02/11/19 -- HB 188 -- Establishes a Prescription Drug Monitoring Program
I am very much against Prescription Drug Monitoring Programs (PDMP) for many reasons. First, they don't work -- Missouri is often criticized for being the only state that has not implemented a PDMP, yet its level of overdose deaths remains in the very middle of the states. Furthermore, doctors aren't even required to use them, so the information being collected won't even be universally accessed by those writing prescriptions. But even if PDMP laws were effective, I would still not support them.
PDMP laws by their very nature are massive invasions of privacy. In addition, their law enforcement component amounts to a violation of the 4th amendment's prohibition against unreasonable searches. The patients whose personal information and prescription data are entered into the PDMP database are not suspected of having committed any crimes, yet their actions are subject to monitoring. Unlike a policeman sitting on a street corner watching people travel on a public roadway, PDMP databases allow law enforcement to monitor the private transactions between a patient and their pharmacist (and by extension, their doctor). That is unacceptable.
Moreover, storing all this private information in a database has serious secondary ramifications. Many critics of PDMP note that such a database leaves people vulnerable to identity theft in the event of a security breach. While this is a possibility, it's not one I am particularly worried about, as it is not unique to the PDMP system (most healthcare providers already store personal information on patients, for example). The major concern I have with the security of the PDMP database comes not from forced intrusion, but instead from authorized governmental access. Regardless of what protections a State law might claim, if the Federal government decides it needs access, they are certain to get it.
Why am I concerned with the Feds looking at a MO PDMP database? That's easy: the 2nd amendment. President Trump has already demonstrated that he's willing to "take the guns first, and worry about due process second". He's used an executive order to ban firearms accessories, and has supported other gun control measures in the past. In addition, the Democrat controlled House of Representatives will likely introduce "Red Flag" gun confiscation laws that will allow law enforcement to remove guns from the home of anyone the courts deem a threat. If Trump decides to support such laws and they pass the Senate, our enactment of a PDMP database will provide the Federal government all they need to confiscate guns with little difficulty.
HB 188 would not just track opioid-based medicines in the PDMP database -- it requires tracking of ALL prescriptions. Meaning anti-depressants, and other mental health related medications. Together with a Red Flag law, evidence that someone in your household is on a certain prescription would be all that's needed for law enforcement to seize your guns. Do I recognize that many dominoes have to fall into place in order for that nightmare scenario to occur? Of course. HB 188 does not directly take anyone's weapons. However this is not a fanciful scenario that I am concerned about. In the Missouri Senate, SB23 and SB42 have both been filed that propose Red Flag confiscation laws at the state level. So even if no federal law is ever enacted, local authorities might some day soon use PDMP as an excuse to take your guns.
PDMP is a massive new government overreach into the private information of everyone who fills a prescription. HB 188 may have attempted to address a few of the concerns I've noted, but in every way the bill still creates a fundamentally flawed and dangerous system.
I was strongly and firmly a "no" vote here. I did make an attempt to modify the bill via an amendment during the perfection process. My amendment (066H03.15H) would have required doctors to register with the Department of Health each year and indicate if they intended to use the PDMP program or not. The department would make the list of responses available on their website so people could use this information when choosing which doctor to visit. My amendment failed on a voice vote.
Sadly, the bill as a whole did end up passing the House, with no amendments of any kind added to make it even a little bit better. You can view the full roll call results here. Hopefully this will die in the Senate.
FOOTNOTE: During perfection of this bill, the floor debate lasted for an extended period of time and overlapped a 2pm appointment that I had previously scheduled. Around roughly 2:30 I left the floor to meet the people who had patiently waited for me in my office. While I had hoped to return to the floor quickly, by the time the meeting concluded I had missed roll call votes on amendment 0666H03.06H (which failed, but I would have supported) as well as the final perfection vote, which I would have voted against.
Also of note: There were several amendments offered to this bill that failed during perfection. One to add marijuana to the list of monitored drugs, another to make usage of the system mandatory, and finally one to exempt patients with chronic pain.