Local lawmakers weigh in on prescription monitoring legislation

Members of the Missouri Senate on Thursday approved legislation creating a statewide prescription drug monitoring program, an electronic database to monitor the prescription and dispensing of all Schedule II, III and IV controlled substances

Holly Rehder

Similar legislation has been carried and passed by the House of Representatives in years past but has historically faced opposition in the Senate enough to kill the measures. This year, the Narcotics Control Act -- carried in the House by Rep. Holly Rehder, R-Sikeston, and in the Senate by Sen. Tony Luetkemeyer, R-Parkville -- was approved by a vote of 21-10.

Missouri is the only state that does not have a statewide PDMP, but several counties are already covered by existing monitoring programs, including Cape Girardeau County.

Seventy-five jurisdictions are participating in the St. Louis County PDMP -- covering about 85% of the state's population -- but more than 50 counties are without coverage, according to the St. Louis County PDMP's website.

In August 2017, Cape Girardeau County approved Ordinance 17-01, establishing the Prescription Drug Monitoring Ordinance and joining more than 30 Missouri counties to establish a PDMP. The St. Louis County Department of Public Health holds the contract in which the county program is operated and in which Cape Girardeau County has a subscription to participate, according to the ordinance.

State legislators who have opposed the Narcotics Control Act believe the establishment of a statewide program could do more harm than good.

Concerns

Barry Hovis

In mid-February, local state Reps. Barry Hovis, R-Whitewater, and Kathy Swan, R-Cape Girardeau, voted against the Narcotics Control Act, for concerns over patient privacy and the effectiveness of a statewide program.

Kathy Swan

Reps. Rehder and Rick Francis, R-Perryville, voted in favor of the bill.

Rick Francis

Swan explained her vote, noting the proposed bill "is not as effective" as programs already in place in Missouri counties.

The county's PDMP ordinance includes language that indicates a "prescriber" as any person who is authorized to prescribe Schedule II, III or IV controlled substances, a fact Swan noted as an important difference from the language written into the Narcotics Control Act.

The proposed bill, with amendments, states a dispenser is "a person who delivers a Schedule II, III, or IV controlled substance to a patient," but does not include "a hospital that distributes such substances for the purpose of inpatient care or dispenses prescriptions for controlled substances at the time of discharge from such facility," a practitioner or "other authorized person who administers such a substance," or a wholesale distributor of a controlled substance.

Hovis, who previously worked in law enforcement for 30 years, said he thought the bill should include a mandatory requirement of participation in a statewide PDMP.

"It was important to me to make sure that if doctors have the ability to prescribe drugs that they have under their control, that they also would have to enter that into the system if they give them out from their office," Hovis said.

Rehder explained the proposed bill is much the same as the PDMP currently in place in St. Louis County, noting while physicians and pharmacists are not required to check the PDMP database before prescribing or filing a script, many states have begun moving to a physician mandate to review data before prescribing.

"None started with that requirement," Rehder wrote in a Wednesday text message to the Southeast Missourian, "and I'd say only about half require that right now."

Swan also mentioned concerns about potential breaches to a PDMP database.

"It seems it's almost become an epidemic of people grabbing and using other's personal data for reasons that are not quite as honorable as we would hope," Swan said.

She pointed to a 2017 privacy breach by consumer credit reporting agency Equifax, which exposed the personal information of 147 million people, and a 2013 incident in which the names of more than 163,000 Missourians who had concealed-weapons permits were released.

"The creation of yet another centralized government database is also something to be concerned about," Swan stated. "Databases get hacked all the time (as with Equifax) or information gets exposed due to sheer carelessness (as with Missouri's concealed-carry list). I have grave concerns that something similar might happen with this database."

When asked about privacy concerns in regard to the bill, Rehder noted the Narcotics Control Act would "actually be more secure, once passed statewide," because it includes Second and Fourth Amendment protections, she said.

Wayne Wallingford

State Sen. Wayne Wallingford, who represents Bollinger, Cape Girardeau, Madison, Perry, Scott and Wayne counties, voted against the Narcotics Control Act on Thursday, noting it was a "very controversial bill." He said senators debated the bill from 2 p.m. Monday until 12:30 a.m. Tuesday.

"The consensus in talking to my constituents is that they feel that we have a stronger program actually in our Cape Girardeau PDMP program than the bill that's being presented," Wallingford said. "The people that are against the bill say they don't want to compromise the rights and privacy of those who have done nothing wrong."

Wallingford said, according to his research, a relatively small percentage of deaths are due to doctor shopping, in which a patient obtains controlled substances from multiple health care practitioners without the prescribers' knowledge of the other prescriptions.

"My constituents don't mind doctors having the information, or the pharmacies, but they do mind government or law enforcement having your personal health records," Wallingford said.

When the Narcotics Control Act reached the Senate floor Thursday, legislators called for amendments giving oversight of the PDMP to a board made up of licensed medical professionals, rather than the Missouri Department of Health and Senior Services, as the bill originally read.

Rehder said the "private board" would be made up of two licensed professionals from the Missouri Board of Registration for the Healing Arts, two licensed members from the Missouri Board of Pharmacy, one licensed advanced practice registered nurse from the Missouri Board of Nursing and one licensed member from the Missouri Dental Board.

The bill was also amended, Rehder said, to include a three-year rolling purge of data, and clarifying language was added to note the PDMP would be covered by HIPAA law.

Only licensed medical professionals abiding by HIPAA law would have access to medical information in the electronic records, which Rehder explained was an ask from the conservative caucus.

Despite the controversy surrounding the Narcotics Control Act, Rehder emphasized the PDMP legislation is a "medical tool" to combat the misuse and overprescription of opioids.

"President [Donald] Trump has been pushing to expand PDMPs because they are the most effective tool right now in the fight against the opioid epidemic," Rehder stated. "... It's not a silver bullet. But as the Trump administration has been saying -- it's our most effective tool in the toolbox right now."

What's next?

Because amendments were added to the bill on the Senate floor, the legislation must return to the House for another vote before it can be signed into law.

On Thursday, Swan and Hovis said they would need to review the amendments before disclosing how they would vote again on the bill.

"I would probably be open-minded about [the Narcotics Control Act] if there have been changes to it, and I would like to see them," Hovis said by phone Thursday.

Concerns about COVID-19, also known as the coronavirus pandemic, caused the Missouri Senate to cancel its session this week, ahead of the legislative spring break, March 23 through 27. Hovis explained Thursday the House still plans to convene this week, citing the body's constitutional requirement to approve the state's budget.

The Narcotics Control Act has been referred back to the House's Fiscal Review Committee before it moves back to the House floor for a vote.

For more information on the Narcotics Control Act, visit house.mo.gov or contact state representatives, whose information can be found at house.mo.gov/MemberRoster.aspx.