Prescription drug monitoring programs (PDMPs) are electronic databases that track prescriptions of controlled substances. Every state except Missouri has implemented a statewide PDMP to monitor prescriber and patient behavior in near real-time with high geographic precision. St. Louis County created a PDMP in 2012, but not all areas of the state currently participate. SB 63 would establish the Joint Oversight Task Force of Prescription Drug Monitoring within the Office of Administration.1 This body would be tasked with identifying and contracting with a vendor to create a PDMP for monitoring the prescribing and dispensing of medically important drugs with the potential for abuse in the state. SB 63 also specifies privacy protections for patient information, including deletion of data after 3 years, de- identification when data is provided to outside entities for research purposes, and prohibitions on providing data to law enforcement or any other body for purposes outside of those outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The bill also establishes fines for dispensers who do not submit accurate dispensation information and criminal penalties for anyone who violates the privacy protections established by the bill.
Laws regarding PDMPs vary, with some states simply requiring that all prescriptions of Schedule II, III, and IV substances be recorded, while other states require that prescribers consult a patient's PDMP record before providing controlled substances (referred to as “must access” or “mandatory access” laws). As of 2019, 40 states have enacted must access laws, while states without these provisions have argued that their inclusion places a significant administrative burden on prescribers and may impede appropriate prescriptions. SB 63 would not mandate that providers consult PDMP records before treatment, but would require the vendor to provide dispensation data to patients and health information exchanges upon request.
As with other medical records, PDMP records are subject to HIPAA privacy regulations. However, de-identified PDMP records are often used as data in studies assessing health outcomes related to prescription drug trends. For example, states such as Kentucky have used data from PDMPs to monitor trends in overall opioid prescription volume, the number of opioid providers, and the number/size of prescriptions per recipient.2
Due to recent upticks in prescriptions of opioid analgesics and opioid poisoning, PDMPs have been considered not just as a data source, but also promoted by the Centers for Disease Control and Prevention as a tool for preventing inappropriate opioid prescriptions.3 In principle, providers can consult PDMPs prior to prescribing opioids or filling a prescription, potentially allowing them to identify and preempt substance abuse. For example, patients who seek refills before their previous prescription is supposed to have been consumed or patients who receive prescriptions from several providers are thought to be at high risk of substance abuse or “diversion” (providing opioids to those who do not have a prescription).
However, several studies have found that the effectiveness of PDMPs as a tool depends on the state-level regulations surrounding their use. Specifically, lack of “must access” provisions often result in low rates of PDMP consultation prior to prescribing opioids. In these cases, studies often find no effect of PDMP creation on opioid prescription trends.4
In contrast, “must access” PDMPs have been associated with decreases in opioid prescription volume and decreases in the number of patients receiving prescriptions from multiple providers.5,6 Notably, implementation of these laws is also associated with increased out-of- state prescription-seeking behavior. Given this, the lack of a statewide PDMP in MO may make it a destination for those seeking to obtain multiple, often unnecessary, prescriptions. Despite these findings, studies have not consistently demonstrated any downstream effects of PDMPs on opioid overdose rates,7 though at least one national study has identified a decrease in opioid- related death rates associated with the implementation of a PDMP.8