TARGET 8: Debate over drug database centers around protecting lives, liberty
JEFFERSON CITY - Samantha Lowell spent much of her life addicted to prescription pain medication. She said it sometimes took years before the authorities arrested her doctors for over-prescribing.
“They eventually lost their licenses because of overdoses, you know. Teenagers overdosing on OxyContin and Oxycodone,” Lowell said.
Missouri is the only state in the nation that has not passed a prescription drug monitoring program, otherwise known as a P.D.M.P. The program. would allow doctors and pharmacists to track the prescriptions patients are getting by entering the information into a secure database, and could also help keep tabs on doctors who intentionally over-prescribe.
"It's a national epidemic, and until we start treating addiction as a disease and not a moral failing, Missouri will continue to see the spike in death rates,” said Missouri State Rep. Holly Rehder, R-Sikeston.
Last year, Rehder sponsored a bill called the Narcotics Control Act, which would have implemented a prescription drug monitoring program in Missouri. It failed, in large part, due to the efforts of State Sen. Rob Schaaf, R-Buchanan.
“I’m not the only one. There are several senators who are opposed to putting every citizen's data on a government database to which 30,000 people have access," Schaaf said.
Schaaf, who successfully defeated similar legislation in 2012 after leading an eight-hour filibuster, fears the P.D.M.P. could violate patient privacy.
"You know, just because Missouri is the only state that doesn’t have this, is not a good reason to pass it,"he said."
TARGET 8 sought to find out why Missouri remains the sole outlier when it comes to the program, and discovered a gridlock that has many people close to the issue calling for action.
NUMBERS POINT TOWARD AN EPIDEMIC
According to the Missouri Department of Health, deaths from prescription drugs have more than quadrupled in Missouri over the past 10 years, to 900 annually. Heather Gieck, a former drug addict who doctor shopped in the past, said it was easy to get the narcotics she wanted.
“I’m not gonna say [where], but I went to one of our hospitals here in Columbia Missouri, actually, and that’s really where they just poured the Xanax’s out on me,” Gieck said.
Gieck said she was always confident she'd get the prescriptions she wanted.
“I never worried about them catching me. I wasn’t thinking about, they’re going to track that I went to this doctor, and they’re going to track that I went to that doctor," Gieck said. "I never even… that wasn’t even a thought to me.”
A recent survey shows three out of four heroin addicts started out by using prescription drugs. The C.D.C. reports that 45 percent of people who used heroin between 2011 and 2013 were also addicted to prescription painkillers.
Furthermore, people who abuse or are dependent on prescription opioid painkillers are 40 times more likely to abuse or be dependent on heroin. To put that into perspective, people who abuse alcohol are only twice as likely to abuse heroin.
A staggering new report released by the surgeon general shows nearly 21 million people are suffering from substance use disorder, and only one in 10 seeks treatment. To put those numbers into context, more people died in 2014 from drug overdoses, approximately 50,000, than car accidents, approximately 32,800. To make matters worse, drug use and related disorders cost the U.S. government an estimated $193 billion.
With these numbers in mind, TARGET 8 decided to look into whether a prescription drug monitoring program might help Missouri in the fight against addiction.
ARE PDMP’S EFFECTIVE?
While the numbers point toward an epidemic, studies have questioned whether monitoring programs effectively address the problem. Earlier this year, TARGET 8 looked into the effectiveness of border state Kansas' P.D.M.P., and found that, since the program was implemented in 2010, opioid-related deaths have gone up significantly in that state.
Schaaf, a family physician, said he believes there's a reason for the increase in opioid-related deaths.
“It’s been clearly shown that after a P.D.M.P. is put in place, more people die of heroin overdose, simply because they cannot get access to the prescription drugs that they’ve been getting," Schaaf said.
But not everyone in the medical field agrees with Schaaf. Dr. Steve Keithahn, a physician who’s practiced in Columbia for 20 years, said Missouri doctors, by and large, favor the implementation of a P.D.M.P.
“Almost all of us will wholeheartedly agree that this is a huge problem,” Keithahn said. “And while a prescription drug monitoring database wouldn’t entirely fix the problem, it would be an important and critical tool in helping us fight this epidemic."
Keithahn disagrees with the notion that a prescription drug monitoring program would cause more people to die of heroin overdoses. He said there's evidence that the P.D.M.P saves lives, but that the mortality rate may not show such progress until the program is implemented - and doctors/pharmacists are required to use it - for a long period of time.
“While the death rate from drug overdoses may be increasing, the PDMP’s may be affecting the rate of that increase. In other words, it would be much worse if we didn’t have PDMP’s," Keithahn said.
Both proponents and opponents of monitoring programs. agree a database is more effective when doctors are required to use it.
