It's an almost daily occurrence, said Davin Vaughn, owner of Wilkinson Pharmacy in Carthage. A customer from another state shows up at his store with a prescription for painkillers or some other controlled substance.
Vaughn said he won't fill it because he has no way of knowing how many other prescriptions that customer may have had filled already.
It's the same with Sheree Starrett, co-owner of Medicine Shoppe Pharmacy in Joplin, and for the same reason.
Missouri is the only state in the country without a prescription drug monitoring program that would allow pharmacists to track prescriptions for drugs such as oxycodone, Vicodin and Ritalin, and record who comes to them for prescriptions. Pharmacists have been trying for years to get such a program set up in Missouri, and this spring two measures are making their way through the General Assembly.
Tim Mitchell, the owner of three drug stores in Neosho, said he has been advocating for the database for years, both personally and as an officer of the Missouri Pharmacy Association; he was president of the group three years ago.
"I talked to lots of senators and representatives at that time; now it looks like it's finally getting some traction," he said.
All three pharmacists said that since Missouri has no monitoring program, the state has become a magnet for people who "shop" for doctors who will write prescriptions for narcotics and pharmacies that will fill them.
"Drug abuse is not the biggest problem — prescription drug abuse is," Mitchell said. "Most people feel like prescriptions are easy to obtain and safer to take, so they'll abuse them. Either they're not being monitored by a physician or they're seeing multiple physicians."
Mitchell said he will try to fill out-of-state prescriptions if they appear legitimate.
"But I may call the doctor, and I'll call other pharmacies to see if they have filled a prescription for them. I have technicians who have become real experts at that," he said. "With a monitoring program, we could just get online and check. We want to take care of patients with real needs, but this would enable us to be more efficient."
He also said the need for a database goes beyond drug abuse.
"There could be duplications, contraindications or medications they've stopped taking that they should still be using," he said.
Mitchell said pharmacists now also are being asked by insurance companies to do disease management counseling with patients. He cited a recent experience with a patient who is seeing five different doctors and getting some prescriptions through the mail, adding, "We need to be able to pull everything together."
Vaughn, of Carthage, said that when he refuses to fill a prescription he believes is suspect he also takes the next step, calling the physician and calling other pharmacies in the area to alert them.
"This is a real problem. There are lots of people out there that will (shop) from one doctor to another, then one pharmacy to another. There's no way for us to know what they're getting unless they're honest, and they're not very honest," he said.
When those prescriptions show up, he said they're always for a controlled substance, such as pain pills or anti-anxiety medication.
"There's nobody out there seeing multiple physicians and going to multiple pharmacies for amoxycillin," he said.
Despite a decade-long effort by pharmacists to create a prescription drug monitoring program in Missouri, lawmakers have stubbornly resisted it, expressing concerns about the security of the information that could be included.
"This is so personal. The implications are enormous for people that might be affected if their medical information was disclosed to third parties,” said state Sen. Eric Schmitt, a Republican from the St. Louis area, during a debate last week in Jefferson City. "It's not a matter of if, it's a matter of when."
The same concern is cited by groups including the Missouri Alliance for Freedom, a group that promotes limited government in the state. On the organization's website, Ryan Johnson, president, describes the program as "using your tax dollars to violate your privacy." He said the program, which he described as "a progressive, liberal agenda," is opposed by 53 percent of those questioned. Attempts to reach Johnson were unsuccessful.
State Sen. Kurt Schaefer, a Columbia Republican who opposed the measure, said he was haunted by the state's decision to release information to the federal government regarding its list of concealed-weapons permit holders.
Some lawmakers were enraged in 2013 when they learned that Missouri's database of concealed-weapons permits had been given to federal authorities investigating Social Security disability fraud. Officials of the Missouri Highway Patrol, in questioning before a Senate committee, said the discs containing the materials was encrypted and destroyed after federal officials were unable to read them. The delivery became even more of an issue when lawmakers learned that residents applying for conceal-carry permits at the Missouri Department of Revenue were being asked for personal information not required under state law.
"Having gone through the ordeal with the concealed-carry list,” he said, “I just don't think we need another database of information."
An effort to enact a prescription drug monitoring program failed in 2012, but this year, state Sen. David Sater, R-Cassville, is giving it another try. Earlier this month, despite opposition from 10 of his fellow Republicans, Sater's bill passed the Senate and is awaiting action in the House.
The purpose of the measure, Sater said, is to address the issue of “doctor shopping." A database, he said, would help keep those struggling from addiction from receiving their drugs from pharmacists like him.
Mitchell, the Neosho pharmacist, said that the personal information of customers will be safe.
"We're required to protect those records; if someone wanted something, I would have to have a medical release," he said.
In the Senate, a number of amendments were adopted. One would make the database encrypted. Another requires the information be removed in six months. And a third would require the Legislature to reconsider whether the program should stay in place in five years.
The Sater bill earned the support of Senate Majority Leader Ron Richard, R-Joplin. Defending his bill to other lawmakers, Sater said he believed the privacy protections the Senate has added would make Missouri's prescription drug monitoring program unique among states.
"I think we have the most secure and effective PDMP bill in the country," he said.
Drug monitoring program
A bill creating a prescription drug monitoring program was passed by the Missouri House last month and is awaiting action in the Senate. With changes to both bills in both chambers, lawmakers will likely have to meet in a conference committee to hammer out their differences before solidifying the legislation in hopes to get it on Democratic Gov. Jay Nixon’s desk by mid-May.