Franklin County Commission

In a rare split vote Tuesday, the Franklin County commission adopted a prescription drug monitoring program (PDMP) that will now require physicians and pharmacists to record the prescription of opioids in the county.

Commissioners John Griesheimer and Tim Brinker voted in favor of joining the program and Second District Commissioner Dave Hinson was against the county’s inclusion.

Hinson has been an outspoken critic of PDMP throughout his political career in the Missouri House and has held those convictions as commissioner.

“The biggest thing is a patient’s right to privacy,” Hinson said. “All we are really doing is pushing the problem around. The county didn’t create the crisis and we’re not going to solve it.”

In his argument against the PDMP, Hinson cited a recent article in The Missourian that breaks down the drug deaths in the county (13 methamphetamine, 13 fentanyl and six heroin) as proof none of the deaths were from prescription drugs and a monitoring program would not have prevented them.

“In states that have strict PDMP the deaths are actually going up,” Hinson said. “Florida increased by 22.7 percent, Connecticut increased 25.6 percent. In Missouri, with no PDMP, the deaths actually decreased by 1.6 percent.”

In Favor

Testifying in favor of the PDMP program were representatives from Mercy Hospital Washington: president of the Mercy Clinic Four Rivers Division Dr. David Chalk, Mercy Hospital Washington President Eric Eoloff and head Public Safety and Communications Manager Jason Grellner, who were grilled by Hinson about the program.

“With the current opioid epidemic there are those who would take advantage of the system,” Grellner said. “With the PDMP in place, physicians and dispensers will be better able to identify those individuals.”

Grellner added the PDMP system will be housed in St. Louis County and is provided free of charge due to a grant.

“Franklin County will be joining 75 percent of the state,” Grellner said. “It will include all county doctors, hospitals and pharmacists.”

Three-Prong Approach

Dr. Chalk said the inclusion in the PDMP is part of a three-pronged approach by Mercy to stem some of the drug crisis in the county.

According to a report from the Centers for Disease Control (CDC), Franklin County ranks among the highest in the nation for opioids prescribed by physicians.

The report states the wide variation among counties suggests a lack of consistency among providers when prescribing opioids.

Chalk says the turn to opioids for pain management began in the medical community 15 years ago.

“The Institute of Medicine came out with a proclamation that pain should be considered a fourth vital sign,” he said, “along with heart rate, blood pressure and breathing rate.”

Chalk added with the increased importance placed on pain, a new family of drugs were mandated for management — the opioids hydrocodone and oxycodone.

“Today we live in a society that there must be a pill to fix everything,” he said. “With more of these drugs out there, more people are looking for them.”

The third prong will involve long-term monitoring of patients prescribed opiate for pain, which may then subject them to frequent testing to re-evaluate their need for the drug and limit the number of pills they are given.

Why Opioids?

The CDC reports even at low doses, taking an opioid for more than three months increases the risk of addiction by 15 times. It recommends for acute pain three days or less is often enough and more than a seven-day supply is rarely needed.

To eliminate the addiction factor, the CDC recommends drugs like acetaminophen, ibuprofen and naproxen as alternatives to opioid prescriptions.

If opioids are needed, the CDC also recommends lower morphine milligram equivalents (MME) which measure the amount of the opioids in each dose.

The CDC reports the amount of opioids prescribed per person was three times higher in 2015 than in 1999.

The total amount prescribed in 2015 alone was enough for every American to be medicated around the clock for three weeks.

Pill shopping, the practice of traveling from county to county to find doctors who will prescribe the drugs, also has become a trend with those seeking opioid prescriptions.

Statewide, there are 95 painkiller prescriptions per 100 people.