Doctors write the equivalent of more than 1.5 prescriptions for controlled substances for every person in St. Louis County, according to the first report from the county’s new prescription drug monitoring program.
The report reflects data from the first three months of the program, which tracks prescriptions of opioid painkillers, muscle relaxants, stimulants and other legal drugs with a potential for abuse. There are 14 geographic areas from across Missouri in the report, which also includes St. Louis, St. Charles County, Lincoln County, Cole County and Kansas City.
Of the areas included, Lincoln County residents have the highest rates of controlled substance use, with a ratio of more than two prescriptions for every resident. St. Louis is on the lower end, with 1.2 prescriptions per resident. The report covers controlled substance prescriptions and refills that were filled from April through June 2017 at about 90 percent of pharmacies in the participating areas.
There isn’t enough data yet to make conclusions about Missourians’ use of controlled substances, but the program is working as intended to identify people who are at risk of prescription drug overdose, said Faisal Khan, director of the St. Louis County Department of Public Health.
“We want to continue to empower as many doctors and pharmacists as possible to use the system,” Khan said. “It’s time that Missouri caught up.”
Missouri was the last state to start a prescription drug monitoring program to target the national epidemic of painkiller abuse and overdoses. After the Legislature failed for years to pass bills that would create such a program, two separate drug monitoring efforts were announced this year.
The county health department established its program in April and invited other jurisdictions to participate. Doctors and pharmacists can access the database to check a patient’s prescribing history and watch for potential abuses. Now about 76 percent of the state’s population is covered by the 54 participating cities and counties, Khan said.
Meanwhile Gov. Eric Greitens signed an executive action in July to create a statewide prescription drug monitoring program. Unlike the typical format that tracks patient behaviors, the governor’s system would be primarily used by law enforcement and professional boards to identify doctors and clinics that overprescribe painkillers. The program has not started.
The county program gives pharmacists a new tool to identify people who may need the overdose-reversing treatment naloxone, said Amy Tiemeier, an associate professor at St. Louis College of Pharmacy who serves as an adviser to the program. There were more than 700 opioid overdose deaths — including prescription painkillers and heroin — in the St. Louis region in 2016, with the number expected to increase this year.
A study released Tuesday out of West Virginia raises questions about the effectiveness of prescription drug monitoring programs in reducing total opioid deaths. After the state’s monitoring program started in 2012, there was a marked decrease in prescriptions for painkillers, but more than a 200 percent increase in heroin overdoses. The added attention to prescriptions could be encouraging people to switch to illegal heroin use, although more research is needed, the study’s authors said.
Through the St. Louis County prescription database, pharmacists and doctors can look up a patient’s history to check for the drugs they have been prescribed, by which provider and in what amounts over a certain time period. Doctors can also check their own records to look for any fraudulent prescribing under their names.
Red flags could include multiple doctors, multiple pharmacies and high quantities of opioid painkillers that the patient is refilling at a quick pace. While there could be legitimate reasons for the prescribing behaviors, patients should be aware if they are at risk of overdose, Tiemeier said.
One potential problem identified in the report is the nearly three prescriptions for every woman older than 65 in St. Louis County. It is not uncommon for patients with arthritis or cancer to be prescribed a fast-acting painkiller, a longer-lasting painkiller and an anti-anxiety medication, which could explain the figures.
Still, Tiemeier said the numbers are concerning.
“We need to do some deeper digging to see where that’s coming from,” Tiemeier said. “Pharmacies have a huge opportunity to really impact mortality around the use of opioids.”