DEBATE OVER LIBERTY:
In 2012, Schaaf led an eight-hour filibuster that, ultimately, kept the P.D.M.P. from becoming a reality in Missouri. It is the closest the bill has ever gotten to becoming a law to date. Year after year, Schaaf has fought against bills such as the one Rehder introduced, citing a violation of privacy as his main concern.
“People who care about their liberty are outraged that we would even be considering putting sensitive medical data on a database run by the government," Schaaf said.
Specifically, Schaaf is worried that the database could be hacked.
“Can you imagine if somebody in a physicians office, who maybe wasn’t the most ethical person, found out that your grandmother had Oxycodone in her house, what do you think the chances are that her house might be burglarized?" Schaaf asked.
Natalie Newville, the spokesperson for the drug-prevention group ACT Missouri, disagrees with the argument that the data would be any less secure than it is now.
“We look at it like any other electronic medial record that doctors already have access to," Newville said. "It would still be covered under HIPAA, so it would only improve the quality of care."
Dr. Keithahn agrees with Newville.
"It doesn’t violate privacy any more than anything else that we’re doing," Keithahn said. "And we work with this privileged health information all the time to make sure that it is used appropriately and privately as possible."
Though he's been portrayed as the face of the P.D.M.P.'s opposition, even gaining national criticism, Schaaf said he thinks that characterization is unfair. Though he does not believe the P.D.M.P. actually saves lives, he said he has come forward with his own P.D.M.P. bill this year that, if implemented, he believes would serve its purpose while still protecting people's sensitive medical information.
“I have introduced a P.D.M.P. bill that has a database in it, and it protects liberty by having the bureau of narcotics and dangerous drugs present the information on the database to the prescribers and dispensers in a more liberty-preserving way,” Schaaf said.
Schaaf told KOMU 8 News he has created a bill that would involve a database, but one that only a "handful" of people in the bureau of narcotics and dangerous drugs could access. Schaaf said prescriber's would have to make a request to the P.D.M.P. board, which would then advise them on whether or not the patient should receive a prescription.
“They would report what it was they wanted prescribed to a given person, and the P.D.M.P. would tell them back within probably a millisecond as to whether or not there’s a problem, which is exactly the information they would be getting if they were looking at the data themselves,” Schaaf said.
Schaaf said the people with a user name and password would only have access to just an indication of whether or not it was safe to give the drug, unlike Rehder's bill, which would give doctors full access to prescription information.
P.D.M.P.'s AND THE AVERAGE PATIENT:
While the P.D.M.P. has been advertised as a way to stop drug abuse, supporters of the P.D.M.P. emphasize the benefits it could have on the average patient. Dr. Keithahn said he believes it could help prevent addiction before it starts.
“It would help us identify people who are sort of coming up to the line of being addicted,” Keithahn said.
But Schaaf has a different point of view; he said the P.D.M.P., as it is typically orchestrated in other states, only helps criminals.
Most people don’t break the law, the lawbreakers who go and doctor shop or illegally get drugs are the only people who benefit from the P.D.M.P. It’s not right," Schaaf said.
The former addict, Lowell said she thinks Schaaf is mischaracterizing people.
“People think we’re criminals, but we’re not," Lowell said. "We’re just lost, broken people, and we’re looking for any kind of substance to alter our thinking or to just numb us.”
Lowell used to doctor shop, and recalled one specific doctor who would prescribe her anything she wanted for a monthly fee.
“There was another doctor in Lowry City, sixty bucks a month and he was writing me whatever I wanted,” Lowell said.
Lowell said she didn't mean to get addicted, but that the feeling she got from opioids was too strong to resist. She wonders if a monitoring program might prevent people from ending up where she is now.
“If it would have been monitored, I would not have gotten that prescription, there was no reason for me to be getting those prescriptions," Lowell said. "It shouldn’t have happened.”
A FORMER ADDICT'S PERSPECTIVE:
Gieck, who founded The Healing House and New Beginnings in Jefferson City three years ago, was honored for her work in the mental health field in June. She said she's come a long way from her days of addiction, and is hopeful that the P.D.M.P. would give other addicts an opportunity to restore their lives.
“The prescription drug monitoring program is going to save lives. It’s gonna save children’s lives, it’s gonna save teenager’s lives, it’s gonna save the neighbor’s life. It’s gonna save everybody’s life,” she said.
Gieck said it's easy for people who have never suffered from addiction to make arguments about liberty. She has a request for lawmakers: stop fighting and do something.
“Until your family is destroyed because of it, it may never be a reality because it’s not your reality, but unfortunately, it is a reality for hundreds and thousands and millions of people across this planet," Gieck said.
Missouri's legislature starts its session on January 6, 2017. Both Rehder and Schaaf have filed P.D.M.P. bills similar to last year's, and the fight appears to be far from over. Anyone wanting to share their opinion can contact Rehder and Schaaf in their offices.
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