Missouri doesn't monitor painkillers because senator thinks overdoses remove patients 'from the gene pool'

Republican state Senator Rob Schaaf believes that when people die of a drug overdose it “just removes them from the gene pool.” He has led a small group of senators for the last six years against any prescription drug monitoring programs, making Missouri the only state in the country not to monitor.

In one legislative session, Schaaf led filibusters against any proposal to establish a monitoring program and threatened to do so again in other sessions, STAT News reports. Programs vary state by state but all require doctors and pharmacists to enter prescriptions into a database to prevent patients from doctor hopping looking for painkillers. Schaaf is a physician, so it's unclear if he's preventing these laws because it might hurt his own bottom line, critics say.

In Oct. 2016, Schaaf explained those databases don't work and infringe on people's privacy. “Most people don’t want the government to have that information and have it on a database in which many people can get it,” he said.

A new program that Schaaf is proposing isn't a typical monitoring program at all, rather it would require doctors to send a list of names of patients they're considering giving painkillers to the state's health department. The state would manage a database that would then alert the prescriber to any troubling patterns and the prescriber could decide how to proceed. So, some doctors could continue to charge patients to dole out painkillers regardless of the state's concerns. No other state operates this way.

The Missouri State Medical Association has come out against the bill, noting that the bill would create a system so different that Missouri couldn't coordinate with other states. It's problematic for cities like Kansas City and St. Louis that are close enough to Kansas and Illinois respectively to allow addicts to cross state lines to obtain painkillers.

The National Association of State Controlled Substances Authorities also opposes the bill because it would remove medical decisions about risk from doctors.

“You are charging [the bureau] with making a medical decision and that doesn’t make any sense to me,” Larry Pinson, who serves on the board, told STAT News. “How are they going to know if there is a true medical reason for that patient to need a narcotic?”

Another bill has been proposed by two other Republicans that would form a more traditional program. Schaaf told the St. Louis Post-Dispatch that he will filibuster it.

“I’d just as soon not have a PDMP. Would they rather have a database that protects privacy or no database at all?” Schaaf said.

There were 1,066 overdose deaths in Missouri in 2016. The company that manufactures oxycodone, headquartered in St. Louis, Missouri, has expressed support for the legislation that sets up a more traditional program and not Schaaf's bill.