Between July and September last year, 557.4 opioid prescriptions were written in Boone County for every 1,000 residents.
Although Boone County's rate was below the average of 27 counties and cities included in the St. Louis County prescription drug monitoring program report, Lucas Buffaloe, assistant professor of clinical family and community medicine at MU, was taken aback by the amount. “I think it really is surprising to see it’s that high."
Still, Boone's rate ranked 25th. Madison County had the highest rate, followed by Lincoln and Pemiscot counties. In Madison County, 1,152.6 opioid prescriptions were written for every 1,000 residents.
The rates were released in a quarterly report published by the Columbia/Boone County Public Health and Human Services Department. It was the second report issued since the jurisdictions joined the St. Louis County prescription monitoring program, which was launched April 25. By the end of 2017, 57 jurisdictions had enacted legislation to participate in the program.
The surge in the use and abuse of these painkillers has made the prescription of opioids a significant public health concern. Officials created a database to track dispensing of controlled substances in an attempt to bring what Gov. Eric Greitens called a "modern plague" under control.
Women received more opioid prescriptions than men. In Boone County, women over age 65 received the highest rate of prescription opioids.
Buffaloe attributed this to women being more likely to suffer from chronic pain, and older people are more likely to be prescribed opioids.
Older patients and women "are more likely to be experiencing pain, or going through medical procedures that require pain medication,” Buffaloe said.
Before the database was created, one way Buffaloe could identify a suspicious patient was through his cooperation with pharmacies. If a patient was filling multiple prescriptions from different doctors, he would get a call from the pharmacy warning him.
Now that the St. Louis County database is in use, before Buffaloe writes or refills a prescription, he enters the patient’s name and can see a list of the patient's prescriptions for controlled substances, including opioid pain medications. The system also tells him where and when the patient filled the prescriptions and who wrote them.
If Buffaloe sees a patient has been filling prescriptions from multiple physicians, he would be concerned because that might indicate the patient is not using the medication but giving it to others or is abusing the medication.
The biggest limitation Buffaloe sees in the current system is that some pharmacies in Missouri that are filling prescriptions are not being shown in the database. “For us in Boone County, some of our surrounding counties are not enrolled in the program. For instance, Callaway County is not, so patients can go to Fulton to fill prescriptions, and that will not be included in the database. So there are gaps there,” Buffaloe said.
However, more counties continue to join the program daily, and the numbers of approved users are increasing. There were only 996 approved users when it was first launched, but the number increased to 5,294 by December. Approved users include healthcare providers who have full access to the database; authorized law enforcement and state departments with limited access to the database; and individuals who can request their own data but don't access the database.
Because the city of Columbia joined before Boone County and the county didn’t join in time to be included in the first quarterly report, the first report published by the program included data only of Columbia, while the second one included data from Boone County.
Eric Stann, community relations specialist of Columbia/Boone County Public Health and Human Services Department, said all future reports will contain data for all of Boone County.
While there is no separate database that simply tracks Columbia residents, Buffaloe thinks that most of the data came from Columbia, because “most people do live in Columbia and fill their prescriptions in Columbia.”
While not enough data is available to identify trends, already “more and more doctors are being more careful about their prescribing practices," said Buffaloe.
“My bet is that over the course of the next year, or maybe the next couple years, we will see a trend where fewer prescriptions for controlled substances are being written, especially for prescription opioids,” Buffaloe said.
The report tracks the dispensing of controlled substances — not just opioids — submitted by pharmacies in 32 participating jurisdictions from July to September last year.
Madison County, Pemiscot County and Jefferson County had higher controlled substance prescribing rates, while Boone County's rate was below the system’s average.
Supervising editor is Mike Jenner.