By Phill Brooks
Ever since the first narcotic monitoring bill was introduced into Missouri's legislature 14 years ago, I've wondered about the real motivations and forces behind the bill. Has the primary purpose been to protect patients from addiction, as some supporters argue or has it been to empower cops and prosecutors to go after drug abusers, doctors and pharmacists.
This year's House bill is a perfect example of the two components. The bill establishes a database in state government of controlled-substance prescriptions, essentially potentially addictive narcotic pain killers. Pharmacists and physicians could search the database to make sure that a patient was not going to multiple doctors to get prescriptions for the same drug. Police and prosecutors could access the database only with a court-ordered subpoena.
But there's a catch, a huge catch, in the bill.
The bill would require Health Department staff to monitor the database for potential abuse and report violations to law enforcement and professional licensing boards. The bill provides that "the department shall review the dispensation information and, if there is reasonable cause to believe a violation of law or breach of professional standards may have occurred, the department shall notify the appropriate law enforcement or professional licensing board and provide any dispensation information required for an investigation."
That essentially would turn the Health Department into a law enforcement investigation agency.
Another nagging question for me about this issue has been why the legislature has failed for so many years to achieve a compromise on such a major issue. For several years, former Sen. Rob Schaaf was portrayed as the barrier that blocked Senate action on a prescription drug monitoring database. I always felt it was a bit of an unfair characterization.
While the St. Joseph physician is a firm supporter of the confidentiality of doctor-patient relationships, he was not necessarily opposed to a database of controlled-substance prescriptions. For more than half of his years in the Senate, Schaaf actually sponsored bills to do just that.
And some of those counter proposals contained many of the same provisions as the House-passed bills, including mandating the Health Department notify appropriate officials if there was reason to believe a law or professional standard had been broken.
Further, over the years Schaaf softened his stance. He dropped a requirement that the measure be approved by state voters and he extended how long a prescription drug record would be retained in the database from 90 to 180 days.
It's still far short of the three-year retention allowed under the current House bill. But as a legislative budget leader told me many years ago, when the difference involves a number, it's always easy to find a middle ground—just split the difference.
Maybe, Schaaf's retirement from the Senate will open the door for finally making Missouri the last state to establish a system to monitor controlled-drug prescriptions. But given the history of legislative gridlock, I'm doubtful.
That will be one of the major questions for the 2019 legislative session.
The history of legislative failure to pass a drug monitoring plan has made me wonder if smaller steps might be a better approach to dealing with the issue in an era in which there is such a lock-step partisan and ideological divide.
A few smaller, less drastic steps have been proposed in this year's legislative session to address the opioid epidemic. One, sponsored by a pharmacist—Sen. David Sater, R-Cassville—would restrict dentists from prescribing extended-release opioids for acute pain, with exceptions. A similar bill has been introduced in the House.
Another bill would require the Health Department to adopt rules on opioid prescriptions. There's also a bill to impose additional restrictions on writing a third opioid prescription to a patient.
EDITOR’S NOTE: Phill Brooks has been a Missouri statehouse reporter since 1970, making him dean of the statehouse press corps. He is the statehouse correspondent for KMOX Radio, director of MDN and an emeritus faculty member of the Missouri School of Journalism. He has covered every governor since the late Warren Hearnes.
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