Senator changes stance on prescription drug monitoring program

After years of opposing and filibustering a statewide prescription drug monitoring program, Sen. Rob Schaaf, R-Buchanan, said he’ll support a program under one condition.

The physician from St. Joseph said he supports the current version, sponsored by Rep. Holly Rehder, R-Sikeston, as long as it includes a requirement that physicians use the program.

“The one thing we know beyond a doubt is that the program works best in states where prescribers are expected to use it and more lives are saved in those states,” Schaaf said during a news conference announcing his decision. “Missouri deserves no less.”

Schaaf has fought a statewide program for nearly five years, citing privacy concerns for residents.

“The liberty of the people of Missouri is put at risk, so if we’re going to have versions that put people’s private, very sensitive information on a government database, by golly, it ought to get used,” he said.

Rehder said she was “speechless” after the announcement.

“We’re very surprised,” she said. “Sen. Schatz and I, neither one, had expected this. We didn’t realize this was coming.”

Rehder agreed that states have better results with drug-monitoring programs when physicians are required to use it.

“So of course the devil is in the details,” she said. “It is something we need to look at to see how other states are doing it, what the best process is. We certainly don’t want to hamstring physicians or the medical process, but we absolutely want the best outcomes.”

The Missouri State Medical Association supports a statewide program but isn’t supportive of the idea that a physician would have to check the database every time the write a prescription.

“We favor them checking the PDMP when it’s clinically appropriate for them to do so,” Jeff Howell with the association said. “If it’s not clinically appropriate for them to check the PDMP, then we feel their time is better used in other places.”

Howell said some of the times it may not be clinically appropriate would be a prescription for a hospice patient.

“If you have a hospice patient or a cancer patient who is dying and they need morphine and you’re forcing the prescriber to check the PDMP in order to write that prescription.”

Some people first get introduced and addicted to prescription drugs after a surgery. Howell said one option would be that the doctors don’t have to check the database if they’re writing someone a prescription for five days or less, but they would if it was a longer prescription.

“Once the patient fills the prescription, they’re in the database,” Howell said. “We are definitely willing to listen to maybe having doctors check the PDMP for lengthy prescriptions. Maybe things that are five days prescriptions for post-op patients, you don’t have to check those, but if you’re writing a prescription for a longer period of time you would have to check those.”

Howell said the PDMP is a clinical tool and should be used as one.

“We want doctors to be able to be able to use the clinical tools at their disposal when they feel its necessary to do so,” Howell said. “We don’t want the government to force doctors to say, ‘This is how you practice medicine. If X and Y happens you have to do this.’ That really puts constraints on how the best health care is delivered to our patients.”

Schaaf said he changed his mind amid strong support for the bill this session in both the Legislature and the governor’s office.

“The only thing I ask is, let’s make sure it gets used,” Schaaf said. “Let’s put in there a simple requirement that it be the standard of care, that it be checked before a prescriber prescribes a controlled substance.”

Schaaf, a senator for six years, said he wants to attach an amendment to the bill that would require the use of the prescription drug monitoring program by physicians and stipulate that failure to do so would constitute medical malpractice, comparing it to if a doctor did not give antibiotics to a patient with a potentially fatal infection.

“It should be the standard (that) if a patient might have an addiction problem, a physician ought to use this important tool, especially since the people of Missouri are giving up a measure of their privacy by having their private medical information put on a government database,” Schaaf said.

Rehder said she’d like to look at what other states have done in requiring physicians to use a PDMP.

“It’s something that all states have moved to years later,” she said. “And so once they’ve got the program in place and once they started using the program, then some states just recently have started moving to requiring physicians to access the database and check it before writing those prescriptions.”

The Narcotics Control Act has been referred to the Senate Public Safety Committee