Lawmakers have reached a compromise that should allow Missouri to adopt a statewide prescription drug monitoring program.
Early Tuesday, Sen. Tony Luetkemeyer, R-Parkville, proposed an amendment to the bill that passed the House which would create a “Joint Oversight Task Force for Prescription Drug Monitoring.” The body would allow licensed medical professionals, such as physicians and pharmacists, to oversee the collection and use of data rather than the Department of Health and Senior Services.
Luetkemeyer’s amendment also explicitly limits the ability of law enforcement agencies to access the information and states that the data cannot be used when someone is trying to buy a firearm.
The amendment also adds fentanyl and a few other drugs to those being monitored.
A key goal of the compromise is to minimize privacy concerns about the gathering of the data.
Now the program will be overseen by a private board and "we put a provision in that had a complete bar on basically sharing the data for non-prescribing or treatment purposes," Luetkemeyer said. "So you can't give it to law enforcement. You can't have the government have free rein to go through medical records in the database. Now, it's really just being used as a treatment and clinical tool."
The compromise ended a filibuster by conservative Republicans who have long opposed it.
"I think it addressed the biggest concern that the conservatives had ... what we didn't want to have as a final product was a government-run database," and they accomplished that, said Sen. Bill Eigel, R-Weldon Spring. "So what we're going to have is a scenario where doctors are going to have better access to information on their patients without the involvement of a government organization running (it) and having access to private data ... I was very pleased with the sponsor's willingness to compromise."
Eigel said he would "probably not" vote for the bill. "I see a very very narrow role when it comes to government telling doctors and telling healthcare providers what to do, but ... I really hesitate to even say that, Missouri is going to have a PDMP after the passage of this bill. The reality is, we've just set up a system so doctors can have better access to patient information without the presence of the government having access to such a network."
Rep. Holly Rehder, R-Sikeston, the sponsor of the House bill who has led the effort to adopt a PDMP in Missouri, said she believes this could be the answer. She said senators included her in their behind-the-scenes deliberations.
"I think it's a great option, great solution to have the members of the professional boards that are the overseers of this,” Rehder said. “Of course it still has a few more hurdles, but certainly I think the concept is wonderful. I think it's a great compromise."
Rehder added, "We certainly were very cautious in making sure everyone was at the table that has a stake in this, so I'm hopeful that it is an acceptable solution. I think the members of the professional boards overseeing certainly makes sense."
Under the Narcotics Control Act, a statewide electronic prescription-monitoring database would be established, asking medical providers to track drug prescriptions with the potential for abuse. Missouri is the only state without a statewide program.
Instead, a PDMP program administered by St. Louis County is in place. Seventy five jurisdictions — including Columbia — have joined that program, which now covers about 85% of Missourians, according to prior reporting.
"This bill provides health care providers with the information they need to make the best possible decisions for their patients," said Luetkemeyer said during debate Monday night. "Most importantly, it protects Missouri families from the devastation caused by the opioid abuse and epidemic that has swept the state and the country."
Luetkemeyer pointed to a study by the National Institutes of Health, which found thatstate implementations of PDMPs helped combat opioid-related deaths, adding for example that there was a 41% decrease in opioid prescriptions in Ohio after implementation.
The compromise is meant to address concerns that opponents brought up again Monday night, citing privacy concerns of such a database.
"The original concept for this was never about patient data. It was never about getting patient data into the hands of physicians," said Sen. Eric Burlison, R-Springfield. "It was about getting data into the hands of law enforcement."
Law enforcement can't access medical records without a warrant because it's private, added Burlison, but "if this data belongs to the state, then law enforcement can go on fishing expeditions" and access the data.
Other senators also questioned the effectiveness of a PDMP despite the research Luetkemeyer brought up.
Sen. Ed Emery, R-Lamar, said statistics show that Missouri is doing better at dealing with the opioid epidemic than many other states with PDMP programs. "We haven't seen a demonstration that this really does work," he said.
Sen. Cindy O'Laughlin, R-Shelbina, made a similar argument last year, on which PolitiFact ruled that PDMP effectiveness can't be measured on mortality alone and that state-by-state comparisons weren't effective.
Luetkemeyer, addressing potential concerns, emphasized that the bill has privacy protections, noting the police cannot use the database as the sole basis of a warrant or to deny someone access to a firearm. Unauthorized use of the database would bring stiff penalties.
Conversation over the legislation went well into the evening, with senators working behind the scenes to see if they could hammer out a compromise.
If the Senate passes Rehder's House bill with the amendment, it would go back to the House for approval.
Ultimately, Luetkemeyer said, PDMP is here to stay in Missouri.
"The only question is whether we want that PDMP to be controlled by St. Louis County or by the state," he said.