Less than a month after the state failed to pass legislation that would have created a database to track patients' prescriptions, the Butler County Commission will soon be asked to sign an ordinance establishing a Prescription Drug Monitoring Program locally.
In late April, the Butler County Health Department's board of trustees approved the language for an ordinance for the county to join the Prescription Drug Monitoring Program (PDMP) out of St. Louis County, explained Robert Hudson, health department administrator.
The board had held off asking the commission to approve the ordinance until the fate of a bill in the Missouri General Assembly was known.
The bill would have created a statewide monitoring program, aimed at curbing opioid and other prescription-drug abuse in Missouri, the only state in the country without such a program in place.
With the bill's recent failure, "we're back to looking at approaching the commission to do an ordinance," Hudson said.
If the ordinance passes, Butler County will join a number of other counties/cities which already have joined, including Stoddard County and the city of Dexter.
"It looks like they are adding quite a few more agencies on to St. Louis County," Hudson said. "We'll be part of that group; it looks like it is moving forward in a strong manner."
Health department officials, according to Hudson, worked with the Community Resource Council, including Karen Crook and Jeff Rolland, in deciding how to proceed.
Local pharmacist Ken Michel and Dr. Dorothy Munch serve on the board of trustees, and both "see, out in the field, what's going on and what's happening in the community, as well as we do work with the coroner on issues," Hudson said. "We're aware of the opioid problem."
During the discussions, Hudson said, local officials visited St. Louis County's health department and learned more about the program, as well as its software vendor.
"They couldn't show a lot because it wasn't live, but they showed us the background on it ... talked about the privacy of it and the ability to transmit data," Hudson said.
After those discussions, Hudson said, the program was "taken to our board of trustees who were already looking at the opioid abuse problem we have in the county and what we could do."
The board decided to draft and pass the ordinance, which is something it could do in a third-class county, such as Butler, when it relates to public health, said Hudson, who indicated the ordinance was modeled after St. Louis County's ordinance.
"Rather than trying to go on our own, we certainly want to talk with the commission and say let's move forward," Hudson said. "That's where we are at."
Hudson said St. Louis County made an agreement with the software vendor that it would "purchase the software from them, but, a signed user agreement and an ordinance from a local jurisdiction, would allow us to participate in the program also."
The PDMP, according to Hudson, is not the "only solution; it's not a cure for all the issues we've had with opioids; however, it is one component that will help."
A subscriber fee of a "little less than $2,000," he said, will allow the county's more than 15 pharmacies, as well as doctors (prescribers), to participate.
Hudson said the pharmacies and prescribers will have access to the data, but the pharmacies will be mandated to upload the data.
The goal, he said, is for the data to be entered in as "real time as we can."
The data, he said, will be maintained by St. Louis County.
The PDMP would track Schedule II to IV drugs, such as Oxycontin and Hydrocodone, Hudson said.
"This is not about people with cancer drugs" or drugs needed to treat chronic diseases, Hudson said. "We're not talking about that" or a less than five-day supply of a medication.
The intent, he said, is to track those who may be doctor or pharmacy shopping -- obtaining and filling multiple prescriptions from multiple doctors and pharmacies -- specifically seeking opioids, Hudson said.
With the program, Hudson said, the pharmacists can see when and what prescriptions previously have been filled, which could lead to "discussions" between the pharmacies.
Hudson said Michel has reported pharmacists already spend time verifying prescriptions before filling them. This would be another verification.
Ideally, Hudson said, the prescribers will check the patient's data before a prescription is written and have a discussion with the patient.
An education component, he said, also is included.
"Do you need 30 Hydros or more if you have a tooth pulled, no," Hudson said. " ... A lot of people say my doctor did give it to me; I'm supposed to take that."
Some, he said, will continue to take the medication, which leads to their addiction.
Others, he said, are left with unused pills.
"What are you going to do with them," said Hudson, who indicated it's not just "young people" who look through medicine cabinets in search of the pills.
Hudson said proper disposal is needed, and a drop-off box is located at the Poplar Bluff Police Department for that purpose.
Prescription medications, he said, should not be flushed down the toilet or sink, where they potentially could get into the water supply.
"I think we need to do a better job of educating how to dispose" of the drugs, he said.
The PDMP, according to Hudson, is about education not enforcement.
It is "another tool" to curb abuse and misuse; it's not "like someone is going to hunt you down," Hudson said.
Law enforcement personnel, like the health department, will not have access to the data, he said.
If approved by the commission, Hudson said, the county would join the program on Sept. 1.
At that point, he said, the county will have access to the software, and then work with St. Louis County officials to educate the local pharmacists and prescribers.
The data entry, he said, will be very similar to what now is required of pharmacists regarding prescription pseudoephedrine purchases.