There is a common belief that the present problem Missouri faces with the abuse of prescription opioids and heroin is largely due to the fact that Missouri is the only state that has refused to sign to the prescription monitoring program. Under this program all patients receiving prescription of opioids would be on a national register and all that the physician has to do is check the name to see if he/she is doctor ‘shopping’ i.e. going from doctor to doctor to obtain multiple prescriptions.  Sign on to the program and presto the problem goes away! Forty nine other states have signed on and states like Ohio, Massachusettes, Vermont, etc. have seen alarming rise in deaths from heroin.  The problem is a lot more complex than just looking up a name. Nationally, less than 50 % of the doctors writing for prescription opioids bother to look up a patient on the registry! There is so much heroin coming into this country that we are seeing more and more patients trying heroin as the first drug of abuse. Most physicians have become cognizant of the problem and have drastically cut back on casually prescribing opioids. What do you do for the patients who are addicted to opioids and heroin? What is the most common ‘treatment’? Yes, opioid drugs like methadone and buprenorphine as substitution drugs. They are highly effective but can be abused. Methadone can only be administerd in a clinic setting and patients have to go the clinic daily to receive the drug. Buprenorphine can be administered in a physician’s office, but the physician is required to obtain a waiver from the DEA and can only treatment 30 patients the first year and 100 after that. The sales of buprenorphine formulations have exceed a staggering $2 billion a year and we don’t see any lessing of the problem with addiction to opioids. Much more needs to done than than signing on to the drug monitoring program. We have to offer evidence-based treatments to those addicted to opioids. Only a small percentage of patients receive this treatment, for many it is three hots and a cot, also known as jail or prison. Sadly, Missouri does a better job feeding the addiction to alcohol. Low taxes and easy access are the major contributoring factors to the disorder. More people in Missouri are impacted by alcohol and more die from alcohol related complication that opioid overdose death. What are we doing for this group? Don’t drink and go the AA is not the answer.]]>