There has been rampant news of the numerous deaths and hospitalizations tied to opioid abuse, with marked rises in such abuse and deaths in the last two decades. As a consequence, 49 states – all but Missouri, where I reside currently – created some form of prescription drug monitoring program (PDMP) to identify high-risk prescribing and patient behavior (for example, hopping among doctors from whom patients are obtaining or seeking to obtain opioid prescriptions). Scholars at Vanderbilt found that a state’s implementation of a PDMP was associated with a reduction of 1.12 opioid-related overdose deaths per 100,000 people in the population in the year following the program’s implementation, with greater effects in those programs that were more vigorous (e.g., monitoring greater numbers of drugs).
Missouri is a curious case in this regard because while it ranks high in the number of opioid prescriptions per person (it falls within the category of 82.2-95 prescriptions), it is the lone state that failed to adopt a prescription drug monitoring program that would help to avert deaths and other medical complications as a consequence of this high rate of prescribing. But unlike many states in the US, while not monitoring opioid prescriptions within the State of Missouri, they prohibit patients from filling prescriptions of any sort by physicians from other states.
Let’s think about the practical implications. When I moved here from New York, if I had wanted to, I could have gone to ten different Missouri doctors for Vicodin or Percocet and they would not have been able to monitor that behavior that would have been unequivocally suspect and unhealthy. However, I was unable to fill the prescriptions from my New York doctors for Zofran, which is an anti-nausea medication, and for calcitriol, which is a specific form of vitamin D. Neither medication has any remote habit-forming property. The pharmacist’s explanation for my inability to fill prescriptions for these medications that from an addiction standpoint are completely innocuous (though are very valuable to me!) was that Missouri was working to combat drug abuse and addiction.
If that is true, and by all accounts it should be true (in addition to high rates of opioid prescribing, meth lab seizures increased 37% between 2007 and 2009 and is around the national average with respect to drug-induced deaths), the State of Missouri should think more carefully about the policies best targeted at the problem. After all, the culprit with respect to opioid prescribing and abuse is not likely to be licensed physicians in neighboring states issuing excessive prescriptions for addictive medications (and if that is a particular problem, regulating out-of-state prescriptions for controlled substances would be a better policy to adopt than the more general constraint currently imposed), but rather individuals shopping for prescriptions among doctors within their region. When we opt for a federal or state government intervention, it should be tailored to the ill that it seeks to cure. (An unrelated though timely example is some individuals' misguided discussion of bans of automatic weapons in the aftermath of the Orlando shooting, because while tighter gun control overall would be preferable to many, it would not have impacted the shooting, which was done with a semi-automatic weapon). To preclude one from filling an anti-nausea prescription from a New York doctor while theoretically allowing the filling of ten opioid prescriptions from Missouri doctors does nothing to curb the opioid abuse problems that persist in the state.
Missouri is a curious case in this regard because while it ranks high in the number of opioid prescriptions per person (it falls within the category of 82.2-95 prescriptions), it is the lone state that failed to adopt a prescription drug monitoring program that would help to avert deaths and other medical complications as a consequence of this high rate of prescribing. But unlike many states in the US, while not monitoring opioid prescriptions within the State of Missouri, they prohibit patients from filling prescriptions of any sort by physicians from other states.
Let’s think about the practical implications. When I moved here from New York, if I had wanted to, I could have gone to ten different Missouri doctors for Vicodin or Percocet and they would not have been able to monitor that behavior that would have been unequivocally suspect and unhealthy. However, I was unable to fill the prescriptions from my New York doctors for Zofran, which is an anti-nausea medication, and for calcitriol, which is a specific form of vitamin D. Neither medication has any remote habit-forming property. The pharmacist’s explanation for my inability to fill prescriptions for these medications that from an addiction standpoint are completely innocuous (though are very valuable to me!) was that Missouri was working to combat drug abuse and addiction.
If that is true, and by all accounts it should be true (in addition to high rates of opioid prescribing, meth lab seizures increased 37% between 2007 and 2009 and is around the national average with respect to drug-induced deaths), the State of Missouri should think more carefully about the policies best targeted at the problem. After all, the culprit with respect to opioid prescribing and abuse is not likely to be licensed physicians in neighboring states issuing excessive prescriptions for addictive medications (and if that is a particular problem, regulating out-of-state prescriptions for controlled substances would be a better policy to adopt than the more general constraint currently imposed), but rather individuals shopping for prescriptions among doctors within their region. When we opt for a federal or state government intervention, it should be tailored to the ill that it seeks to cure. (An unrelated though timely example is some individuals' misguided discussion of bans of automatic weapons in the aftermath of the Orlando shooting, because while tighter gun control overall would be preferable to many, it would not have impacted the shooting, which was done with a semi-automatic weapon). To preclude one from filling an anti-nausea prescription from a New York doctor while theoretically allowing the filling of ten opioid prescriptions from Missouri doctors does nothing to curb the opioid abuse problems that persist in the state.
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