Drug, addiction policy makes mixed progress in Legislature

JEFFERSON CITY, Mo. -- Missouri lawmakers took steps this year to address the growing number of drug overdoses, but health-care advocates say more work remains.

Health officials point to opiates, such as heroin and oxycodone, as a major factor in the rise in drug deaths, and many states have tailored their drug policies accordingly. This year Missouri lawmakers voted to make it easier to get medicine that counteracts opiate overdoses.

But other proposals, such as legal protections for people who call 911 to report overdoses, have gotten little attention in Missouri. Others, such as expanding Medicaid or allowing doctors to recommend marijuana as an alternative to painkillers, have been voted down.

Many health-care activists want a prescription-drug monitoring program, which would require pharmacies to report to the state health department details about medications dispensed. That information would go into a database accessible to doctors, pharmacists and law enforcement.

Every other state has one, but lawmakers' concerns over privacy have halted efforts to establish a Missouri program for more than a decade. The state's inaction has prompted some local governments to create their own.

St. Louis County is establishing a prescription monitoring system, and St. Louis City Board of Aldermen voted recently to include the city's pharmacies in the program. St. Charles and Jefferson counties are considering it as well, said Ron Fitzwater, CEO of the Missouri Pharmacy Association.

"We'd hate to see a system get cobbled together," he said, adding that a statewide system would be better.

Critics of a prescription monitoring system have pointed to studies showing restricting access to painkillers can drive people to seek other forms of opiates, such as heroin.

Nationally, about 4.3 million people were nonmedical users of prescription painkillers in 2014 -- that's 1.6 percent of the population age 12 and older, according to the U.S. Department of Health and Human Services' National Survey on Drug Use and Health. The number of people who were current heroin users was about a tenth that amount, but has been increasing, according to the survey.

More than 28,600 people in the U.S. died of overdoses involving opiates in 2014, the most recent year for which the Centers for Disease Control and Prevention has published figures. Opiates played a role in more than 60 percent of the country's 47,000 overdose deaths that year.

Missouri had 1,067 drug overdose deaths in 2014. And the state's annual drug hospitalizations more than doubled -- from about 29,000 to more than 76,000 -- between 2001 and 2012, according to Missouri's Department of Mental Health. The state's drug-induced deaths have climbed at a similar rate.

Monitoring programs can help get people into treatment more quickly by flagging potential opiate abuse, said Bob Twillman, executive director of the American Academy of Pain Management.

Only about 14 percent of drug users in Missouri receive treatment, according to the federal survey. Of the 22,000 people who received state-funded treatment for a substance other than alcohol, more than one-quarter of patients' primary drug problem stemmed from heroin or painkillers, according to Missouri Department of Mental Health data for the 2014 fiscal year.

Legislation to allow pharmacists to sell naloxone, an anti-overdose medicine that currently requires a prescription, won broad support in both chambers this year. Easing access to the medicine could make it easier for a drug user's friends or family to provide some first-aid before emergency responders arrive.

Naloxone's anti-opiate effects are temporary, so the bill requires people to immediately call medical help after administering the medicine.

But fear of arrest can deter drug users from dialing 911 when someone is overdosing, and that leads to more deaths, said Jeronimo Saldana, a policy manager at the Drug Policy Alliance, a national organization that opposes the nation's current law-enforcement approach to drug use. Passing "Good Samaritan" laws that grant those callers legal protections against drug charges can help ease the stigma around calling for help, he said.

At least three lawmakers introduced Good Samaritan bills this year, according to legislative records. Two never got a hearing; the other never got a vote after its hearing.

Some lawmakers also touted medical marijuana as a less dangerous and addictive option for patients with cancer and other chronic diseases. But many in the Legislature remain skeptical of marijuana's medical value, and the House twice defeated measures that would have allowed doctors to recommend it.