Gov. Eric Greitens signed an executive order Monday to set up a statewide prescription drug monitoring program, ending Missouri's status as the final state in the nation without such a database.
The order also bypasses another round of debates in the Missouri legislature, which came close to establishing a broad program during the regular session, but failed. Several cities and counties in the state already have set up their own monitoring program.
Greitens announced the order Monday at a news conference in St. Louis. The order directs the database to be built by the Department of Health and Senior Services, with help from St. Louis-based, pharmacy benefit management company Express Scripts and other "private-sector" partners. Greitens said it will take $250,000 in state money to set up the database.
"Opioids are a modern plague," Greitens said. "And like the plague, opioids take their victims without regard for how rich or poor they are. ... There is not a corner of this state that hasn't been visited by this curse."
"Missouri is the only state in the country that, until today, did not have a prescription drug monitoring program," the Republican governor said. "Today, I'm here to tell you that we are taking action. We were sent here to fight for people, to protect people and that's exactly what we're going to do."
In interviews with reporters after his announcement, Department of Health and Senior Services Randall Williams said that the state would enter into a $250,000 contract with Express Scripts to set up the program. He said his department would need to add staffers to administer the program.
Williams said the money for the program "comes from the Department of Social Services under Medicaid."
"As soon as the Office of Administration executes the contract with Express Scripts, we will start this program which we think will be within the month," Williams said.
According to Greitens' executive order, the database will "analyze prescriber and pharmacy prescription and dispensing data." It went onto say that the Department of Health and Senior Services will "use the analyses for the purpose of identifying activity indicating that controlled substances are being inappropriately prescribed, dispensed, or obtained; investigating such activity; and making referrals regarding such activity to appropriate government officials, including law enforcement and professional licensing boards."
"If you have one prescriber in one particular county that seems to be the source of the majority of opioid prescriptions in that county, that can be flagged," Greitens said. "Because we're using this data in an innovative way, we're going to be able to much more precisely identify problem areas both from prescribers and dispensers than we've ever been able to before."
"Too common"
In the bi-state St. Louis region last year, at least 712 people died from opioid overdoses — nearly 200 more than the year before, according to the anti-addiction group NCADA St. Louis.
Greitens paused for more than 20 seconds before starting his prepared remarks, in which he talked about how his cousin died of a heroin overdose. He said, "these stories have become all too common throughout the state of Missouri."
“You have families across the state of Missouri, communities which are being torn apart by this," Greitens said to reporters after his announcement. "And I think it’s so important when we hear these statistics that we remember that these are individual human lives and families that are dealing with these individual tragedies. And that’s why I’m proud to be here to set up this prescription drug monitoring program.”
Some conservative lawmakers blocked legislative efforts to set up a monitoring database, citing privacy concerns. Greitens says believes he has the authority to set up and administrate the program.
"We’re going to take action. We’re not waiting any longer," Greitens said. "No more excuses. No more inaction. We’re going to get this done.”
Two lawmakers, St. Joseph Republican Sen. Rob Schaaf and Sikeston Republican Rep. Holly Rehder were at the middle of the General Assembly's fight over trying to create a drug monitoring program. Schaaf didn't immediately return a request for comment.
Sherry Green of the National Alliance for Model State Drug Laws said in an interview that the rest of the prescription drug monitoring programs throughout the country were set up through legislation. She said some governors issued executive orders to get databases set up more expeditiously.
Green added that some governor contemplated issuing executive orders, but decided against such a move once a legislature approved a bill setting up a monitoring program.
Mixed reaction
In any case, some lawmakers questioned whether it was right for Greitens to act without legislative approval. State Rep. Shamed Dogan, R-Ballwin, said in a tweet that "governing by executive order because you couldn't get a bill passed was wrong under Obama and it's wrong today."
Added Sen. Ryan Silvey, R-Kansas City: "For a Republican outsider, [Greitens] sure has quickly embraced the Obama doctrine of governing by executive order."
In a statement, U.S. Sen. Claire McCaskill said she has "serious questions about how meaningful this action will be if doctors writing prescriptions — and pharmacists filling those prescriptions — don’t have access to this database."
"The welcome mat is still out for drug dealers to shop for prescriptions in our state," said McCaskill, D-Mo. "The real solution here is for our elected officials in Jefferson City to get off the sidelines, and pass a robust statewide program into law that gives law enforcement, pharmacies, and doctors the tools they need.”
Republican Attorney General Josh Hawley praised Greitens' executive order, adding in a statement that the "first step toward a prescription drug monitoring program in Missouri is long overdue."
“I brought suit against major opioid manufacturers last month to start the fight to end the opioid epidemic in our state," Hawley said. "A prescription drug monitoring database is critical to that effort.”
And in a statement, Rehder said she was "overjoyed to learn of the governor’s order to help combat our opioid epidemic."
"I look forward to ensuring our county approach, along with the Governor's order today, provides all stakeholders the tools they need to combat this epidemic," Rehder said. "It is my hope that these two programs together will save many lives.”
The "county approach" that Rehder referred to is a reference to how St. Louis County started its own database to track prescription drugs. St. Louis County Executive Steve Stenger said in a statement "we will continue to operate our successful program with the hope that whatever the governor proposes does nothing to hinder our progress."
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