“Doctor shopping” is defined as a person or persons who go to multiple doctors in order to get multiple prescriptions for drugs (to satisfy their drug habit).  These prescriptions are then taken to pharmacies (usually different pharmacies) in exchange for drugs.

The bill sponsor, Representative Holly Rehder (pronounced: Ray-durr), Scott County, proposed the legislation as a result of her daughter becoming addicted to drugs after cutting her thumb at work.  There is not clarity as to how a PDMP would have prevented her daughter’s drug addiction.

Less than 3% of the abuses result from “doctor shopping.”  In other words, 97% of persons receiving prescription drugs practice personal responsibility, take the drugs as prescribed, and as a result do not contribute to drug abuse.  Even though these facts are well know, the drug abuse problem, specifically abuse of opioids, has taken on emotional energy.  Often, statements are made that something must be done to solve the problem, and since Missouri is the only state in the union without a PDMP, we must join the ranks of the other 49.

Consider this, 49 states have acted as independent laboratories.  According to the Prescription Drug Monitoring Program Training and Technical Assistance Center, New York was the first state to implement a PDMP in 1918.  These states have, in a sense, been conducting an experiment intended to control abuse.  These experiments have all failed.

Since Missouri is the only holdout state it would make sense that we would have the most abuse.  This is not the case.  Missouri ranks at 25 out of the 50, as the most abusive.

One might ask, “If the statewide PDMP does not work, why would the state continue the program?”  The answer is simple: once a government program is implemented it seldom goes away.

The United States does indeed have a problem with drugs.  Missouri is not exempt either and deaths from the misuse of drugs must not be taken lightly.  When analyzing the problem, though, the CDC (Center for Disease Control) Atlanta, GA, published results from a study showing that although deaths from drug overdoses increased from 2000-2017, the increase was due to illegal drugs, not prescription drugs.

According to the CDC (Center for Disease Control) in Atlanta, GA, deaths due to the abuse of fentanyl have skyrocketed.  Fentanyl, a synthetic opioid, is the culprit for an inordinate number of deaths in recent years, however, fentanyl prescribed by physicians has not been, and is not, the problem.

Illicit (illegal) fentanyl is being produced in makeshift laboratories (predominately in China and Mexico).  These producers are concerned only with quantity, not quality (and, of course, the “almighty” dollar).  As with the production of the illegal, fake marijuana, K2, illegal fentanyl can have wide variations (as much as 50 % greater concentrations in the same batch) in the potency and its ingestion can have (and has had) fatal results.

When HB 188 was debated in the Missouri House, proponents commented on several occasions that the bill was not perfect (this would mean to most logically thinking persons that it could be made better).  Before a bill is passed, it goes through a “perfecting” phase (during which time amendments may be added to the bill).  During the Perfection debate, several amendments were offered which the bill proponents admitted would have made the bill better!  Even still, all amendments were voted down.  There is a reason for this.  I’ll explain, but first, allow me to mention what happened during the bill’s hearing (in committee).

The bill, titled, The Narcotics Control Act, was assigned to the Insurance Policy committee.  Typically, bills are presented allowing public testimony and questioning by the committee members followed by a week or more for Representatives, lobbyists, and the public to “iron out” any objections, if any.  When the bill is ready to be voted on by the committee, amendments may be offered (and, potentially adopted) and a vote taken (again, usually at least a week after the initial hearing).

When HB 188 was heard, a vote was called for in the same committee hearing.  An amendment was offered – a good and necessary one (requiring the physicians to participate in – to actually use the PDMP in order to ensure patients receiving the drugs are not abusing the drugs).  The chair of the committee refused to accept amendments to the bill!

Remember my diatribe on the House Rules?  It makes me wonder: first, why would a committee chair rush a vote on a bill and, second, why the chair disallow amendments to the bill?

Since this report is getting a bit long-winded, I’ll get right to the point: A leader in the House instructed the chair to disallow amendments.  The reason: Any bill changed by a body (House or Senate) must be returned to the other to approve of the changes before final passage.  In the case of HB 188, the bill stands a better chance of being passed by the Senate without amendments – especially, the one requiring doctors to actually use the program.

Nonetheless, the Missouri House passed HB 188.  Of course, I voted, “NO.”

The bill now awaits a hearing in the Senate.

You may view the Perfection and Third Read debates in the House by following these links:

Perfection:

https://mohouse.granicus.com/MediaPlayer.php?view_id=1&clip_id=842

Third Read:

https://mohouse.granicus.com/MediaPlayer.php?view_id=1&clip_id=855

Representative Mike Moon