Last year, frustrated with a lack of commitment from state legislators, St. Louis County created its own prescription-drug monitoring program with the specific expectation other areas of the state could join in – and they have.
Officials say the rollout has been successful. But on the program’s first birthday, county representatives say they’d still like to see a Missouri-wide system.
Missouri remains the only state without a comprehensive drug monitoring program, one of the many tools states have begun using with the hopes of reducing overdoses and opioid addictions.
With a monitoring program, doctors and pharmacists can track a patient's prescription-drug history. Before prescribing a controlled substance such as Percocet or hydrocodone, a doctor enrolled in the system can check the database to see if the patient has been “doctor-shopping” for multiple prescriptions, indicating possible addiction.
Since its creation, the county’s database has added 59 towns and counties to its system. (It’s still referred to as a St. Louis County program.)
During its first year, the program found, on average, 21,000 controlled substances are dispensed each day within participating jurisdictions, the most popular being the painkillers hydrocodone, oxycodone and tramadol. According to the county health department, those three drugs comprise 85 percent all opioid prescriptions tracked by the program.
Since last year, the system, which includes St. Louis, has flagged 14,000 patients who received multiple painkiller prescriptions from different doctors, indicating possible addiction.
County health officials say the program is so young – and the epidemic so large – it’s hard to say whether the database has resulted in fewer overdoses. But they say it has given doctors the ability to decide if they should prescribe controlled substances or not.
“The system is being used to be able to make better clinical decisions,” said Amy Tiemeier, professor at the St. Louis College of Pharmacy, at a press conference Tuesday morning.
Tiemeier said the county is working on educating system users on how to approach patients who have been flagged and steer them toward treatment.
“[It’s a] really important interaction at the pharmacy counter,” she said. “If you know someone is misusing or overusing — maybe they aren’t at that point where they’re ready for treatment — you still make that recommendation.”
If the patient isn't ready for treatment, “You could still provide naloxone,” said Tiemeier, referring to the overdose-reversing antidote available at Missouri pharmacies.
Though many parts of the state are eager to participate, County Public Health Director Faisal Khan is still worried about the lack of a statewide database.
“There remain areas of the state close to the borders of Iowa and Arkansas that are not part of the program,” he said. “These areas risk becoming pill-shopping capitals for the entire region.”
Last year, Gov. Eric Greitens introduced his own version of a prescription-drug monitoring system in which the state collects de-identified prescribing data to target “pill mills” and doctors who over-prescribe dangerous medications. Unlike many systems, the database isn’t accessible to health-care providers and pharmacists.
Khan said any program lacking that accessibility “isn’t a PDMP.”
“What they’ve done is take a punitive approach to punishing physicians who over-prescribe or prescribe outside the parameters of guidelines established by professional agencies. That may or may not be useful — it remains to be seen. What it has done is inculcate a culture of fear whenever they deal with patients or clients that have genuine pain-management needs,” said Khan.
Use of the county-run program remains voluntary even for participating jurisdictions. Other states such as Kentucky require mandatory checks for their state databases. Khan said his focus for the next year is to encourage more enrollment from all parts of the state.
St. Louis County Executive Steve Stenger says he’d like to see the database spread statewide.
“Legislation at the state level would be relatively easy,” said Stenger. “It could be mandated that counties are required to join our PDMP. It would be a great step, if the state were willing to take that step.”
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