If Missouri lawmakers want a statewide drug monitoring program, they’ll need to fight for it in a legislative conference committee.
The Senate Appropriations Committee on Wednesday cut funding for a prescription drug monitoring program that Gov. Eric Greitens created in an executive order in summer 2017.
The House included funding for the nearly $375,000 program in its version of the budget, but the Senate committee cut funding for the program after some senators complained about how the program was created and about the burdens it could place on doctors.
“I have severe heartburn because this program is actually hurting people,” Sen. Rob Schaaf, R-St. Joseph, said. “The physicians across the state are afraid to prescribe narcotics.”
The monitoring program tracks what and how many narcotics physicians are prescribing to patients. The goal is to combat the opioid crisis and ensure patients aren’t receiving more drugs than they need.
Some lawmakers, led by Schaaf, have fought the creation of a PDMP for several years. Greitens signed an executive order in July directing the Missouri Department of Health and Senior Services to begin work on the program, but it needed an appropriation from the Missouri General Assembly to operate.
Schaaf said the program would place a burden on physicians by requiring them to look back through records and provide information to the department if it requests it. He said he would have “quit prescribing opioids forever” had the department ever asked him for information. Schaaf is a family physician in St. Joseph.
“I couldn’t afford to have somebody sit down and go through 10,000 charts to see if I had prescribed opioids,” Schaaf said. “What I’m afraid here is that as a result of this, patients aren’t getting opioids that they need.”
Sen. Jason Holsman, D-Kansas City, took issue with Greitens’ executive order, saying the program, if created, should be done through legislation.
“I don’t have a problem with the mission of what they’re trying to accomplish, but I wish that it were done statutorily,” Holsman said. “I have a problem with the executive, for what I believe to be political reasons, involving themselves in an issue that should be a legislative priority.”
St. Louis County launched a prescription drug monitoring program in early 2017, and 47 counties and 10 cities have joined the program, including Boone County and Columbia.
“Our counties already have a workable system that’s in place for a large percentage of the state,” Holsman said. “We have to deal with this at the state level if we’re going to put these funds in place, and I just think that doing it this way is not the appropriate policy position to take.”
Rep. Holly Rehder, R-Sikeston, introduced legislation this year to create a statewide drug monitoring program, but the bill was not referred to a committee. The same bill Rehder sponsored last year passed both the House and Senate in different versions but died toward the end of the session.
Rehder said in order to move her legislation forward, it would need to include a provision that would purge data after a certain period of time and cover less medication than the St. Louis program in order to address concerns with some Senate members. Because of that, "we just do not have the votes to move it."
If the program is funded by the legislature, it would be operated under the Division of Regulation and Licensure within the health department. Division Director Dean Linneman told the Senate committee Tuesday that the department already has the authority to audit physicians who prescribe narcotics, but a monitoring program would help the department be more efficient through data collection and analysis.
Currently, the department audits doctors through occasional field visits or if it receives complaints from patients about physicians. Linneman addressed Schaaf’s concerns, saying the program would actually increase the department’s efficiency because it would only be looking at certain physicians who seem to be prescribing narcotics outside the normal.
“We’re looking at the ones that are obviously — based on the way we’re analyzing it — look like something is just a little different,” Linneman said. “We have a lot more information readily available to us to prioritize and hopefully make our job a little more efficient so that, again, we’re not adding a burden to a physician who appears to be prescribing within the standard.”
Once the Senate passes its version of the budget, both chambers will meet in a conference committee to work out the differences. The appropriations committee plans to meet next week to continue work on the budget.