If Missouri legislators want to stop the opioid crisis, they sure have a funny way of showing it. After years of failed attempts, legislators finalized a bill to adopt a statewide Prescription Drug Monitoring Program, or PDMP.
These efforts will be lauded by law enforcement, health care providers and families who have lost loved ones to overdose.
But before celebrating, consider this: Less than a week earlier, Republican legislators blocked funding for Medicaid expansion despite voters’ support in the August 2020 election. Not only did they undermine voters’ wishes, but they also rejected $1.6 billion in federal funding that would have gone a long way toward treating substance-use disorders in our state.
If legislators are sincere about their desire to stop overdose, they must recognize that PDMPs alone will not do the trick. Only by expanding access to health care treatment can we hope to interrupt the cycle of overdose and death that is robbing us of our loved ones and devastating our state.
PDMPs are not health care tools. Originally designed to help law enforcement monitor physicians and patients, they were implemented by many states in hospitals, clinics and pharmacies in the mid-aughts. They work like this: Before prescribing or dispensing opioids, physicians and pharmacists can look you up in the PDMP and see what drugs you have received, in what amount, from what providers and can use that information to decide whether you deserve more. But law enforcement also has access to this data and it uses it to monitor health care providers and patients. You might think that privacy law prohibits law enforcement from access, but you would be wrong. PDMP data is not protected by HIPAA and law enforcement has always been able to get prescription data, just not as easily.
The bottom line is that PDMPs do not diagnose disease nor do they provide treatment options. They are law enforcement surveillance technologies above all. I have spent the last decade researching how health care providers and enforcement agents use PDMPs. My research shows that PDMP use does not help physicians and pharmacists treat patients more effectively. Instead, they help providers police patients by refusing to prescribe or dispense opioids. Patients find themselves thrust out of the health care system with nowhere to turn except for illicit drug markets that pose even higher risks of overdose and death.
Meanwhile, treatment options are bleak. The addiction treatment industry is vast and varied. Largely unregulated, many treatment facilities provide no treatment at all, certainly not evidence-based medications for addiction treatment like buprenorphine and suboxone that dramatically reduce overdose risk. Nationwide, only 17% of people who need addiction treatment receive it and far fewer receive evidence-based care.
Emergency departments routinely dismiss patients who have overdosed without any continuity of care, leaving them vulnerable to overdosing again. And few physicians have an X-waiver, a special dispensation from the Drug Enforcement Administration that allows them to treat patients with medications for addiction treatments.
What we need in Missouri is a robust treatment system, one that provides meaningful care for people with substance-use disorders. And we need to give health care providers the tools to treat, not police their patients. That is why legislators must fund Medicaid expansion now. The Affordable Care Act requires that those who receive insurance under Medicaid expansion receive services for mental health and substance use disorders on par with other medical services. We can learn from our neighbors. States that have expanded Medicaid have reduced their overdose rates by 6% compared to non-expansion states.
At a time when our treatment facilities are already overtaxed and the COVID-19 pandemic exacerbates conditions like isolation, unemployment, and housing insecurity that stoke drug use, why would our legislators turn down free money from the federal government that Missourians support? Legislators cannot compensate for their egregious disregard of Missouri voters by offering a law enforcement tool that won’t stop overdose and could make things worse.
We must expand Medicaid in this state. It is our best hope for expanding our addiction treatment infrastructure and curbing overdose deaths. Missourians agree. It is time for our leaders to get on board.
Elizabeth Chiarello, Ph.D., is an associate professor of sociology at Saint Louis University who has spent the last decade researching the overdose crisis.