Cape County adopts prescription drug database plan

Cape Girardeau County soon will join more than 30 Missouri counties in adding a prescription-drug monitoring program.

Cape Girardeau County’s program is slated to take effect later this year.

The countywide program differs from the statewide program enacted by Gov. Eric Greitens in July, as the county program enters dispensed controlled-substance prescriptions into a database accessible by any pharmacy participating in the database.

Greitens’ measure is a closed database that tracks physicians’ written prescriptions but does not give a pharmacist an indication of whether a patient recently has filled another prescription.

Abe Funk of John’s Pharmacy in Cape Girardeau said he sees a problem with Greitens’ monitoring program.

Funk called Greitens’ program “a great PR move” but said it does nothing to help those pharmacists with an individual who needs help.

“It’s a closed database, available to only one private company,” Funk said. “I can’t look when someone brings in a prescription I have a concern about, to know if there’s a problem.”

Jane Wernsman, Cape Girardeau County Public Health Department director, said the planning for the county’s prescription-drug monitoring program has taken about a year.

The health department, its board and the county commission began reviewing the invitation from St. Louis County early this year, Wernsman said.

Appriss Inc., a software company in Louisville, Kentucky, has a three-year contract with St. Louis County to provide the database, security and support, Wernsman said.

Cape Girardeau County would subscribe to that program via a user agreement, Wernsman said.

Presiding Commissioner Clint Tracy said the driving force behind this ordinance is a need to address a “plague” of opioid-addicted patients across the state.

“Missouri is the only state that doesn’t have a statewide system,” Tracy said, which “makes us a magnet … for folks in other states who are trying to abuse the system, or ‘drug shop.’”

The county ordinance went through six drafts, Wernsman said, and was reviewed by the Greensfelder Law Firm of St. Louis.

Wernsman said Greensfelder gave the ordinance and user agreement their stamp of approval.

Information sessions held May 12 and June 8 were attended by physicians, pharmacists and other health-care professionals, as well as law-enforcement officials and first responders.

“[There was] an overwhelming response in support of the ordinance,” Wernsman said.

The ordinance and user agreement passed unanimously at Monday’s county commission meeting and will go before the St. Louis County Health Department for its approval.

Wernsman said Cape Girardeau County’s health department already has sent drafts of the ordinance and agreement to St. Louis County “and to our knowledge have passed their approval.”

Under the user agreement, the Cape Girardeau County Health Department would be a subscriber to the St. Louis County program, and users would include dispensers — that is, pharmacies or pharmacists dispensing Schedule II, III or IV controlled substances.

There are exemptions, Wernsman said, to the mandated reporting.

Hospitals prescribing controlled substances for inpatient care or at time of discharge would be exempt, as would be practitioners in an alcohol or drug-abuse treatment facility.

Wernsman said the reporting process contains manuals and guidelines, including step-by-step directions for a dispenser to register and add delegates if desired.

The prescription-drug monitoring program has a cost, Wernsman said. A three-year contract is in place between St. Louis County and Appriss, she said.

Each user would cost $7, Wernsman said, and the county has about 400 potential users.

That’s about 2.2 percent of the state total, so the anticipated statewide cost of $125,000 annually would mean Cape Girardeau County would pay $2,750, plus $2,800 for user fees, totaling about $5,550 annually for a three-year period, Wernsman said.

This would be funded by the county health department and the county commission, Wernsman said.

St. Louis County has submitted a grant application to the Department of Justice, Wernsman said, which would cover the first two years of the program’s cost for each participating county.

The grant award will be announced in September or early October, Wernsman said.

Commissioner Tracy thanked St. Louis County for taking a proactive approach to discourage an influx of people looking for opioids.

“Hopefully this will give doctors a tool to identify patients who might be leaning toward some type of addiction,” Tracy said, noting a common story of an athlete with a sports injury who is prescribed opiates to recover after surgery and becomes addicted.

“At the least, we can make sure Cape County is a place where people can’t come to get opioids unrestricted from out of state or otherwise,” Tracy added.

Chad Garner, director of emergency services at Saint Francis Medical Center in Cape Girardeau, said he is in favor of the program.

“If you had one person come into the ER department with an overdose, we just paid for the whole three years,” Garner said, adding it takes only seven days for a patient to become addicted to opioids, often prescribed in a 10-day supply.

Randall Rhodes, chief juvenile officer for the 32nd district court circuit, said since 2015, there have been many weeks in which his office removed more than 10 children, mostly in Cape Girardeau County, “and about 80 percent of the families were drug-involved.” Rhodes said this program is a very good tool.

Funk said as the law stands, he has no ability to call another pharmacy or hospital to ask whether a patient has recently filled a prescription for a controlled substance.

“I don’t know unless they happen to submit it through their insurance, and most of the time, they don’t,” Funk said.

Funk said if a patient has a problem, there are resources the pharmacist can point the patient toward, but pharmacists in Cape Girardeau County are not necessarily able to determine whether the patient has a problem.

The system is set up to avoid privacy concerns, Funk said, and he’s watched the system in action for several months with his other pharmacies in counties subscribing to St. Louis County’s program.

To access the database, a person must be a licensed health-care provider or be signed up under a licensed health-care provider’s license, Funk said.

A list of all information accessed pops up when he signs in, Funk said, calling it a “check and balance.”

Tracy said he has heard concerns about law enforcement having greater access to prescription information, but he said this program is not an opportunity for law enforcement to be involved outside of the normal process requiring warrants to conduct a lawful search.

Wernsman said if the state does pass a statewide prescription-drug monitoring program in the future, “we could revisit this ordinance to change it to participate in the state program.”

Wernsman said counties are added to this program on a quarterly basis, so it may be September or October before Cape Girardeau County is included.

mniederkorn@semissourian.com

(573) 388-3630

Pertinent address:

1 Barton Square, Jackson, Mo.