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Missouri Opioid Deaths Rise, But More Slowly

Is prescription-tracking program working?

The number of Missourians who died from opioid overdoses continued to rise from 2016 to 2017 - but state health officials say there is reason to be optimistic.

There were 951 opioid-related deaths in Missouri in 2017, up from 908 in 2016, according to the Missouri Department of Health and Senior Services.

The health department highlighted a drop in the rate at which opioid deaths increased. From 2015 to 2016, opioid- or heroin-related deaths increased by 35 percent. But from 2016 to 2017, the increase was only 4.7 percent, the health department said.

A drug-monitoring program started in late 2017 by former Gov. Eric Greitens, who lost a cousin due to opioid use, was supposed to crack down on over-prescription that is believed to be among factors fueling the painkiller overdose crisis.

Randall Williams, director of the Missouri Health and Senior Services Department, said Thursday the program works by identifying physicians the department believes "are grievously abusing the system."

Through the program, Missouri receives voluntarily provided data from physicians that is collected by Express Scripts, a pharmacy benefit management company.

Springfield and Greene County and many other local governments in the state enroll in a separately run prescription drug monitoring program pitched as more comprehensive than the one created by Greitens, which has been criticized as a half-measure.

Since July 2017, investigators have conducted 350 inspections and investigations related to over-prescription, according to the health department. That's up from 279 probes conducted between July 2016 and June 2017, and up from about 100 conducted between July 2013 and June 2014.

Referrals also increased, from 92 to 138 from fiscal 2017 to fiscal 2018, including 110 referrals to the Drug Enforcement Administration. The number of cases flagged for further investigation has risen since late 2013, according to data provided by the Department of Health and Senior Services.

When problems are identified, referrals are made to either the DEA if there are criminal concerns or the Missouri Board of Registration for the Healing Arts if there are licensing concerns, Williams said.

Ten prescribers "immediately surrendered" their controlled-substance registrations, and 56 people had been "disciplined for violating controlled substance laws" and referred to the DEA and state regulators, the health department said in its analysis of the past year. 

"In one example, (drug) investigations revealed physicians signing hundreds of prescriptions in advance for clinics where they did not practice or didn't have a patient/physician relationship," the health department said in a statement. "Those prescriptions were then being handed out by nurses or other personnel without any physician interaction, which is against the law."

Williams said he thinks education and regulation could help Missouri reduce the number of people who potentially become addicted to opioids. He noted there was a correlation between consecutive days of opioid use and the likelihood of addiction and said: "what makes this crisis different from previous drug crisis in America is that 80 percent  of people who use heroin started with prescription drugs."

Greitens' PDMP just one tool 

Williams said he doesn't think the change in the fatal overdose growth rate can be attributed to Greitens' monitoring program alone. 

A spokeswoman for the Department of Health and Senior Services, Megan Hopkins, said that while Missouri's program might help, it's not the only tool the state is using.

"The increase in referrals can be attributed to many factors including the additional investigators in the field, increase in awareness by both the public and providers," Hopkins said, "as well as the increased information received as a result of the data being shared from the pharmacy benefit management organization."

Most other states' prescription drug monitoring programs examine patient data, but Missouri's plan only tracks physician data offered voluntarily. 

Williams said he thought a traditional prescription drug monitoring program also would be effective. A doctor himself, Williams said he had previously participated voluntarily in a prescription drug monitoring program and found it beneficial.  

"There are those that say that if it's not mandatory, then it has limited value," he said. "We feel strongly that for those doctors who use them, they can be helpful, and my own personal experience would bear that out."

He added that mandatory prescription drug monitoring programs increase doctors' administrative duties, which physicians cite as a top contributor to career burnout. And he emphasized that "the vast majority of physicians are doing the right thing."

"While the system is still very new, any system that leads to saving lives and protecting the health of Missourians should be considered a good investment," the health department said.

Company given Sunshine notice
Greitens' executive order required the Department of Health and Senior Services to seek out data from companies like Express Scripts, which has shared de-identified data with the state for the purposes of fighting the opioid epidemic. 

Express Scripts, which gave $10,000 to fund Greitens' inaugural, received a no-bid contract to do prescription drug monitoring work for the state. Early reports pegged the value of the contract at $250,000.

But Williams, the department director, says he is not aware of any money changing hands between the state and the St. Louis-based company.

An Express Scripts executive confirmed Williams' statement that no money had been exchanged between the company and the state. In a statement, Express Scripts said it "stands by our efforts to help modernize the state’s opioid monitoring system."

"We are voluntarily sharing our data to help end this crisis," Express Scripts said in a statement. "Maintaining the status quo is not an option."

The contract includes a clause noting that prescription data that is collected and provided to the Department of Health and Senior Services may be subject to the Sunshine Law, Missouri's open records act.

But the contract also promises to give Express Scripts notice whenever someone requests the data and allows the company "time to oppose, request redactions or limitations on any disclosures ..."

More than 10 million "pieces of data" have been collected since late November as part of the program, according to the health department. That data is closed under state law requiring confidentiality for complaints, investigatory reports and information, the health department said.

Nikki Loethen, general counsel for DHSS, says Express Scripts has never requested that the state withhold any information in response to a Sunshine Law request.

Loethen said she was not sure which side put the open records provision in the contract but says the clause requiring the state notify the company about open records requests was "not unique."

It was not immediately clear how often this provision is written into state contracts.

(story shared by the Springfield News-Leader.  Read the original article here


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