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County Commission Communications

A Periodic Column Written by Ed Douglas, Presiding Commissioner

2017 - Addressing the Opioid Epidemic | East Courthouse Parking Lot | Bridge Construction

County Roads | County Zoning | County Sales Tax Passes | A Step Forward | Budget Finalized | Budget Work

2016 Newsletter Topics | 2015 Newsletter Topics

September, 2017

Recent articles in the Kansas City paper, the Chillicothe Constitution Tribune and the Wall Street Journal have discussed the growing opioid epidemic in our country. According to the Constitution-Tribune editorial that quoted the New York Times, "59,000 people died from opioids in 2016."

Opioids are a class of drugs that includes heroin but also prescription pain relievers such as morphine, oxycodone 
(oxycontin), hydrocodone (vicodin) and fentanyl, among others. The 59,000 deaths last year from Opioids are more than annual automobile deaths, annual gun deaths or even the total deaths from the Vietnam War. Physicians wrote 240 million prescriptions for opioids in 2014 and four out of five addicts started with prescription painkillers. The Kansas City paper published a chart of opioid prescriptions of every county in our state and our county was in the bottom or worst quartile of the state based on the amounts of morphine milligrams dispensed per capita. There can be multiple reasons for this high a number; but in general, it is not a good sign and can indicate abuse of the system.

The opioid epidemic is a huge problem that as a county government we can't completely solve - but we can help. Our Commission has been in contact with the St. Louis County Department of Public Health, who has developed a Prescription Drug Monitoring Program (PDMP). This is a database that tracks prescribing and dispensing of controlled prescription drugs (including opioid pain relievers, or OPRs), to patients. This database collects information from dispensers and ordinarily pharmacies, and makes it available to prescribers.

Data shows that the adoption of a PDMP results in a reduction of 1.12 deaths per year per 100,000 the year following adoption. For the state of Missouri, this means nearly 600 fewer deaths each year.

We began studying the St. Louis County's PDMP program with a conference call to the program director. Early this year, the St Louis County Department of Public Health made their program and data base available to other counties; and in a short period of time, the program has been adopted by the Counties in St Louis, Kansas City, and Columbia areas.

We recently invited a local pharmacy owner to help us review the program, and he liked what he heard. We then sent the material to our five local pharmacies, including the hospital, for their review. We also had the director of our County Health Center, Sherry Weldon, review this material. Sherry Weldon then arranged a teleconference with the pharmacists from the local pharmacies and the St. Louis County Department of Public Health. This gave all a chance to hear the plan and to ask questions as to the specifics of the program and how it would work. The consensus from the pharmacists was that this was a needed program that is long overdue and that we should adopt it.

Consequently, our county has executed a user agreement with St. Louis County and adopted authorizing legislation, 
Ordinance number 090517, effective immediately. The ordinance requires the local pharmacies to enter information regarding level II-IV substances on a data base. This data base will be then available to both doctors and pharmacies to help prevent abuse of opioid use. Although the county has adopted the Ordinance, it will take several months for St. Louis County to get the data base system in operation. We are comfortable it will all be functional by the first of the year.

How does abuse happen? An example would be a patient going to several different doctors and then several different pharmacies to fill the same painkilling prescription. This system we are adopting allows both physicians and pharmacies to see what prescriptions have been filled by a patient, and when, thereby allowing doctors and pharmacies to potentially catch and prevent abuse and misuse before it happens.

The programs stated goals are: 1) improve controlled substance prescribing by providing critical information regarding a patient's controlled substance prescription history, 2) inform clinical practice by identifying patients at high-risk who would benefit from early preventions, and 3) reduce the number of people who misuse, abuse, or overdose while making sure patients have access to safe, effective treatment.

The cost to participate in this program through St. Louis County is modest at only $240 per year. If our state adopts a state wide program in the future we can transition into it at that time. Missouri currently is the only state in the country that does not have a comprehensive program like this statewide. Governor Greitens has recently authorized a program that helps to address the opioid issue from a slightly different direction that this PDMP does. But both the Governor's program and a PDMP we are adopting can work together for the same common goal.

Our Commission plans to encourage surrounding counties to adopt this program. Having other counties involved helps prevent a potential opioid abuser from going to another doctor or pharmacy in a neighboring county.

The drug epidemic in our country is very serious, and we hope that our Ordinance requiring pharmacies to enter this information into the monitoring systemís data base will provide a needed tool to help fight the problem.

2016 - Election Congratulations (Nov 2016)
Plans for County Roads (Oct 2016) | Country Revenue Shortfall (Sept 2016) | County Sales Tax Proposal (09/26/16)
County History and Facts (Aug 2016) | Addressing Constituent Question (July 2016)
Job Descriptions Unfamiliar to Public (Jun 2016) | Revenues Stagnant But Expenses Rise (May 2016)
Still Important to Try to Buy Locally (Mar 2016) | Courthouse Happenings (Feb 2016)
2016 County Budget - Tight, But Workable for Another Year
| Jail Costs Increasing Significantly (Jan 2016)

2015 - Tax Rate Comparisons Between Counties (10/15) | Emergency Preparedness (09/15)
A Visit to the Daviess-DeKalb Regional Jail (07/15) | Pay Me Now or Pay Me Later (06/15)
Learning More About County Law Enforcement (06/15) |
Our Township Form of Government (05/15)
Court House Offices to be Open During Noon Hour (04/15)
The Importance of Buying Locally (03/15)
The County Budget (Jan/Feb 2015)

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