It’s been about six months since Columbia City Council voted to join St. Louis County’s prescription drug monitoring program, and Columbia pharmacists say it has already become easier to combat some of the methods addicts use to obtain opioids.
Council voted March 6 to launch the program, and it began collecting data on April 25.
“(With the program), things are a million times better,” said Alex Smith, head pharmacist and part-owner of Flow’s Pharmacy on Keene Street.
The convenient location of the pharmacy near the intersection of Interstate 70 and U.S. 63 had made it a particular magnet for opioid addicts, he said. Customers could be Columbia residents. Or they could be people just passing through to get drugs. Detecting the difference by checking on a patient’s history is now much easier.
“A lot of pharmacies are used to doing it the old way,” Smith said. “They could have argued, ‘Oh, I didn’t know (this person didn’t need that prescription),’ but now you do know.”
Prescription drug monitoring programs are seen as a crucial tool in combating the national opioid addiction crisis. Although Gov. Eric Greitens signed an executive order in July directing the Department of Health and Human Services to create a statewide monitoring program, Missouri remains the only state in the nation without a full-scale program.
Columbia’s program provides multiple ways to determine whether a patient might be abusing opioids, including:
- By multiple names, which are common in opioid abusers;
- The date a prescription was filled;
- The date a prescription was written by a doctor;
- The type of drug;
- The quantity prescribed;
- The number of days the prescription should last;
- The prescriber;
- The prescription number;
- The pharmacy;
- The number of refills;
- The milligram morphine equivalent per day (MME/D);
- The payment type.
Tracking how a patient pays for prescriptions can be a powerful tool. If the pharmacist notices that a patient is paying for prescriptions in various ways — cash in one place, insurance at another — it can be a sign of a possible opioid abuser or trafficker.
People have been caught because they’re using cash to buy their prescriptions, said Beth Stubbs, pharmacist and partner of Kilgore’s Medical Pharmacy. There’s usually a pattern of aggression and change in payment to cash in abusers, Stubbs said.
In previous Missourian reporting, Stubbs talked about how pharmacies used to communicate with one another when they suspected there was a possible opioid abuser going to pharmacies. The new monitoring program has “opened a gateway of communication,” she said.
Stubbs has also noticed changes with her patients. She said some people have called to ask if Kilgore’s Medical Pharmacy participates in the program, and if they are, people are transferring to other pharmacies because they say they’re concerned about privacy violations. But it’s only a tiny number of people, “maybe a half dozen,” she said. Overall, people are generally okay with the program, especially as the number of counties participating increases.
A weakness of the program is in the delay between when the prescription is written and entered into the system and when it becomes viewable by pharmacists. Smith said there is a 3- to 7-day lag.
The data so far
The Columbia/Boone County Department of Health and Human Services released the first quarterly report of the St. Louis Prescription Drug Monitoring Program on Oct. 11. The report found that women are dispensed Schedule II to IV controlled substances at higher rates than men, according to previous Missourian reporting.
It also found that Columbia has a Schedule II to IV controlled substances dispensation rate of 1,637 prescriptions per 1,000 population, with opioids being the most-dispensed drug.
Stubbs said pharmacists aren’t interested in acting as law enforcement and regulating who gets medicine. She said: “But we do have an obligation to do what’s in the best interest of both the patient and the prescriber.”