Academic journal article Missouri Law Review

Missouri Shows the True Meaning of the "Show-Me" State: Missouri's Unfounded Hesitation to Enact a Prescription Drug Monitoring Program

Academic journal article Missouri Law Review

Missouri Shows the True Meaning of the "Show-Me" State: Missouri's Unfounded Hesitation to Enact a Prescription Drug Monitoring Program

Article excerpt


Drug overdoses in the United States have more than doubled over the last two decades, resulting in more deaths due to opioid overdoses than to vehicle accidents. (1) In 2014, there were over 28,000 deaths due to opioid abuse. (2) Out of the total number of drug overdoses in 2013, illicit drugs were not the primary culprits. (3) Rather, over half of the deaths were associated with prescription drugs. (4) Opioids contributed to 42,249 deaths in 2016 and were responsible for the vast majority of accidental overdoses, which more than quintupled since 1999. (5) As prescription drug deaths became an epidemic, forty-nine states as of early 2017 joined to combat this trend by enacting prescription drug monitoring programs. (6) After New Hampshire became the forty-ninth link in the chain in June of 2012, (7) the "Show-Me" state stood alone from 2012 to 2017 in the battle against prescription drug abuse. (8)

All fifty states have now enacted a prescription drug monitoring program ("PDMP"). (9) A PDMP is a statewide database that monitors the prescriptions distributed within a given state. (10) PDMPs have been shown to act as useful tools in a variety of ways. For example, they aid in decreasing prescription drug abuse through intervention, and they are powerful mechanisms to help physicians realize if they are unknowingly treating addicts searching for unnecessary painkillers (11) (this is known as "doctor shopping"). (12) Because prescription drug abuse is one of the most pressing drug-related problems in the United States, (13) PDMPs have the ability to save lives. Between the years of 1999 and 2014, drug overdose fatalities increased by 386%, (14) and out of the 28,000 opioid abuse-inflicted deaths alluded to above, over 1000 of the lives claimed belonged to Missourians. (15) This is no surprise considering Missouri's controlled substance death rate is far higher than the national average. (16)

This Note examines the reasons why Missouri took so long to enact any form of PDMP legislation. Part II of this Note introduces the background of PDMPs as they emerged across the country. Part III highlights the hurdles that states encountered in passing PDMP legislation and how they overcame them. Part III also discusses some of the recent developments in Missouri's own efforts to pass PDMP legislation. Part IV of this Note examines the benefits of PDMPs as they apply to both preventing statewide prescription drug abuse as well as aiding prescribers in knowing exactly what their patients have previously been prescribed. Part IV then discusses the criticisms PDMP legislation has received across the nation, specifically in Missouri. Finally, this Note concludes with a brief comment on the outlook of drug abuse in Missouri now that Missouri has joined the war against prescription drug abuse.


This Part traces the history of PDMPs in the United States and discusses how PDMPs have evolved to become law across the country. Though PDMPs are not mandated in every state, the federal government provides financial aid to states that want to construct and implement statewide PDMPs as part of a combative fight against drug abuse. (17) As of 2012, all states had implemented operational PDMPs or had enacted PDMP legislation, except for Missouri. (18) In 1918, New York became the first state to enact a PDMP. (19) California and Hawaii followed suit in the early 1940s, chased by many others during the 1970s to 1990s, including Washington, Texas, Illinois, Michigan, Rhode Island, and Indiana. (20) In 1991, Oklahoma became the first state to enact an electronic PDMP. (21)

A. What Do PDMPs Monitor?

Though each state's PDMP differs, the basic information collected and utilized through the programs remains consistent. Dispensers (22) are asked to submit data that includes patient identification (name, address, birth date, gender), prescriber information, dispenser information, drug information, quantity dispensed, and date dispensed. …

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