Less than two months remain in the legislative session, but some who are familiar with the wrangling over an online Prescription Drug Monitoring Program (PDMP) say local pressure could finally force Missouri lawmakers to create statewide tracking similar to those used in 49 other states.

Missouri lawmakers have debated a state PDMP for around 12 years, differing most seriously on privacy: who would have access to patients’ private medical information and under what circumstances.

This year, Rep. Holly Rehder, R-Sikeston, introduced House Bill 90 to enact the Narcotics Control Act, which she told Government Technology would give medical professionals the information they need to accurately prescribe.

Meanwhile, state Sen. Rob Schaaf, R-St. Joseph, sponsored Senate Bill 74, the Prescription Drug Monitoring Act, which he told Government Technology would restrict sensitive data to “a handful of people.”

On Tuesday, April 4, Schaaf — who had filibustered against Rehder’s bill in previous years — said he would drop his opposition provided the bill is amended with a provision that physicians be required to use the database.

“I am simply asking, since this is designed to help break the scourge of addiction and because it cannot help if it is not used, that it include a provision that it be the standard of care to use it before prescribing a controlled substance,” Schaaf said in The Missouri Times.

After about four hours of concerted debate, Rehder’s bill cleared the state Senate on Thursday, April 13 — headed back to the House, where it will likely undergo review by a Conference Committee comprising House and Senate members. Both chambers are expected to have to vote on it again to pass it before adjourning May 30.

But this year as never before, local agencies — six cities and 12 counties including St. Louis, the state’s largest — have already taken the law into their own hands and are creating their own PDMP.

St. Louis County, which spans more than 500 square miles and is home to around 1 million people, will go live on Tuesday, April 25, with the first phase of its PDMP, with second and third phases scheduled to be approved by local legislation and go live on July 1 and Oct. 1, respectively.

A total of 17 other agencies are participating with St. Louis County as subscribers, meaning they have passed their own local legislation and user agreements to join. These include the cities of St. Louis, Kansas City and Columbia; and the counties of Lincoln, Cole and Stoddard.

St. Louis County’s ordinance commits to monitoring “prescribing and dispensing of schedule II-IV controlled substances” with the goals of improving prescribing, identifying high-risk patients and reducing the number of people who “misuse, abuse or overdose.”

The county selected Appriss Inc., a major PDMP provider to other states, to stand up its program at an estimated cost of $320,000, Sarah Patrick, deputy director for St. Louis County's Department of Public Health, told Government Technology earlier this year.

Similar to the bills advanced by Rehder and Schaaf, the county’s database would require reporting parties and members of the medical community to prove who they are before granting access, while law enforcement would need a subpoena and be working on an active case.

Rehder told Government Technology local momentum behind a county-level PDMP has given her bill more momentum than Schaaf stepping aside, pointing out that the counties combined represent around 53 percent of the state’s population.

If the Legislature passes HB 90, she said it would set the stage for the state to simply assume the Appriss contract and continue the program already in place at a cost of around $1 million per year. Some of that, she said, could likely be funded by federal grants.

“I think that the main push has been that the counties are passing this. Regardless we’re going to have a PDMP across this state. I just think it’s ‘Which one do you think is the best version and where is the best place for it to be kept?’ And I would argue the state is the best place for it to be kept,” said Rehder, whose family members have battled addiction.

St. Louis County Council member Dr. Sam Page, who testified to the state Senate earlier this year in support of Rehder’s bill, agreed.

“I think the main point is that we’re going to have a PDMP in Missouri either through a network of counties or through a state bill and it’s going to happen this year,” Page said. “This is one of the most important tools you can have to make good decisions on how to treat patients who are in pain or may have addiction problems.”

Among its provisions, HB 90 would:

Require dispensers to notify the state Department of Health and Senior Services (HSS) within 24 hours of filling a prescription, either electronically or by paper. Require collection of information about patients’ prescriptions including quantity, dosage and whether a prescription is new or a refill; as well as patients’ names, addresses, dates of birth and an “identification number,” which could include a driver’s license number, or government or insurance ID number. Keep all prescription information confidential and not subject to public disclosure, with specified exceptions. Make unlawfully and knowingly accessing or disclosing private information — regardless of whether a person is authorized to handle such information — a Class E felony. Fine dispensers $1,000 for failing to notify HSS that a prescription has been filled, or for providing incorrect information. Require HSS to notify authorities if it believes the law has been violated or professional standards breached. Keep dispensation information from being used to deny anyone the right to get or own a firearm. The state Senate approved amendments including a mandatory data purge every 180 days to preserve privacy; a six-year sunset; and, according to The Associated Press, only requiring medical professionals to report opioids and benzodiazepine drugs like Xanax.

Rehder said she thinks the debate and amendments show several state senators involved “don’t understand addiction.”

“We need to address addiction, we need to address the root of the problem not on the back end when we’re putting people in jail, the babies are being removed from the home. It’s a bit short-sighted,” she said.

Page said the House will be difficult to sell on an amendment that focuses on opioids and benzodiazepines, but described the state bill as having “a lot of momentum.”