Brother' in Your Medicine Cabinet?
By David Armstrong
March 24, 2012
The Missouri House has passed legislation
that would allow the government to compile a database
of everyone's prescription of a controlled substance.
Proponents of the legislation say a prescription
drug monitoring program is needed in Missouri to
catch "doctor shoppers" and decrease the
number of prescription drug overdoses.
The Senate version of the program, sponsored by Senator
Kevin Engler, R-Farmington, would direct the state
health department to implement and monitor the program,
with funding to come from grants, gifts, or donations.
Most states currently have some type of drug monitoring
program in place, including the adjoining states to Missouri.
"We need this program because people from other
states are coming to Missouri and getting their prescriptions,
then going back to their own state to sell the drugs,"
Sen. Engler said. "These people can doctor-shop all
they want because we have no way to track anything because
they pay in cash."
However, for one Missouri senator, the legislation means
that every Missouri resident will have "Big Brother"
in their medicine cabinet.
"Letting the government have your very personal
and sensitive medical information on a government database,
it's just wrong and Big Brother shouldn't have that effect
on our lives," said Senator
Rob Schaaf, R-St. Joseph, and a family physician.
"Engler means well, but this is liberty versus safety."
What is a prescription drug monitoring program
The Senate legislation would monitor the prescribing
and dispensing of all Schedule II, III, and IV controlled
substances by those licensed to prescribe or dispense
such substances in Missouri.
Information to be collected includes the date of the
dispensation; the prescription number; whether the prescription
is new or a refill; the prescriber DEA or National Provider
Identifier number; date the prescription is issued by
the prescriber; source of payment for the prescription;
National Drug Code ("NDC") for the drug dispensed;
number of days' supply of the drug; quantity dispensed;
patient identification number, including any one of the
following: (a) patient's driver's license number; (b)
patient's government-issued identification number; or
(c) patient's insurance cardholder identification number;
(8) patient's name, address, and date of birth.
Once the state health department has your information,
they could provide it to doctors, law enforcement, pharmacists,
and state medical boards.
Although a physician or pharmacy would not be required
to check the database before prescribing a drug or filling
a prescription, they would have the option to do so, therefore
knowing exactly what prescriptions you've had filled.
"We believe most doctors will check the database
because doctors don't want to be scammed by a doctor shopper,"
"Doctor shopping" is a term applied to anyone
who visits different physicians, emergency rooms, dentists,
etc., to get prescription controlled substances to abuse
or sell. According to available research, drug monitoring
programs do raise a red flag on a doctor shopper.
However, opponents of the legislation are concerned about
big government intruding even more into the lives of Missouri
"Catching doctor shoppers is important, but at what
price?" said Sen. Schaaf. "You're going to let
the government have a database of every prescription controlled
substance you take just to catch some doctor shoppers?
I don't want that."
Do drug monitoring programs work?
There is no doubt prescription drug abuse is at an epidemic
level. A recent report
from the Centers for Disease Control and Prevention (CDC)
says the death toll from overdoses of prescription painkillers
has more than tripled in the past decade.
However, this was during a time when many states already
had drug monitoring programs in place. The questions become:
Do prescription drug monitoring programs cut down on overdose
deaths and reduce drug abuse? Will patients who need pain
relief be deprived of adequate medication to manage their
The CDC compared rates of overdose deaths in states with
and without drug monitoring programs between 1999 and
2005. Their research found that drug monitoring programs
had no effect on overdose deaths and did not decrease
narcotic drug abuse.
"Even if you go and get a month of medicine legally
from one doctor, you could overdose and kill yourself,"
Sen. Schaaf said. "Drug monitoring programs don't
cut down on overdose deaths. People who want to abuse
drugs will find a way to do it."
The CDC also says that over 75 percent of people who
misuse prescription painkillers use drugs prescribed to
Further, about one-half of prescription painkiller deaths
involve at least one other drug, including cocaine and
heroin, two drugs that no drug monitoring program will
track. Alcohol is also involved in many overdose deaths.
As for a drug monitoring program causing people to receive
less pain medication than they need to control their pain,
the jury is still out.
A 2004 Virginia study showed that over a three year time
span, 36 percent of physicians reported they had prescribed
fewer Schedule II prescription drugs, citing increased
media coverage and law enforcement activity as the main
Additionally, 31 percent of doctors indicated the monitoring
program had a negative impact on their ability to manage
their patientsí pain.
However, recent research involving the Iowa state monitoring
program showed that controlled substance prescriptions
have increased during the monitoring program, although
some of the increase could be attributed to an increase
in prescribers and pharmacies that had registered in the
The Iowa research does verify other statistics that show
prescription drug monitoring programs do catch doctor
shoppers, including individuals who try to get controlled
substances from five to 15 or more prescribers or pharmacies.
"Yes I know a program can help catch those people,
but look at the very small percentage of people who are
doctor shopping," Sen. Schaaf said. "To catch
a few shoppers we are going to put every citizen into
a gigantic database, run by the government and funded
by either federal money or by the drug companies. It's
Senator Engler views it another way, however.
"We have people on Medicaid who use Medicaid to
get one prescription then they use cash to get more prescriptions
from other doctors and pharmacies," Sen. Engler said.
"We have to find a way to stop that and this program
will stop it."
• Read Senate Bill