Gov. Eric Greitens’ drug monitoring executive order aligns Missouri with rest of states

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Missouri may no longer be the only state without a prescription drug monitoring program after Gov. Eric Greitens issued an executive order creating one on Monday in St. Louis.

Greitens’ order directs the Department of Health and Senior Services to build the database, which will be designed to help prevent doctor shopping, by which people get medicine from multiple physicians to feed an addiction or to sell. The announcement was made at the headquarters of Express Scripts, a St. Louis-based pharmacy benefits management company.

“Like the plague, opioids kill the young, the old, the healthy, the sick, the virtuous and the sinful,” Greitens said in a prepared statement. “There’s not a corner of our state that hasn’t been visited by this curse.”

Forty-nine other states use a monitoring program to identify people who acquire excess prescriptions for addictive painkillers and tranquilizers, as well as the physicians who overprescribe them.

Greitens’ order instructs the health department to contract with pharmacy benefits managers, who work with insurers to hold down prescription drug costs, to use their prescriber data to look for activity that points to inappropriate dispensing of controlled substances.

U.S. Sen. Claire McCaskill, a Missouri Democrat who has repeatedly called on elected leaders in Jefferson City to enact a statewide prescription drug monitoring program, released a statement questioning the effectiveness of Greitens’ order.

“While I certainly welcome the governor’s attention to this crisis, I have serious questions about how meaningful this action will be if doctors writing prescriptions – and pharmacists filling those prescriptions – don’t have access to this database,” she said. “The welcome mat is still out for drug dealers to shop for prescriptions in our state.”

Instead of an executive order, McCaskill said state lawmakers should “get off the sidelines and pass a robust statewide program into law that gives law enforcement, pharmacies, and doctors the tools they need.”

Jeff Howell, the Missouri State Medical Association’s legislative liaison, said he was still analyzing Greitens’ order Monday morning. He said the governor had not consulted with his association, which represents the state’s physicians.

“It’s a surprise to everyone,” Howell said.

Republican legislative leaders contacted by The Star Monday afternoon said they had not seen the governor’s executive order and were still trying to track down a copy before offering a comment.

Sen. Jason Holsman, a Kansas City Democrat who sits on the legislative committee that will review any rules established by state agencies to implement the governor’s executive order, questioned whether Greitens’ action is constitutional.

“The executive branch cannot unilaterally allocate spending,” he said, “so even if (the governor) has the power to create the program, which is highly in doubt, the legislature will have to fund its implementation.”

Rep. Shamed Dogan, a St. Louis County Republican, said “governing by executive order because you couldn’t get a bill passed was wrong under Obama and it’s wrong today.”

Opponents of a drug monitoring program in the Missouri General Assembly have argued that in other states with a database, patient privacy has been breached. Additionally, they argue, a drug database represents an infringement on personal liberty.

It’s unclear how Greitens’ proposed drug database will affect local drug monitoring programs. Among the localities that set up their own databases are some of the state’s largest counties and cities: Jackson County, Kansas City, Independence, St. Louis and St. Louis County.

This story will be updated throughout the day.