Prescription Drug Monitoring Programs: An Interview with an Expert

headerIt is important for college students to know about politics as we position ourselves as the next generation of policy influencers and change makers. At WashU this means getting involved in the community we call home and understanding the issues that affect it. The opioid epidemic has hit cities particularly hard, and in St. Louis, overdose-related deaths have increased 70% over the past five years.* I spoke with Brandon Costerison, MO-HOPE** Project Manager and Public Education Specialist for the National Council on Alcoholism and Drug Abuse of Missouri, about the potential impacts of a proposed Prescription Drug Monitoring Program.

MU: To begin with some background info, what is the current status of the prescription drug monitoring program in Missouri as compared to other states?

 

BC: It’s complicated. Every other state in the country has a statewide prescription drug monitoring program (PDMP for short) which tells you how far behind the ball we are. The reason we are so behind is because of a former state senator Robert Schaaf who has filibustered the proposal for the past 8 years. He has been turned out of office so that obstacle no longer exists.

 

MU: So does Missouri not have any PDMPs at all?

 

BC: Missouri does not have a statewide PDMP but there are municipal-based PDMPs. For example, there is one that is operated by St. Louis county. Overall, many Missouri counties have signed on. About 80% of Missouri providers are in counties that participate. That program is continuing to expand, and it has been very successful. However, it is still not comprehensive.  

 

MU: Why is it important to have PDMPs in place?

 

BC: Basically, a PDMP is a database that doctors and pharmacists can access to see the controlled substance history of their patients. It is important because it allows them to make sure they are practicing medicine in an ideal way. It can really save lives.

 

MU: In practice, do PDMPs help prevent substance abuse?

 

BC: Absolutely! PDMPs are more of a prevention tool to help prevent people from developing substance use disorders to begin with. And the data shows that they work when properly implemented. I say properly implemented because there are 50 states and 49 PDMPs that exist and no two are identical. You can have a good one or a bad one or a just okay one. They do work, especially when they are paired with providers who are willing to make sure that they refer patients who might be misusing prescription drugs to treatment.

 

MU: In Missouri and in general what is the opposition to PDMPs?

 

BC: There are a couple schools of thought on why that is. The first, and this is where Senator Schaaf was coming from, was that he has a very libertarian perspective and he felt that a PDMP was a violation of 4th amendment rights against unreasonable search and seizure. He and others who share this view did not like the government having access to controlled substance prescribing history. Another perspective is that by implementing a statewide PDMP, it will make it more difficult for people who have chronic pain, for example, to access those controlled substances.

 

MU: What difference would be made in implementing a statewide PDMP if 80% of counties already employ one?

 

BC: Well Missouri has a lot of counties, we have 130 plus the city of St. Louis, so right now if someone wants to circumvent the PDMP all they have to do is drive across a county line. For people who have substance use disorders or for people who want prescription drugs to sell on the street, making a drive out of the county is no problem at all. A comprehensive statewide version would prevent that from happening. Currently, the legislation to create a statewide PDMP has passed in the Missouri House and it is in the Senate awaiting a hearing.

 

*https://stlouisco.com/Portals/8/docs/document%20library/Recover/Opioid_Action_Plan_2018_webv2.pdf

**Missouri Opioid-Heroin Overdose Prevention and Education (MO-HOPE)