JEFFERSON CITY • After years of fruitless debate, the Legislature this week took its first tentative step toward creating a statewide prescription drug database — but critics wondered whether the proposal would serve to block more effective measures.
The Missouri Senate gave initial approval Wednesday evening to a proposal offered by the very lawmaker most responsible for keeping the state the last one in the nation without such a database.
It wasn’t the measure many expected to pass, and opponents say it would impose limits on physicians not found in the other 49 states.
Under the plan from Sen. Rob Schaaf, R-St. Joseph, the state’s roughly 30,000 medical professionals wouldn’t have direct access to patient records. Instead, they would submit a patient’s name to the Bureau of Narcotics and Dangerous Drugs, which would grant access only if it determined the patient was a potential abuser.
All other states put the information at doctors’ fingertips as long as they have an authorized username and password. A group of Missouri counties, including St. Louis, St. Charles, Jackson and Ste. Genevieve, plan to launch a similar program in April. And the Centers for Disease Control and Prevention prescribe even more openness, recommending doctors allow physician assistants and nurse practitioners access to the list.
But where doctors and medical experts see an essential tool in combating opioid addiction by making it harder to “doctor shop” — when addicts visit multiple doctors seeking similar prescriptions — Schaaf sees an invasion of privacy.
That’s why he has spent the last five regular legislative sessions thwarting attempts by Sen. Dave Schatz, R-Sullivan, and Rep. Holly Rehder, R-Sikeston, to give medical professionals comprehensive access.
He has warned of hacks like the one in Virginia, which exposed 35 million records. He has offered studies showing the rise of heroin overdoses in other states with databases, though research published in the New England Journal of Medicine rejects the connection. He once even said people who overdose on drugs were “removing themselves from the gene pool.”
Then on Wednesday, he said he sensed time, term limits and counties were working against him. He bemoaned the governor’s announcement making passage a priority in a Facebook Q&A last week. And in a move he compared to euthanizing a beloved pet, he urged colleagues to support his more limited plan while privacy-minded senators remained a force in the chamber.
“I’m going to vote for this bill ... and I’m going to say to myself, ‘What did I just do?’” he said. “But I think this is the lesser of two evils because if you don’t pass something, we’re going to end up with something worse.”
At a Thursday news conference, he said his proposal would balance privacy and public health.
“We perfected a version of (a prescription drug monitoring database) that protects the liberty and privacy of Missouri citizens,” he said. “If (Schatz and Rehder) care about what they say they care about — saving lives — this is PDMP that can do that.”
Opponents weren’t buying it.
“This makes things worse and not better,” said St. Louis County Councilman Sam Page, a physician who pushed for the county’s database initiative. “This system is cumbersome, unprecedented and makes it more difficult for doctors to treat patients with complex and dangerous problems.
“I have no idea what Rob’s trying to do other than put as many hoops between doctors and this information as possible.”
The Missouri Medical Association panned the result, calling Schaaf’s effort a “fake PDMP. Rehder stressed that Schaaf’s measure ignored the will of the state’s largest counties, which contain nearly half its population.
“This is about local control,” she said. “It’s not for me to tell people how to keep their citizens safe sitting here in the state Capitol.”
The Senate perfected the measure Wednesday night by a solid vote of 20 to 13, with 8 Republicans and 5 Democrats dissenting. In the days before the vote, Schaaf seemed to extend debate on other legislation far beyond serious discussion, prompting speculation he was doing so to force a favorable vote on his bill.
“Politics is like playing chess,” Schaaf said. “If you’re good, you advance your legislation. I’m using the tools available to me to achieve my goal which is to protect the privacy of the people of Missouri.”
Regardless, Rehder, whose own legislation has twice commanded majorities in the House, confirmed Thursday she would remain ardently opposed to Schaaf’s bill.
“I appreciate his willingness to try and compromise,” Rehder said Thursday morning, “but this to me is a medical tool and it’s important for doctors to be able to see their patient’s history without an additional barrier to helping people who are sick. Without that taken care of, I can’t support his bill.”
Schatz isn’t giving up either. He read aloud a long list of his bill’s supporters Wednesday night, including doctors, law enforcement associations and pharmaceutical companies such as Mallinckrodt Pharmaceuticals, which makes the highly abused painkiller oxycodone. His bill is scheduled for debate in upcoming weeks and he said the Senate can pass both bills and the let House or governor decide.
But the St. Joseph senator has no intention of letting that happen. “I fully intend to filibuster if they don’t want to compromise with me,” he said. “I’d just as soon not have a PDMP. Would they rather have a database that protects privacy or no database at all?”
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Missouri Edges its Way Towards its Own State Prescription Drug Database