The debate over prescription drug monitoring in Missouri hit yet another stalemate last week — and this one just might kill the bill.
Missouri is the only state without a prescription drug monitoring program. The Senate recently approved a House bill that would bring Missouri in line with other states. But that bill had several amendments tacked on.
Those amendments — one that would limit the drug monitoring program to opioids and benzodiazepines and another that would purge records from the system after 180 days — may prove too high an obstacle to overcome.
The House failed to accept the Senate amendments and has now requested a conference committee to work out the differences.
Rep. Holly Rehder, bill sponsor and longtime proponent of drug monitoring, said both the amendments are problematic. Rehder’s objective will be to make sure the drug monitoring system can maintain data for a longer period.
She said medical professionals need about two years’ worth of prescription data to determine whether a patient is struggling with an addiction.
“The 180 days is a deal breaker,” said Rehder, a Sikeston Republican.
But Sen. Will Kraus, a Lee’s Summit Republican who offered that amendment, sees 180 days as the absolute longest it would be acceptable for a government agency to maintain prescription data.
Kraus doesn’t see much room for compromise. In fact, he said 90 days would be sufficient.
“If we move, we should go south,” Kraus said. “We should go less.”
The disagreement over how long data must be kept comes from a larger disagreement over the purpose of a drug monitoring program.
Proponents of a data purge say the programs are effective not in preventing addiction and abuse, but in preventing illegal doctor shopping. Doctor shopping is the practice of moving from prescriber to prescriber to acquire large amounts of prescription drugs.
“They say this is to stop doctor shopping,” Kraus said. “Now they want to change this bill to be one where we want to see if you may have a problem, so they need two years of information. I’m just not comfortable keeping people’s information in databases for two years, especially people who have done nothing wrong.”
But Rehder insists it’s not a doctor-shopping bill. She said it’s about providing holistic care.
“Purging it after 180 days really does not help someone who is having those early signs of addiction,” she said. “And that’s what we want our physicians to be able to detect and start helping their patients back towards a healthy lifestyle.”
Rehder also took issue with the amendment that limited the types of drugs recorded in the database, pointing to the growing abuse of drugs such as Adderall and Ritalin.
For years, prescription drug monitoring has been held up by Sen. Rob Schaaf, a St. Joseph Republican who said drug monitoring is an invasion of privacy.
So when Schaaf announced two weeks ago that he no longer intended to fight the bill, proponents were hopeful this might be the year. His only requirement — an amendment that would make use of the program mandatory for all physicians — passed with relatively little opposition.
Even if the state prescription drug monitoring program doesn’t pass, many Missourians are still having their prescriptions monitored by a growing county system. It includes some of the state’s largest counties and cities: Jackson County, Kansas City, Independence, St. Louis and St. Louis County.
The increase in counties adopting prescription drug monitoring was one of the factors that caused Schaaf to resign his stance. But Kraus said he’d still rather have a county system than a statewide system without a 180-day limit.
Kraus comes from a county that has a drug monitoring system — one that does not purge data.
“At least my information won’t get out of Jackson County,” he said. “It won’t be with everybody else in the state.”
Rehder said she remains optimistic that a compromise can be reached for a state program.
But Sen. Denny Hoskins, a Warrensburg Republican who is among the Senate opponents of the program, isn’t so thrilled with the idea of a compromise.
“Whether you drink a gulp of spoiled milk or a sip of spoiled milk,” Hoskins said, “it’s still spoiled milk.”