Missouri, the last state without a prescription drug monitoring program (PDMP), is making efforts to protect our citizens from opioids and dangerous street drugs such as heroin and fentanyl. In 2016, the St. Louis County developed a PDMP that has spread across the state and as of March, 2018, is covering over 58% of Missourians, primarily along the I-70 corridor and the bootheel.

PDMP legislation has failed in our state legislature for over 10 years and Missourians are seeking a multitude of methods to curb the tide of this national epidemic.  The Missouri Academy of Family Physicians signed onto a collaborative effort, “Emergency Room Strategy for Reduced Misuse and Abuse” in November, 2015, which impacted the prescribing of opioids in the emergency room. In addition to the MAFP, other groups endorsing this strategy are the Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons, the Missouri College of Emergency Physicians and the Missouri Hospital Association.

The Centers for Disease Control and Prevention (CDC) released their guidelines in 2016 which received an ‘affirmation of value’ from the American Academy of Family Physicians (AAFP) due to the methodology used and lack of supporting evidence. The Missouri Academy concurs with the position of the AAFP with the ultimate goal of ensuring our patients receive the care they need and effectively manage their pain.

The CDC guidelines are just that, guidelines, never intended to be codified into legislation or regulation. The guideline offers 12 recommendations about initiating or continuing opioid therapy for chronic pain, including drug selection, dosage, duration of treatment and follow-up, as well as risk assessment, addressing possible harms of opioid use and alternative therapies for pain.

The Missouri Department of Social Services issued an important message on March 5, 2018, to Medicaid prescribers that “In an effort to address Missouri’s emergent opioid crisis, the Departments of Social Services, Health and Senior Services and Mental Health are expanding upon the Opioid Prescription Intervention (OPI) Program. The OPI Program helps ensure MO HealthNet participant safety by enforcing national standards through the use of Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain.”

The Missouri Academy of Family Physicians supports the effort of these departments but is concerned that guidelines should not be implementing for enforcement without the opportunity of stakeholders to recommend changes or comments. The MAFP has sent a letter to Missouri Governor, Eric Greitens; Randall Williams, MD, Director, Missouri Department of Health and Senior Services; Steve Corsi, Psy.D., Director, Missouri Department of Social Services; Mark Stringer, Director, Missouri Department of Health, and our state legislators, expressing our concern with their OPI program enforcing guidelines.

Quick Links:

MAFP Letter to Governor Greitens
Governor Eric Greitens Press Release, Crackdown on Medicaid Providers Overproviding Opioids
OPI Program Changes, Missouri Department of Social Services
MoHealthNet Prescribers Letter
Missouri Opioid Crisis Website
AAFP Clinical Practice Guidelines, Opioid Prescribing for Chronic Pain
Missouri Hospital Association HealthStats, Economic Cost of the Opioid Epidemic in Missouri
Missouri Hospital Association Trajectories, Opioids: A Population Health Dilemma
Opioid Use in Missouri:  Updated Opioid Prescribing Guidelines (Missouri Hospital Association)
Emergency Room Strategy for Reduced Misuse and Abuse of Opioids
Patients in Pain, and a Doctor Who Must Limit Drugs, New York Times, March, 2016