JEFFERSON CITY — The fate of implementing a statewide prescription drug monitoring program is once again in the hands of the Senate following a 98-56 House vote in favor on Monday night.
House Bill 1693, sponsored by Rep. Holly Rehder, R-Sikeston, would establish the “Narcotics Control Act” and would require the Department of Health and Senior Services to establish a statewide electronic medical record that would allow medical professionals to access their patients’ prescription narcotic history.
Rehder said this is her eighth year working on the bill, which died in the Senate again last year, where it faced opposition from members of the Conservative Caucus who cited concerns about Missourians’ privacy.
Boone County’s delegation split, but not completely along party lines. Rep. Kip Kendrick and Martha Stevens, both D-Columbia, and Rep. Chuck Basye, R-Rocheport, voted in favor. Rep. Cheri Toalson Reisch, R-Hallsville, and Rep. Sara Walsh, R-Ashland, voted in opposition.
“This program allows medical professionals to get to the root of the opioid epidemic by recognizing addiction in its earliest stages,” Rehder said. “Certainly that’s what we want to do is to get to a place where we have less people becoming addicted.”
Rehder also noted that while the statewide program would mirror the program currently used in St. Louis County and many other locations, including Columbia, her bill has Second and Fourth Amendment protections. For example, the database cannot be used for the sole basis of issuing a warrant, it cannot be used to deny someone access to a firearm and unauthorized use of the database would be a crime.
Rep. Mike Moon, R-Ash Grove, addressed concerns about risks such as data breaches, saying that the state should “leave the law-abiding citizens alone.”
Rep. Mike Stephens, R-Bolivar, refuted claims that the program raises concerns over privacy, noting that little information is still private.
“Pardon my cynicism, and with the deepest respect for those who are the defenders of privacy, let me say this ... they know everything,” Stephens said. “And if you believe that defeating PDMP is protecting someone’s privacy, I beg your pardon, you are sadly and naively mistaken.”
Missouri is the only state without a statewide prescription drug monitoring program. Rehder said Monday that 63% of Missouri’s counties are part of an existing local PDMP, but that 87% of Missourians are covered by one due to densely populated counties. Municipalities like Boone County currently participate in St. Louis County’s PDMP as part of a “patchwork” program.
According to the federal Centers for Disease Control and Prevention, PDMPs improve patient safety because they let doctors see if patients are getting opioids from more than one physician and show whether patients are being prescribed medication that may increase their risk of taking opioids, among other things.
About 1,100 Missourians died from opioid overdoses in 2018, an increase from 951 deaths in 2017. Opioid use accounts for about 1 in 56 of all deaths in the state, according to the Missouri Department of Health and Senior Services. Between 2014 and 2018, St. Louis County saw the greatest number of opioid-related deaths, at 1,110, according to DHSS.
The cost of implementing a PDMP in Missouri would depend on whether the state acquires St. Louis County’s preexisting program. If the state does acquire the program, the effect on the General Revenue Fund would be lower, but St. Louis County would lose over $600,000 in federal funding. If the state does not acquire St. Louis County’s program, the cost would be higher because the state will have to either develop or purchase a system.
One option for funding is the federal Harold Rogers Prescription Drug Monitoring Program grant, which allows states to apply for a one-time grant of $400,000 to start a program controlling narcotics. The grant was established federally in 2002, and 49 states and Guam have since received grants to help implement programs.
Missouri is currently ineligible for this grant however, because applicants must have already passed legislation for a narcotics control program. If PDMP legislation is passed this year, the state could apply for the April 2021 deadline.
At the end of the debate, Rep. Shane Roden, R-Cedar Hill, asked Rehder whether she would hold up the legislation of lawmakers who voted against it, “like (she) did last year.”
“Are you going to use your position to try to influence our bargaining chip and try to hold it over legislators who may not agree with you on this? Are you going to hold up their personal legislation? Are you going to get into a fight with the Senate again?”
Rehder said there are several representatives who have voted no on PDMP and still got legislation passed through her committees last year without being held up. “How is that using my position?” she asked.
The bill now heads to the Senate, where it has died multiple years.