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How to Fight Missouri’s Opioid Crisis


Op-Ed submitted on behalf of State Rep. Holly Rehder, a Republican from Sikeston who represents the 148th District.


Addiction to prescription painkillers and heroin is a national crisis. It is now the leading cause of accidental death in America. Right here in Missouri, more than 1,000 of our friends and loved ones are dying every year from this horrible epidemic.

Painkillers like Vicodin and OxyContin are opioids – a class of drugs that also includes heroin. Over the past 15 years, the number of people dying from an opioid overdose has quadrupled. One major reason is that over the same period, the number of opioid prescriptions had quintupled. That is no coincidence.

There is no silver bullet here. I wish there was. But doctors and patients in Missouri should have every tool available to fight this disease. One such tool is what’s called a Prescription Drug Monitoring Program – or PDMP. These are state-run electronic databases that track prescriptions of potentially dangerous drugs, including opioids. Doctors can check them before writing a new prescription.


Why is this important? For two reasons. First, it can alert the doctor to early signs of addiction – such as a patient asking multiple doctors to prescribe a painkiller. Second, it can help prevent doctors from accidently prescribing a drug that could be lethal in combination with another drug the patient is taking. (For example, using an opioid like Vicodin along with a sedative like Xanax quadruples the risk of overdose.)

That’s why I introduced the Narcotics Control Act this past legislative session and will again for the 2017 legislative session.  The Narcotics Control Act would require the state to create this life-saving system.

PDMPs already exist in 49 states. Missouri is the lone exception, even as evidence pours in that these databases can save lives – according to one study, more than 600 every year. The Centers for Disease Control and Prevention recommends that all doctors consult their PDMP before prescribing an opioid. Tragically, Missouri doctors can’t follow the CDC’s advice.

The experts all tell us that PDMPs work. And yet some in Jefferson City have spent years preventing our state from creating one. They use outdated studies and misleading arguments that collapse when you actually examine them.

One of them is that limiting opioid painkiller prescriptions just pushes people abusing that drug to an even more dangerous drug, heroin. I don’t even know where to start on that one. Do these critics also think we should let teenagers drink alcohol, because otherwise they’ll turn to cocaine? A New England Journal of Medicine article published this year found no evidence that limiting prescriptions leads to more heroin use. In fact, multiple studies have found that limiting the availability of opioid painkillers reduces the number of overdose deaths. That’s why we need a PDMP.  

There are others who say a PDMP gives the government power to dictate medical decisions. As a conservative, I understand that worry. So let me be clear: health care decisions should be between a doctor and their patient – the government should stay out of it. But PDMPs don’t betray that principle. The decision on whether to prescribe is still up to the doctor. If your doctor thinks you need painkillers to treat your chronic pain, you’ll still get it. These databases simply make sure they have all the information they need to recommend the safest course of treatment. 

And then there are those who say PDMPs can violate a patient’s privacy, that the data can be used by law enforcement or even stolen by hackers. By that logic, we should do away with computerized medical records altogether – and I doubt anyone would support that. There are ways we can make sure the data is secure, and punish anyone who misuses it. Every other state has built a PDMP that protects a patient’s privacy while giving doctors the tools they need to save lives. Missouri can do the same.   

Addiction does not discriminate. It kills men and women, whites and blacks, Democrats and Republicans. That’s why we must all come together to fight it. Every other state has realized that PDMPs can save lives. It is long past time for Missouri to join them.