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Could prescription drug monitoring curb further abuse?

Statistics from the Centers for Disease Control show 80 percent of people who use heroin started on prescription opioid medication.

St. Francois County is taking part in a drug monitoring program which could help intervene before people would become addicted or start misusing the drug – leading to further addictions. In June, the St. Francois County Commissioners approved a recommendation from St. Francois County Health Center Director Jessica McKnight for the county to take part in the St. Louis County Public Health Department Drug Monitoring Program.

According to the National Alliance for Model State Drug Laws (NAMSDL), a PDMP is a statewide electronic database which collects designated data on substances dispensed in the state. A recent study of national data found implementation of prescription-drug monitoring has led to a 30 percent reduction in the rate of prescribing opioids between 2001 and 2010.

The PDMP is housed by a specified statewide regulatory, administrative or law enforcement agency. The housing agency distributes data from the database to individuals who are authorized under state law to receive the information for purposes of their profession.

The program monitors the prescribing and dispensing of Schedule 2, 3 and 4 controlled substances.

“It’s not a policing matter,” McKnight said. “It’s more of a preventive factor. They are wanting to improve patient safety by allowing clinicians or providers (with certain information) … that’s who is seeing the data.”

The commission approved participating in the St. Louis program this past June, due to the fact that Missouri is the only state to not have a statewide PDMP program already in place.

The latest failed attempt by the Missouri Legislature to pass a PDMP was this spring when House Bill 90, a measure that would have created a database to track prescription drug purchases across the state, never made it to a vote.

Bill sponsor Rep. Holly Rehder, R-Sikeston, said its goal was to prevent addictions and block doctor shopping when patients go from doctor to doctor for prescriptions. Some opponents of the bill cited invasion of privacy concerns with the proposed database.

How St. Francois County came on board

The St. Louis County Public Health Department obtained the technology needed for a drug monitoring program in April of this year.

“They started allowing different counties and jurisdictions to become users of their program,” McKnight said. “They had several counties that went live in April. Slowly, but surely, as of the end of September … 85 percent of the state providers and 69 percent of the state population is in this St. Louis County program.”

Providers include doctors, nurse practitioners, dentist and veterinarians – anyone who would be prescribing a controlled substance.

Database information is entered by pharmacists. The monitoring program gives the provider access to see what a patient is currently using.

McKnight said the monitoring program is a way to improve patient safety by allowing clinicians to identify patients obtaining prescription opioids.

“One of the big factors is (obtaining prescriptions from) multiple providers (at the same time),” she said. “… and identify patients who are being prescribed other substances that may increase their risk of drug reactions.”

Local health departments receive only aggregate data on the information – no names or identifying information, only numbers. Quarterly reports received by the department include the percentage of providers accessing the database and numbers on how many substances have been prescribed.

“Even law enforcement has no access to this information without a subpoena,” McKnight said. “Privacy is something they are very concerned with and want to make sure the people getting the information are the ones who need the information.”

What role can the drug monitoring system play in the fight against heroin abuse?

“Eighty percent of all IV drug users started on prescription opioids,” explained St. Francois County Health Center Assistant Director Amber Elliot. “Obviously this system is not going to treat people that are using IV drugs. It’s really more of a prevention before they get to that point.

“It’s a step in the direction of trying to prevent further addictions.”

Elliot acknowledges there is a connection between prescription drug and IV drug abuse – but is not always a precursor to IV drug abuse.

“This is mainly to identify those high risk patients who might benefit from early intervention to prevent abuse or misuse,” McKnight said.

The database also allows for finding safe and effective treatment for those with an identified risk “so we can get them the resources they need to prevent further misuse or abuse.”

The system gives alerts to providers for patients who have crossed a threshold established by the St. Louis County Department of Public Health.

“It will tell them if (the patient) has exceeded the number of controlled substances,” she said. “It’s the same thing with the provider … the St. Louis County Department of Public Health will receive a list of providers who go over an identified threshold for prescribing.”

Taking proactive measures

In July, Missouri Governor Eric Greitens signed an executive order creating a prescription drug monitoring program for the entire state. At that time the commission announced its intention to follow through with the ordinance passed in June creating a program for monitoring the prescribing and dispensing of schedule 2, 3 and 4 controlled substances in the county.

McKnight said state legislators have attempted to pass a statewide program for the past couple of years with no success.

Opponents of a drug monitoring program in the Missouri General Assembly argued that in other states with a database that patient privacy has been breached, saying a drug database infringes on personal liberty.

Sen. Will Kraus, a Lee’s Summit Republican who helped derail the legislation this year, said the government should not be in the business of “creating databases to track law-abiding citizens.”

“We are the only state in the U.S. that doesn’t have one,” McKnight said. “(The executive order) doesn’t go along the traditional sense of a PDMP where that data is there for providers to see. It is more so reviewing prescribing recommendations, develop prescribing requirements, education for providers.

“It’s not necessarily that same database the traditional PDMP would be.”

One piece of the executive order are statewide opioid summits held at various locations.

“(The executive order) is more information than giving a database,” McKnight said. “It’s not the same. The PDMP from St. Louis County is really targeted at providers, giving them that information.”

The director said local jurisdictions have been encouraged by the governor and the director of health and senior services for the state to continue passing local ordinances such as the one passed by St. Francois County.

“They know that a statewide PDMP is just another piece of the puzzle. It would work in connection with the PDMP from St. Louis County,” McKnight explained.

And the program allows for communication with other states for those participating counties near state lines.

“The system does (cross state lines) if someone goes across the (state) line and gets a prescription because other states do have that monitoring system in place,” she said.

St. Louis County was recently awarded grants to allow local jurisdictions to buy into the program and become users for no cost until September of 2019 – something McKnight told the commission could be a possibility when presenting the program in June.

At that time, the county’s cost to participate in the PDMP program for two years would be $1,699 – with McKnight telling the commissioners the county would be charged a pro-rated cost of $700 if the grant was not obtained.

“We’re really excited about that,” she said. “We felt it was definitely something (for the commission) still to be willing to provide for the county. (The health department was) ready to pay for that cost because it’s the preventive factor and what we do is prevention.”

Editor’s note: Daily Journal Reporter Kevin Jenkins also contributed to this story.

“It’s a step in the direction of trying to prevent further addictions.”

Amber Elliot, assistant director, St. Francois County Health Center

Pharmacist Sean Jewell with Clark's Pharmacy in Farmington enters information into the computer. Jewell came to the area from Illinois - where he saw firsthand the positive impact a statewide drug monitoring system had on the battle against opioid addiction. Missouri is the only state without a statewide program, leading county health facilities to adopt a program created by the St. Louis County Public Health Department. St. Francois County implemented the program this summer.

Pharmacist Sean Jewell with Clark’s Pharmacy in Farmington enters information into the computer. Jewell came to the area from Illinois – where he saw firsthand the positive impact a statewide drug monitoring system had on the battle against opioid addiction. Missouri is the only state without a statewide program, leading county health facilities to adopt a program created by the St. Louis County Public Health Department. St. Francois County implemented the program this summer.

Shawnna Robinson is the managing editor of the Farmington Press and can be reached at 573-518-3628 or srobinson@farmingtonpressonline.com

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