The Politics of Pain Pills

Forty-nine. That’s the number of states that have implemented prescription drug monitoring programs, which serve to prevent addicts from hopping from doctor to doctor to stock up on pills. The lone exception: Missouri. This year, a bill that would have created a PDMP here passed the House but languished in the Senate, never even coming to a vote. Had it been enacted, the bill would have created a central database of prescription information. Pharmacists would enter each prescription filled for a controlled substance, and doctors could then look up patients to view their prescribing histories.

Abuse of prescription opioids—drugs like OxyContin, Vicodin, and morphine—is an epidemic. According to the Centers for Disease Control and Prevention, more than 165,000 people died of prescription drug overdoses between 1999 and 2014. Four of five heroin users start out abusing prescriptions drugs, and added together, there were more drug overdoses in 2014 than in any other year on record. In other states, PDMPs have proved effective in addressing the problem: In Florida, overdose deaths dropped by 50 percent. In New York, the number of patients seeing multiple doctors for the same drug dropped by 75 percent.

For Rep. Holly Rehder, the Republican from Sikeston who sponsored the PDMP bill, the issue is personal. She grew up in poverty, immersed in drug culture. Her sister became an addict, and a cousin died at 39 as a result of pain pill abuse. Rehder raised her own daughter in church, with her successful parents “knowing all of her business.” But when she cut her finger at work, the young woman was given pain pills in the emergency department and became hooked. From there, she moved on to meth and other drugs.

Her story is symbolic of a shift in drug abuse, which has moved from city alleys to affluent suburbs. Heroin dealers target middle-class kids who are on painkillers after sports injuries. “I know God didn’t give me a microphone to keep my mouth shut,” Rehder says. “It’s very important to me to be as candid as possible and to give a different face to addiction.” After Rehder shared her story in the House, other representatives approached her with stories about a relative in rehab or a friend who’d died of an overdose.

“I know God didn’t give me a microphone to keep my mouth shut,” Rehder says. “It’s very important to me to be as candid as possible and to give a different face to addiction.”

Rehder’s bill has support from both sides of the aisle, in addition to medical and law enforcement organizations. Opposition has largely come from one state senator, Dr. Rob Schaaf of St. Joseph, who has prevented the bill from moving forward by threatening a filibuster. He argues that the database would violate privacy by giving thousands of people access to your prescription history. “That’s just not true,” Rehder says. “No. 1, the people he’s talking about are physicians and pharmacists. No. 2, they’re not allowed to just look at your stuff. You have to have permission from that patient.” The bill even includes a provision that the data can’t be used to keep anyone from buying a gun, on the off chance that, at some unknown time in the future, the feds decide to confiscate firearms from Prozac users. (A separate bill that would increase access to naloxone, a drug that reverses opioid overdoses, did pass this year.)

With the state unable to implement a PDMP, local leaders have stepped up. Earlier this year, St. Louis County passed its own PDMP bill, an effort led by County Executive Steve Stenger. It’s a personal issue for him, too; his nephew Mitchell Stenger died of an overdose, one of 2,700 St. Louis area residents who have died as a result of using heroin or another opioid in the past seven years. “If I can help others avoid what my family went through, let’s move forward with this program,” Stenger says. “It certainly doesn’t save everyone, but it will save lives.” Now other jurisdictions are joining in, pooling their information in a database. Mayor Francis Slay signed a PDMP bill in the city, and St. Charles and Jackson counties have shown initial interest. It’s the type of cooperation that critics sometimes say is lacking among local officials (which Stenger calls a “common misperception”).

Still, compared to a piecemeal county-by-county approach, a statewide measure would be simpler and more effective. In other states, PDMPs have served as the foundation for wider drug treatment programs, allowing doctors who notice worrisome prescription use to get patients help before they end up in the criminal justice system. “All of these other states are building on their programs,” Rehder says, “but we’re still stuck in not even having the knowledge to be able to help people.”

Editor’s Note: This article has been updated to reflect the correct first name of Mitchell Stenger. We regret the error.