Missouri is ground zero in the fight over opioid abuse. The Centers for Disease Control and Prevention estimates right here in Missouri, enough prescription opioids are given out to cover more than 84 percent of the population.
Missouri remains the only state in the country without a prescription drug monitoring program. It is easier for people to work the system and get multiple opioid prescriptions from different doctors, fill fake prescriptions and even come in from out of state to take advantage.
In pharmacies, mainstream music and national headlines, opioid painkillers have made a way into American culture.
Abuse of the drugs is growing rapidly, and Mid-Missouri is no exception.
A recovering opioid addict in Columbia, who did not want to be intentified, told ABC 17 News he started taking the pills when he was 18 years old and took advantage of the loose laws.
"Where I found it all the time was low-income neighborhoods who found out that the prescription they got each month could get them the extra $1,000," he said. "And so, now that they realize this, they're gonna go around to different doctors with the same problem seeing who's gonna prescribe them what in order to sell to some high school kid who's going to distribute it amongst the high schoolers."
Missouri physicians say it is not uncommon that they suspect a patient may be doctor shopping.
"There certainly would be some red flags that a patient's been around to multiple physicians," said Dr. Karl Haake, a medical doctor and pain maagement consultant. "But sometimes when that patient's been around to multiple physicians, they may have an underlying issue that was never adequately addressed."
Haake said when other states enacted prescription drug monitoring programs, he noticed an increase of patients coming to his own practice from those same states.
"When Florida really shut down a lot of their stuff, I all of a sudden saw, you know, 10 days, 10 patients who just moved from Florida," Haake said.
Local pharmacies noticed a similar trend.
"Maybe they're a genuine prescription, but is it really the prescription you want to be filling when both your patient and your doctor are out of state?" said Julia Chisholm, the manager of outpatient pharmacies at MU Heath Care. "It was dated today, and they want to fill it today because they're here on vacation."
Without a statewide PDMP, doctors have no way to check what other doctors have prescribed to many patients.
People who are “gaming the system” are inadvertently hurting those who really need the drugs, according to Haake.
"It's causing physicians to kind of put up this wall to say, I always hate to hear this, they'll say, we don't treat pain, which they really mean, we're not gonna prescribe pain medications," Haake said.
"So it's gotten to the point where some doctors are refusing," ABC 17's Lindsey Berning said.
"Yes," Haake said. "They're refusing to even address some of the pain issues. And that's really sad for those patients because they need help."
Missouri Pharmacies say there is another loophole in the system without a statewide PDMP in place.
"We see quite a bit of prescription fraud," Chisholm said. "So patients presenting, we call those purported prescriptions, so they've maybe altered a genuine prescription or maybe they've just created their own and they think it looks great."
George Oestreich, a clinical pharmacist, said pharmacists look out for certain clues to determine if a prescription is authentic when it does not look quite right.
"If it's for a quantity of medication that's different than what you would expect," Oestreich said. "If it's, the patient doesn't have any other history on file that would indicate that they need medication of that range then that would be also a clue."
If pharmacists are suspicious of prescription fraud, Oestreich said the best thing to do is to contact the doctor or person who prescribed the medicine.
"If you can't contact anyone to validate it, and you've got a significant suspicion, then you simply decline to fill the prescription," Oestreich said. "And that is certainly not good for the patient if they really need it. But that's where the PDMP will come in."
Patients are not the only ones moving to Missouri to take advantage of the system.
"Sometimes we'll see it at the clinical level as well," Chisholm said. "So, providers moving to the state of Missouri to practice because they can practice unmonitored."
There are some checks in place, however, without a PDMP.
The Missouri Bureau of Narcotics and Dangerous Drugs and the state Board of Healing Arts investigate reports of malpractice.
One Mid-Missouri doctor was put on a three-year probation for not keeping complete records of controlled substance prescriptions and letting his staff give out controlled substances to patients who came into his practice for "refills."
But Chisholm said the agencies do not have the resources to investigate every report and it can be a slow process.
"And so there are unfortunately patients caught in the middle getting diverted medications or potentially going down that path of abuse and misuse that if we had tighter controls we would prevent a lot more, rather than waiting for it to get to be such a big issue," Chisholm said.
In the last four years, prescriptions of buprenorphine, a drug to treat addiction of prescription painkillers, has grown by 52 percent.
Today, the man recovering from an opioid addiction ABC 17 News spoke to said he still has to take that drug in order to function or risk relapsing.