Missouri to Become Last State to Create Drug-Monitoring Plan

Missouri became the final state to create a prescription drug-monitoring program after Republican Gov. Eric Greitens signed an executive order Monday aimed at combating a scourge that killed more than 900 residents last year.

The monitoring program could be operating within a month, Missouri Department of Health and Senior Services director Randall Williams said. Greitens signed the order following a news conference at Express Scripts, the St. Louis-based online pharmacy benefits manager that will help provide data analytics as part of the effort.

For many years, Missouri has been the lone holdout without a statewide program that tracks prescription drug scripts as part of the effort to combat doctor shopping and prescription opioid addiction. State lawmakers have considered drug monitoring programs each year but legislation has failed, largely because of privacy concerns about keeping medical information in a database.

Greitens said the Missouri program will focus on analyzing prescriber and pharmacy prescription and dispensing data and will not use private medical information of patients. It will track when prescription painkillers are prescribed and dispensed in an effort to crackdown on doctors and dispensers who are fueling the opioid crisis. Greitens said penalties for doctors intentionally overprescribing opioids could range up to criminal charges or loss of a medical license.

“We have to look at this problem straight in the eye, and the fact is opioids are a modern plague,” the governor said.

Greitens introduced parents who lost a son to an overdose just a month ago, then paused several seconds before speaking. His voice breaking, he said he lost a cousin to an opioid overdose last year.

“Towns are being hollowed out,” Greitens said. “Families are being ripped apart.”

He said that since lawmakers for years have failed to approve a program, his office looked at statutes and determined an executive order was legal. He noted that some other state PDMPs also were established through executive order.

Reaction from Republican lawmakers who have opposed PDMPs largely over privacy concerns was mixed.

State Rep. Kurt Bahr of St. Charles said his “initial reaction is to question whether or not he has the legal authority for such an executive order, as well as if he’s not violating some sort of separation of powers because we did not appropriate any funds for the PDMP. So I don’t know if he can legally spend money that’s not appropriated.”

State Sen. Will Kraus of Lee’s Summit said he’ll be closely watching implementation of the new program.

“As long as it’s not tracking honest, law-abiding citizens, I probably will not have a problem with this,” Kraus said. “When it goes to the point where it says, ‘somebody who hasn’t done anything wrong is going to have their information in a database,’ that’s where I have concerns.”

Eight relatives who have lost loved ones to overdoses attended the news conference, including Gee Vigna of O’Fallon, Missouri, whose 20-year-old daughter, Nicky, died over overdose on Jan. 3, 2013. Vigna said Nicky’s addiction began with prescription drugs before she moved on to heroin, the drug that killed her. Heroin is typically far less expensive than prescription drugs.

“Once the addiction takes hold, there’s a viable alternative users turn to, which is heroin,” Vigna said. “With heroin, you have no idea what you’re getting on the streets.”

Williams and Greitens believe Missouri’s approach could potentially become a national model because of the analytic abilities of firms like Express Scripts. Williams said other private companies have also expressed interest in participating.

Greitens is making a series of announcements this week to address drug use and drug trafficking. He is scheduled to be back in St. Louis Tuesday to discuss preventing overdose deaths; speak Cape Girardeau Wednesday on battling trafficking; host a summit on opioid addiction in rural areas on Thursday in Springfield; and discuss the impact of drug courts in Kansas City on Friday.

(AP reporter Summer Ballentine in Jefferson City, Missouri, contributed to this report.)