP through the Missouri Department of Health and Senior Services to monitor the prescription and dispensing of all Schedule II, III and IV controlled substances.

There were 58 opioid prescriptions written for every 100 Americans in 2017, according to the Centers for Disease Control and Prevention. Per prescription, the average daily amount was more than 45.3 morphine milligram equivalents (MME), the CDC states.

Similar bills have been through the Missouri Legislature in previous years but never made it past the Senate. This year, state Rep. Holly Rehder of Sikeston is sponsoring House Bill 1693 to establish the Narcotics Control Act, which would establish the PDMP program in Missouri.

This is the eighth year Rehder has carried such legislation.

Asked why some might be opposed to the implementation of a statewide PDMP, Rehder pointed to privacy concerns. But that argument doesn’t hold water, she said.

“All other states have been doing this for many years,” Rehder wrote in a Wednesday text message to the Southeast Missourian. “California started the first ... program in the 1930s.”

The Narcotics Control Act actually strengthens privacy protections, Rehder argued, because law enforcement officers would only be able to access a patient’s information for an open investigation by way of a signed court order.

A Senate companion bill to the Narcotics Control Act carried by Sen. Tony Luetkemeyer was heard earlier this week, Rehder said.

“We are hoping for a Senate committee vote on his [legislation] early next week,” Rehder stated. “[The] plan is to have both moving early and hopefully we can get to the Senate floor early this year.

St. Louis County launched a PDMP in 2017, according to its website. Seventy-five jurisdictions are participating in the St. Louis County PDMP — covering about 85% of the state’s population — but about 52 counties in Missouri are without coverage.

“Our medical professionals desperately need a full-functioning statewide program to make the biggest impact on fighting the opioid epidemic,” Rehder wrote.

The proposed legislation would set in place several procedures for the sharing of prescription information, including a requirement each drug dispenser must electronically send dispensation, patient and prescription information for each drug dispensed within 24 hours of dispensation.

The expectation by Jan. 1, 2023, is that such information would be sent in real time.

Rehder noted PDMP programs are regulated by federal law restricting the release of medical information, meaning all information sent is to remain confidential, and the DHSS would be expected to maintain procedures that ensure privacy and confidentiality.

If there is reasonable cause to believe a violation of the law or a breach of professional standards may have occurred, the Narcotics Control Act also establishes a review process including the potential notification of law enforcement or the appropriate professional licensing board.

According to the bill’s fiscal note, states can apply for a one-time federal grant of $400,000 to start a narcotics control program but are only eligible for the grant after they have passed and enacted legislation for such a program.

“We know how much this costs already because St. Louis County has been running for three years now,” Rehder wrote. “It’s about $500K a year and right now, that’s covered by federal grants.”

A public hearing for the Narcotics Control Act bill was completed Jan. 22, and the bill was read Wednesday in the Insurance Policy standing committee.

The bill will move next through the Administrative Oversight Committee, of which Rehder is the chairwoman. From there, it will move to the House floor.

Rehder said she hopes those who may be opposed to the Narcotics Control Act will “get on board” with a statewide PDMP program in Missouri, which would allow legislative oversight versus the “patchwork program” that currently exists.