'Big 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," Engler said.

"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 citizens.

"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 pain?

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 someone else.

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 reasons.

Additionally, 31 percent of doctors indicated the monitoring program had a negative impact on their ability to manage their patients’ 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 program.

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 just wrong."

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 710 here.