Earlier this year when New Hampshire became the 49th state to pass legislation adopting a prescription drug monitoring program, Missouri found itself as the lone holdout.
Legislation establishing such a program died in the Missouri Senate in May, thanks to an eight-hour filibuster by a group of Republican lawmakers led by Sen. Rob Schaaf of St. Joseph.
The standoff has inspired a visit to the Show-Me State from White House drug czar Gil Kerlikowske, who will publicly push for such a program today in the St. Louis suburb of Fenton.
To Schaaf, however, a visit from the director of the Office of National Drug Control Policy won't change his mind.
Kerlikowske "would be more than happy to have people give up their liberty to keep drug addicts from obtaining drugs," Schaaf said. "But I'm not willing to do that, and I don't think most people are willing to do that. If I have anything to say about it, that bill will never pass."
A prescription drug monitoring program is a government database aimed at stopping "doctor shopping," by which people get prescriptions from multiple physicians to feed an addiction or to sell.
Under the legislation in Missouri, the database would include the identities of doctors prescribing certain medications and the patients receiving them, as submitted by pharmacies. That information could be provided to doctors and pharmacists, and law enforcement personnel could obtain it with a subpoena.
Advocates contend the database allows doctors and pharmacists to better monitor patients who frequently seek prescriptions.
Kansas lawmakers approved K-TRACS, the Kansas Tracking and Reporting of Controlled Substances program, in 2008, but a lack of funding kept it from going online until early last year.
Pharmacies and other drug dispensers are required to report to K-TRACS whenever they fill prescriptions for any schedule II, III or IV drugs. Doctors and pharmacists can access patients' prescribing histories from the database to check for possible drug abuse and get patients into pain management or substance abuse treatment programs.
Shortly after K-TRACS started, one pharmacist reported discovering a patient who had gone to 56 prescribers and more than 13 pharmacies.
Health care providers who suspect illegal sales of prescription drugs can report their concerns to law enforcement personnel, who may request a K-TRACS report during an investigation.
According to a report by the Kansas Health Institute, the $400,000 U.S. Department of Justice grant used to initiate K-TRACS ends in October. No funding source has been identified to keep the program running, the report said.
To critics of these programs including Schaaf, a family physician and a first-term senator a prescription drug database represents an infringement on personal liberty.
"Most people are very opposed to turning all their sensitive medical information over to a state-run database," Schaaf said.
Protecting a patient's confidentiality should be a priority, Schaaf said, adding that citizens "shouldn't have to give up their right to privacy just to stop people from doing bad things."
In an interview with The Associated Press, Kerlikowske called prescription drug abuse an epidemic. Nearly 21,000 deaths in the U.S. were attributed to prescription drug overdoses in 2009, the most recent year with statistics available. The Office of National Drug Control Policy said the number of deaths from prescription drug overdoses has increased fourfold over the past decade.
"The number of deaths as a result of prescription drug use and abuse are greater than heroin and cocaine overdose deaths combined," Kerlikowske said.
Without a drug monitoring program, Missouri runs the risk of becoming a magnet for so-called "pill mills," doctor's offices that overprescribe medicines, Kerlikowske said.
Florida was once known as the pill mill capital. Just a few years ago, more than 90 of the nation's top 100 prescription-dispensing physicians were in Florida. That was before the state instituted a tracking program in 2009.
"Now they're down to 13 of the top 100," Kerlikowske said. "Many of those (pill mills) have been opening offices in Georgia, Kentucky and Missouri."
Being the lone state that hasn't moved toward a monitoring program is not a good reason to do it, Schaaf said.
"Just because every other state has passed this program doesn't mean Missouri has to," he said. "We may be the only sane state in the union. I would imagine there are a lot of upset people in other states that now have this."
The Star's Alan Bavley and The Associated Press contributed to this report.