Franklin County Government Center

After a failed motion for renewal Tuesday, Franklin County will no longer participate in the regional Prescription Drug Monitoring Program (PDMP).

In December 2017, the county commission voted 2 to 1 to join the PDMP hosted by St. Louis County and used by 75 jurisdictions covering 85 percent of the state’s population.

As of Jan. 1, 2018, all prescriptions of Schedule 2, 3 or 4 controlled substances had to be reported through a web-based monitoring program.

Now, Second District Commissioner Dave Hinson, who has been against PDMP since his days in the Missouri House of Representatives, said since joining the commission he has not had any updates on the progress of the program.

In fact, First District Commissioner Todd Boland, who was appointed to the commission just shy of two years ago, said until a discussion before the commission meeting Tuesday, he had no idea the county was even involved in the PDMP program.

“There is really no reason to have it,” Boland said.

The Missourian has reported extensively on the PDMP program since before the county joined more than two years ago. 

The PDMP did not cost Franklin County anything and was up for renewal until October 2021.

According to the policy, there are 201 medical professionals in the county who are licensed to prescribe the controlled substances. They have seven business days after the prescription is issued to enter the information into the web-based database.

Presiding Commissioner Tim Brinker motioned for the renewal, but neither Hinson nor Boland seconded and the motion died. The agreement was not renewed.

Brinker, who voted in favor of the PDMP in 2017, said the program was designed to prevent more opioid deaths, but concurred the commission had heard nothing recently from Mercy Hospital, whose doctors had lobbied for the county to sign on.

“We approved the program, but it is really a tool for law enforcement and prosecution,” Brinker explained.

When the PDMP was originally voted on in 2017, former presiding commissioner John Griesheimer joined Brinker in support and Hinson voted against it.

Mercy 

Despite originally lobbying the county commission to sign on to the PDMP program in 2017, Mercy Hospital Washington now says it is not needed.

Both Mercy Hospital Washington President Eric Eoloff and Dr. David Chalk, president of Mercy Clinic Four Rivers, spoke in favor of the PDMP at a commission meeting in 2017.

Now, Eoloff says he was informed by Chalk that Mercy has no immediate need any longer for a PDMP program for two reasons.

“First, we have a connectivity to other electronic medical record systems so in many cases our physicians can see what medications patients have been previously prescribed,” he explained. “Second, our prescribing patterns around pain medications and other medications has become much more restricted and limited by Mercy policy. If we still see value in a PDMP in the future, we can pursue gaining access to it through St. Louis County, which continues to support its PDMP.”

Opioid Deaths 

In the last decade, prescription oxycodone has been a factor in 99 deaths in Franklin County.

Prescription opiates are blamed for the rise of heroin use and overdoses nationwide as well.

It is widely accepted that some patients become addicted to pain medications and then move onto more powerful, deadlier drugs, such as heroin and fentanyl. 

There were 16 oxycodone-related deaths in Franklin County in 2018, which was the highest total since 2009 and was posted one year after the county originally signed on to the PDMP. 

The year before, with no PDMP, the county oxycodone-related death total was eight.

According to the county medical examiner, there were 13 oxycodone-related deaths in 2016; 11 in 2015; eight in both 2014 and 2013; 10 in 2012; six in 2011; 11 in 2010; and eight in 2009.

As of mid-September 2019, fentanyl had claimed the lives of 14 Franklin County residents.

Statistics show deaths related to fentanyl are nearly five times greater than morphine, heroine and other opiates combined.

Some 2019 death investigations are not yet closed and the full medical examiner’s report won’t be released until this fall.

Prescriptions

According to a 2017 report from the Centers for Disease Control (CDC), Franklin County ranks among the highest in the nation for opioids prescribed by physicians.

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.

More opiate prescriptions were filled in Franklin County from 2006-12 — much higher than the state average.

According to the Drug Enforcement Agency (DEA), 33,403,420 prescription pain pills were doled out by pharmacies and doctors in Franklin County during the seven-year span. That was enough for 47 pills per person per year.

The information was released by the DEA and then compiled by the Washington Post.

The most prescription pills were distributed by a Washington pharmacy, 3,957,380 pills; followed by a pharmacy in St. Clair, 3,586,670; and then two Sullivan pharmacies, 2,516,300 and 2,415,420.

Rounding out the top five was a pharmacy in Union, which distributed 2,299,500 pills.

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

2018 Report

According to the 2018 medical examiner’s yearly report, there were 49 opioid-related deaths in Franklin County that year.

Toxicology reports showed 16 different types of opiates in positive tests done by the medical examiner’s office.

Those drugs include heroin, fentanyl, oxycodone, morphine, carfentanil and other lesser-known prescription opiates.

Sixteen of the 49 deaths were specifically associated with prescription oxycodone — nine were accidental; three were suicides; two involved motor vehicle accidents; one was natural causes; and another is undetermined.

Fentanyl

Fentanyl has been a factor in 94 deaths in the county in the past 10 years.

There were 29 deaths related specifically to fentanyl in Franklin County in 2018 and 22 deaths in 2017.

Much like the national statistics, fentanyl use and the ensuing overdose deaths were extremely low compared to other drugs in the county until 2016 when the deaths jumped to 15, compared to only six in 2015.

Before the spike two years ago, the highest number of fentanyl deaths in the past decade was in 2012 with seven cases.