A doctor in Springfield is one of the most prolific prescribers of opioids in the United States for patients in Medicare's drug benefit program.

That fact came to light during a recent City Council meeting, as officials discussed and listened to feedback about a plan to implement a local prescription drug monitoring program.

It appeared to catch Councilwoman Phyllis Ferguson by surprise.

Ferguson asked the speaker, "Did you just say that the second-highest opioid prescriber in the country is in Springfield, Missouri?"

Dr. David Tonkin, who runs pain clinics in Springfield and Myrtle Beach, South Carolina and was urging council members to pass a local drug monitoring program, replied: "Yes, ma'am."

Ferguson later told the News-Leader, "I was shocked to think someone was writing that many prescriptions in a community of this size. Knowing how severe the opioid problem is, I can't imagine how many prescriptions that would be in a year."

Tonkin declined to tell the News-Leader who he was referring to but mentioned some prescriber information is publicly available through Medicare or Medicaid's website.

The Centers for Medicare & Medicaid Services release annual data about prescription drug events incurred by Medicare beneficiaries with a Part D prescription drug plan. That program includes about 70 percent of all Medicare beneficiaries.

The News-Leader found that the second-highest prescriber of opioids nationwide is not in Springfield, but there is a local physician who ranks high on the list, according to Medicare data.

According to the database, Dr. Jay Baker in Springfield wrote 12,853 prescriptions for opioids, including refills, in 2015. That places him 19th in the nation for the most opioid prescriptions.

Baker is an anesthesiologist with OCH Health System's pain clinic.

Responding to a request from the News-Leader, Andrea Harp, spokesperson for OCH Health System, said Baker would not be available for an interview and provided an emailed statement.

"Dr. Jay P. Baker is a board certified anesthesiologist who has a very busy pain management practice at OCH. Many physicians from Springfield and the surrounding areas refer their patients to him because they trust him, and because he does it the right way. His patients are closely monitored with monthly visits and are required to follow a strict pain contract, which includes urine drug screens and pill counts."

Harp also said Baker does more than prescribe narcotics to manage pain, including several different types of implantation and injection procedures.

Harp said Baker "has a high patient safety record" and added the health system is in favor of prescription drug monitoring programs.

The Centers for Medicare & Medicaid Services also includes several caveats, saying the database of Part D opioid prescriptions does not indicate the quality of care provided by individual clinicians and may not be representative of a prescriber's entire prescribing pattern.

People shouldn't read too much into Baker's ranking in the prescriber database for number of opioid prescriptions, according to Dr. Dan Pinheiro, president of the Greene County Medical Society.

"Obviously you would expect a pain specialist to be at the top of any list," Pinheiro said. "If you had somebody on the list like that who is not a chronic pain specialist — like a dentist or dermatologist — then you should be concerned, 'Wow, why is this person prescribing so many narcotics?'"

Pinheiro said nationally and locally, there's been an effort to urge health professionals to use caution when prescribing prescription opioids.

"We want to give narcotics to those who need it, not to take medicine away from dying cancer patients or people with chronic conditions," Pinheiro said. "But at the same time .... we need to be looking at alternative methods of pain control. We should not go to narcotics as the first line. They should be the last line."

An article in the August issue of the Greene County Medical Society Journal drew a connection between rising rates of opioid prescriptions and increasing use of illegal narcotic drugs, as well as related overdoses.

The number of prescription opioids sold in the U.S., as well as deaths from prescription opioids, have quadrupled since 1999, according to the article.

Greene County has been affected as well.

The Springfield fire chief said he's seen the number of overdoses spike recently. Likewise, Police Chief Paul Williams said abuse of narcotics, especially opioids and heroin, has "increased dramatically."

A local health system's use of Narcan, an emergency treatment for opioid overdoses, increased 120 percent between 2015 and the first quarter of 2017, a medical director has previously said.

The journal article said Greene County is fourth in the state for the most number of deaths due to narcotic overdoses.

Pinheiro said the local medical society is helping to spread awareness about how prescribers can help curb opioid abuse.

The new issue of the Greene County Medical Society Journal is dedicated to discussing the opioid epidemic, Pinheiro said, and a national speaker will be invited to speak at a symposium planned for later this year on the issue.

A prescription drug monitoring program will be one step in helping prescribers prevent misuse of narcotics, Pinheiro said.

Tonkin, the doctor who spoke to council at the last meeting, also emphasized the importance of giving prescribers a way of finding out a patient's prescription history.

Tonkin said more doctor training on the dangers of opioid medications is crucial, but a comprehensive solution also includes collaborating with pharmacists as well as patients and their families.

Missouri Gov. Eric Greitens signed an executive order to create a statewide prescription drug monitoring program on Monday, July 17, catching many lawmakers by surprise.

Greitens' announcement won't stop Springfield from moving ahead with its own plans, Mayor Ken McClure said in a statement.

City Council is expected to vote on whether to implement a local prescription drug monitoring program Monday.

The council meeting will be held at 6:30 p.m. on the top floor of Historic City Hall.

Greene County commissioners also plan to vote on a county-wide prescription drug monitoring program Tuesday.

The commissioners will meet at 9 a.m. in Room 212 of the Greene County Historic Courthouse. The commissioners expect to hear from experts on the topic; the public is invited to comment as well.

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