Pharmacists and other providers in the participating counties gave out opioids at a rate almost 10% higher than in 2017, according to the latest data from the state’s drug monitoring program.
But the St. Louis County health officials behind the program say the increased rate could indicate the drug monitoring system is working the way it’s designed.
“Having a PDMP doesn’t necessarily mean that you’re going to reduce prescribing,” said Liz Chiarello, a sociology professor at St. Louis University and Radcliffe Fellow at Harvard University. “What a PDMP is designed to do ideally is to make sure prescribing is appropriate.”
Missouri health providers dispensed enough opioids last year for 70% of residents in participating counties to receive a prescription, according to the report.
Prescription drug monitoring databases help doctors and pharmacists check a person’s prescription history before they give out potentially addictive controlled substances such as benzodiazepine tranquilizers or opioid painkillers. Such programs are designed to promote responsible prescribing and cut down on patients “doctor shopping” for drugs by using multiple providers.
If a patient has received controlled substances from multiple doctors in six months, an alert pops up on the database that helps doctors decide whether to prescribe.
Several other states have statewide programs approved through the legislative process. Missouri is the only state that doesn’t have a statewide system. St. Louis County created its own in 2016. In 2019, 72 of the state’s counties and jurisdictions participate in the voluntary database.
The increase in prescribing rates could be because more counties are continually joining the system, said Spring Schmidt, acting director of the St. Louis County Department of Public Health.
“Because we do normalize the rates with everyone, and we don’t compare them from county to county in the annual report, it may be because we have counties with higher prescribing rates joining in with counties with lower rates that that does change the overall annual rate,” she said.
In both 2017 and 2018, less than 1% of the population within the participating counties filled multiple prescriptions with different providers and triggered an alert, the system found.
The increase could also be due to more pharmacies using the tool correctly, Schmidt said.
“We think at least some of that may be due to pharmacies increasing their compliance with some of the reporting requirements,” she said. “We had several pharmacies come on board, and some of the compliance statistics we were tracking for individual pharmacies did get better.”
The database has a high participation rate for a voluntary program, she added.
Both Schmidt and Chiarello both said the PDMP is a useful tool to use in trying to decrease opioid addiction around the state.
“You can imagine the PDMP can give providers new information that actually makes them more comfortable prescribing,” Chiarello said. “Otherwise, you’re making decisions based on gut feeling.”
Health experts note that the majority of opioid overdoses are now stemming from street drugs such as heroin and synthetic opioids such as fentanyl, not prescriptions such as oxycontin.
There’s a misperception that reducing the rates of prescribing would solve the opioid overdose crisis, Chiarello said. Instead, PDMPs are just one small part of the efforts needed to help reduce overdose death rates.
“I think if we had done some of these kinds of interventions if we had ramped up PDMPs, if we had talked about alternatives to opioids, if we had kind of nipped this problem in the bud in the early 2000s, we would have had a very different outcome,” Chiarello said.
Even though the majority of deaths can be attributed to the rise in powerful non-prescription synthetic opioids, that “by no means says that we don’t need to continue to look at people who may be on controlled substances,” Schmidt said. “I do think that the PDMP is doing what it was designed to do, which is to inform clinicians.”
Days after the county released the report in early September, County Executive Sam Page signed a bill that would require health care providers to report nonfatal overdoses to the county health department.
Health workers have previously only been required to report fatal overdoses. Page says required reporting will help the health department better understand where overdoses are occurring and create plans to address those areas.
Hospitals will be required to report starting in January. Other providers, such as first responders, will be phased in after that, health department officials said.