County considers joining prescription drug program

Wednesday, January 31, 2018

Warren: ‘I don’t see any downsides to it’

The Barry County Commission is considering an ordinance to join the St. Louis County Prescription Drug Monitoring Program, a tool aimed at helping healthcare providers monitor their patients prescriptions to prevent overprescribing or illegal activity.

Emily Varner, coordinator for the program, presented its goals and operations to a crowd of about 30 people Thursday at the Cassville Event Center.

Varner said without a statewide program, the St. Louis County program allows other counties to join to create a system for healthcare providers to use. The ultimate goal, she said, is to reduce misuse, abuse and overdoses via prescription pills, a problem that has been growing across the nation.

According to the Missouri Department of Public Safety, accidental overdoses have been the leading cause of accidental death in the United States since 2010, with prescription pills accounting for almost 33 percent of the total overdose figures and 75 percent attributed to opioids.

“Opioids are synthetic heroin,” the department said. “Many believe that since they are prescription pills — though not prescribed to them — they are safe. In Missouri, in 2016, hospitals reported receiving more than 16,000 patients who had overdosed on heroin. There were more than 900 deaths that resulted from heroin overdoses.”

Accidental drug overdose numbers nationwide have climbed from 42 per day in 2014 to 62 per day in 2015 and 91 per day in 2016.

The St. Louis County program allows healthcare providers, including doctors and pharmacists, access to patient records regarding prescriptions. Counties in the program receive quarterly and annual reports.

Law enforcement can access the information, but only with a subpeona and more request information that what a healthcare provider would have to give.

The cost to Barry County, base don the number of healthcare providers in the county, would be $571 per year, but because of a federal grant, the program is free until September 2018.

“I think [the commission] will be in agreement, but we didn’t talk about [passing an ordinance] at the meeting,” said Cherry Warren, Barry County presiding commissioner. “I think we are in a position we are not going to get anything done statewide until changes in legislature. We can sit back and wait two or three years, or we can go ahead and hook up with St. Louis and it won’t cost the county anything.

“So, I would be in favor of an ordinance. It is a step in the right direction, and can’t see any downsides to it.”

McDonald and Stone counties have recently passed ordinances to join the program. Fifty-one out of 114 counties in Missouri are included in the program so far.

The program went live in April 2017, and it shows prescription rates by age, gender, geography, dosage and drug type. It monitors all drugs schedule 2-4.

Providers, pharmacies and delegates have full access, patients can submit self-requests and law enforcement can get restricted or limited access.

Varner said 99 percent of the requests and use of the program is related to patient care, which is its goal. She said it is not aimed at drug enforcement. However, program administrators can notify license and regulatory agencies if they believe blantant overprescribing is occuring.

Providers receive alerts when a patient surpasses three prescriptions by doctors or three filled prescriptions at pharmacies. Varner said this is not indicative of illegal activity.

“It could indicate doctor shopping, or, someone could get prescriptions a regular doctor, a specialist and a dentist to hit the three providers,” she said. “Someone could also go tho their regular pharmacy, which does not have the full prescription, causing them to visit a second, then have a medical emergency while away and hit three pharmacies.

“The program also calculated dosages on the morphine scale, so providers can maybe prescribe a lesser dose or non-opioid prescription if the patient is getting too much opioids elsewhere.”

Varner said if the state legislature passes a program, it would begin the process of transferring its information to the state program in a takeover. Varner said the state is doing something, but its program is aimed more at enforcement than prevention.

After the federal grant runs out, the cost of the program is $146,000, which would be split among the participating counties based on the number of provides in each county. Varner said 80 to 90 percent of the cost would fall on larger municipalities, such as St. Louis, Kansas City, Springfield and Joplin.

Varner said there are no statistics for effectiveness yet, as the program is only nine months old and needs a year of data to begin making comparisons. She said other states, all 49 of which have state-wide programs, have seen drops in overdose numbers.

Pharmacies and providers, she said, are 90 percent complaint in reporting their filled and issued prescriptions, and the program has about 1,400 patient searches per day and 20,000 prescriptions entered.

If Barry County were to join the program, it would be by county ordinance, with no vote at the polls.

More information on the program may be found at www.stlouisco.com/PDMP.

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