Missouri And Prescription Drug Databases: Considerations For The Curious

Jul 22, 2014
Originally published on July 22, 2014 10:54 pm

Drugs, privacy, prison. Those three things are linked to the debate over prescription drug databases -- and Missouri is the only state in the U.S. without one.

The New York Times published a piece Monday that refreshed the national discussion around the issue. But it's been a topic here in Missouri for some time. A prescription drug database tracks people's prescription-buying habits and flags those who are filling multiple prescriptions in a short time frame -- a clear sign of addiction.

At issue for Missouri lawmakers is whether such a database represents government overreach into personal privacy and whether having such a tool can actually do anything to decrease drug addiction. 

The main points of discussion are the potential that databases have to address addiction, privacy and incarceration.

To help you better navigate the debate, here is a bare-bones exploration:

  • Drugs And Addiction

Link to Heroin: A major focus of prescription drug databases is tracking prescription of painkillers like Percocet and Oxycontin. These prescription drugs are often the gateway substances to use of opioids, like heroin

"Doctor shopping:" When those who abuse or sell prescription drugs can't get enough of the drugs from one doctor, they "shop" to another, and sometimes, another and another. This is called "doctor shopping." Advocates for prescription drug databases say the databases go directly toward stopping this activity. You can find out what some states are doing to try to stop doctor shopping.

  • Data and Privacy

​"Protecting people's liberty:" In their piece Monday The New York Times interviewed Missouri state Sen. Rob Schaaf, the main voice against establishing a prescription drug database in the state. His main issue? Privacy of patient information: 

“There’s some people who say you are causing people to die — but I’m not causing people to die. I’m protecting other people’s liberty,” Mr. Schaaf said in a recent interview in his Senate office. 

Back in 2012, the St. Louis Beacon interviewed Schaaf about the same topic, and privacy was still his primary concern:

State Sen. Rob Schaff, R-St. Joseph, said databases are "fraught with holes." He is a physician with a family medical practice in his hometown. A database allowing access to law enforcement, doctors and pharmacists -- depending on the rules -- could be compromised and violate doctor-patient privilege, he said.

"People are going to lie to get drugs no matter what," Schaff said. "That doesn't meant the rest of the system, the 99 percent of the people who use them properly, should give up their right to privacy just to stop people from doing bad things."

Who gets access to what: Would databases be open to just patients? Doctors? Pharmacists? Law enforcement? There are a variety of answers to that question. The St. Louis Beacon reported in 2012 about two different approaches by two states:

There is not one uniform model for monitoring programs. Pennsylvania has one of the oldest programs, established in 1973. It does not allow access by patients, pharmacists or doctors -- only to law enforcement officials.

In Vermont, all those categories have access, except for law enforcement.

In May 2014, The Wall Street Journal said that the access to these databases is getting more difficult for law enforcement:

In February, a U.S. court in Oregon ruled for the first time that federal agents need a warrant to search that state's prescription-drug database. Last year, Rhode Island raised the barrier of entry to its database, and legislators in Florida and Pennsylvania are considering new limits on law-enforcement access to the records in those states...

In 17 states, law-enforcement authorities must get court approval before searching such databases, according to the [National Alliance for Model State Drug Laws.] Aside from Vermont, where the system is closed to law-enforcement authorities, the rest of the states grant access to investigators with few strings attached.

  • Incarceration

Solving the whole problem: Megan Ralston is  a harm reduction manager at the Drug Policy Alliance, a national non-profit dedicated to finding alternatives to the "war on drugs." She said that the databases, when used solely for a law enforcement purposes, could actually do more harm than good.

"If you're thwarting me at the pharmacy from buying the pills I'm addicted to but you're not making treatment readily and easily and affordably available to me then you're not solving the problem," Ralston said.

And what about costs of incarceration versus drug treatment? An interesting recent study from UCLA showed that there were cost savings for California in treating offenders convicted of nonviolent drug offenses and probation and parole violators, versus incarcerating them - to the tune of more than $2,300 over a 30-month postconviction period.

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