Officials Worry Greitens' Drug Program May Not Mesh With Current Efforts

Jul 19, 2017

COLUMBIA — At the command of the governor, a statewide prescription drug monitoring program is in the works — but local officials say they are concerned about how it may mesh with an established local monitoring program.

Gov. Eric Greitens signed an executive order Monday directing the Department of Health and Senior Services to establish a statewide prescription drug monitoring program, or PDMP. The program will use "de-identified data" to target “pill mills" that give out prescription drugs at dangerous levels, a news release from the governor states. The program also will enable the department to better inform health care providers and patients about pain management to cut down on opioid prescriptions. 

The promise of a statewide program comes after the legislature repeatedly failed to approve a PDMP. Several municipalities in Missouri including Columbia joined up with St. Louis County to start their own. Subscribers to the St. Louis County Department of Public Health program also include Boone, Audrain and Cole counties.

Although specific details on how Greitens' new program will work are scarce, the news release from the governor indicates it will be different from the PDMP used in Columbia now. The proposal would put drug prescription data in the hands of the state to target "bad actors" but will not make it available to prescribers.

In contrast, the St. Louis County program provides access only to prescribing physicians and pharmacists who request it. In the Columbia area, pharmacies are required to input dispensing information within seven days, but physicians are not required to consult the database before prescribing a controlled substance.

The software purchased by St. Louis County is from Appriss Inc., which is used in more than 40 states for monitoring programs. 

Greitens, who called opioids "the modern plague," said in a prepared statement that his office will outline additional steps to address the opioid crisis throughout the week. No single order, law or program can fix the crisis, he said, but the statewide PDMP will be a big step.

"The only thing we won't do is wait,” Greitens said in the statement. “We won’t wait for this problem to get worse. That's not an option.”

The governor's order states the Department of Health and Senior Services will receive the information collected through the statewide program. The order calls for a multi-phase program in which the health department shall:

  • Contract with pharmacy benefit managers to analyze prescriber and prescription data and identify activity indicating controlled substances are being inappropriately prescribed or obtained; and make referrals to law enforcement or professional licensing boards.
  • Implement a rule requiring dispensers to submit controlled substance prescription information to further identify suspect activity and make appropriate disciplinary referrals.
  • Work with private companies, government entities or others to buy and use software to continue monitoring controlled substance prescriptions.

The information collected will remain confidential except to administrative or law enforcement agencies or with written consent of the individual registered in the program, according to the privacy statute the order points to. Greitens' program will not grant physicians or pharmacists the access to the proposed PDMP that they have with the current program.

"Through partnerships with private sector leaders, the state will be able to monitor prescribers and dispensers to find and eliminate bad actors in the system," the news release reads.

A few local officials who pushed for a monitoring program said this week they are skeptical of Greitens’ proposal and hope it does not interfere with the county initiative.

Second Ward Councilman Michael Trapp said that he hasn't reviewed the governor’s full order but that the state initiative sounds like a "criminal sting operation." When they signed on to the St. Louis County program, the city and Boone County were instead focused on public health and wanted to facilitate better communication among medical professionals to inform their prescribing.

Trapp said he hopes that the Department of Health and Senior Services’ program does not cancel what St. Louis County started. The Appriss Inc. software can support the whole state, and it eventually will if other counties continue signing up at a fast pace, he said.

"There is clear direction from local governments to the state government about how (a prescription drug monitoring program) should look," Trapp said.

Third Ward Councilman Karl Skala also said he hopes there is no conflict among the two PDMPs. The local monitoring program and the state’s program could work together to make a difference in the opioid epidemic, he said.

“I think it’s all for the public good,” Skala said. “I am not too concerned about how to get there.”

Local officials are not alone in their concerns, as the Missouri Association of Counties also emailed county commissioners after Greitens’ announcement to let them know the group will offer as much guidance as possible in the coming weeks about how the state and county programs may mesh, according to the email. 

Rep. Holly Rehder, R-Sikeston, said on Tuesday that the governor’s proposal can exist in tandem with what the counties are building statewide. Greitens’ program will address a totally separate arm of the opioid epidemic by targeting the “pill mills,” she said.

Rehder, a longtime advocate of a statewide PDMP, said she has encouraged counties across the state to implement the St. Louis County program.

The St. Louis County program for medical providers “is absolutely capable of handling the entire state, and eventually it will be statewide," Rehder said.

The St. Louis County program launched in Columbia on April 25 and went live in the rest of the county on July 1, said Eric Stann, who is the community relations specialist for the Columbia/Boone County Department of Public Health and Human Services. There are 1,085 drug prescribers and dispensers in Boone County — only 17 of which are outside of Columbia, he said.

The local government will also receive information collected through the PDMP, but it will be aggregate figures and will have no identifying information, Stann said. The statistics will be used to see if there are any patterns in how schedule II-IV drugs are prescribed, he said.

“It’s not patient data we are collecting, it’s just aggregate, overall (numbers) for trends,” Stann said, adding that the health department is not expecting its first quarter of data until later this summer.

Supervising editor is Elizabeth Brixey.