The Role of Prescription Monitoring Programs

3/1/2011 A Prescription Drug Abuse Summit: The Role of  Prescription Monitoring Programs  Georgia State University Atlanta, GA March 2, 2011 What Do Other State’s PMPs  Tell Us About Prescriptions Issued  by Georgia Prescribers? 3/1/2011 Controlled Substances Dosage Units Prescribed by Georgia Prescribers but Dispensed in Other States AK VT ME WA* MT ND OR MN MI WY NE NV UT CO IA KS CA NY WI SD ID IL IN PA OH WV OK NM NC SC AR MS TX DC KY MO TN AZ VA NH MA RI CT NJ DE MD AL GA Million Dosage Units 0.4 LA FL 3.0 Million Dosage Units HI 9.8 million Dosage Units 12.5 Million Dosage Units *Washington has temporarily suspended its PMP operations due to budgetary constraints Average Number of Patients per GA Prescriber for Prescriptions Filled in SC in 2009, by GA Zip Code Legend Average number of patients per prescriber 0.000 - 1.429 1.430 - 6.250 6.251 - 19.000 19.001 - 41.412 41.413 - 73.500 3/1/2011 Average Number of Patients per GA Prescriber for Prescriptions Filled in AL in 2009, by GA Zip Code Legend Average number of patients per prescriber 0.00 - 5.22 5.23 - 18.50 18.51 - 46.83 46.84 - 148.00 148.01 - 437.50 Average Number of Prescriptions per Patient, 2009 Prescriptions Originating in GA and Filled in AL, by GA Zip Code Legend Average number of prescriptions per patient 0.00 0.01 - 1.88 1.89 - 3.33 3.34 - 6.00 6.01 - 10.20 3/1/2011 GA Zip Codes with More Than 100 Patients per Prescriber and More Than Two Prescriptions per Patient, on Average, for Prescriptions Filled in AL in 2009 Legend GA Zip Codes meeting (1) or not meeting (0) the criteria What are  Prescription Monitoring Programs  (PMPs)? 3/1/2011 Prescription Monitoring Program GOALS                • Education & Information • Public Health Initiatives • Early Intervention& Prevention • Investigation & Enforcement Investigation & Enforcement PMP System  Overview Dispensers Data Submitted Reports Sent State  PMP Pharmacists Prescribers Reports Sent Reports Sent Law  Enforcement  & Professional  Licensing  Agencies *Other groups may also receive reports other than those listed 3/1/2011 Data Collected from Pharmacies • PMPs Collect Controlled Substances: 22 collect Schedules II ‐ V 15 collect Schedules II – IV 2 collect Schedule II only 1 collect Schedules II & III  • Some Collect Non‐Controlled Substances 13 collect carisoprodol (Soma 13 collect carisoprodol (Somađ)) 6collecttramadol(Ultramđ) ã ElectronicDataCollection BatchReporting ã ReportingFrequencyvaries 7 to 30 days Prescription Information Collected • P Patient identification:  ti t id tifi ti • Name & Address • DOB & Gender • Prescriber Information p g y • Dispensing Pharmacy Information • Drug Information, e.g • NDC # = name, type, strength, manufacturer • Quantity & date dispensed 3/1/2011 Statutorily Authorized State PMPs, 1939 ‐ 2010 44 PMPs Harold Rogers  Program Started Status of PMPs—September 2010 AK VT ME WA* MT ND OR MN WI SD ID MI WY NE NV UT CO CA AZ NM IA KS OK IL IN PA OH WV VA NC TN SC AR LA NH MA RI CT NJ DE MD DC KY MO MS TX HI NY AL GA FL Operational PDMPs Enacted PDMP legislation, but program not yet operational GU Legislation pending Research is current as of May 28, 2010 *Washington has temporarily suspended its PMP operations due to budgetary constraints 3/1/2011 PMP STATISTICS • Population ‐ P l ti St t States with authorized PMPs  ith th i d PMP 2004 2010 Number % of US 145 million 50% 273 million 89%   • Prescription Records ‐ during 2008  • 29 Operational PMPs • 285 million Controlled Substances Prescriptions  Number of PDMP Reports Produced Per Year 4,500,000  4,000,000  2,596%  Increase  from  2003 Harold Rogers  Program  Started 3,500,000  3,000,000  2,500,000  2,000,000  1,500,000  1,000,000  500,000  ‐ 2001 2002 2003 2004 2005 2006 Est 2007 Est 2008 3/1/2011 PDMP REPORTS BY TYPE OF USER 2006 - 2007 0.8 0.6 0.4 0.2 CA ID KY Prescribers & Pharmacists NV OH OK VA Law Enf & Regulatory Percent of PMP Reports to Prescribers and  Pharmacists by Type of PMP Agency Pharmacists by Type of PMP Agency # of  PDMPs Type of     Agency 3     3    Boards of Pharmacy       Law Enforcement Law Enforcement  % Reports to Prescribers & Pharmacists 90% ‐ 96% 90% 96% 90% ‐ 3/1/2011 PMPs Are Effective! Prescription Monitoring Program Center of Excellence Briefing on PMP Effectiveness _ 2.1 Prescription Monitoring Programs: An Effective Tool in Curbing the Prescription Drug Abuse Epidemic February 2011 10 3/1/2011 Physician Use of Data  • Physicians can stop being victimized by doctor shoppers Physicians can stop being victimized by doctor shoppers • Physicians can use as clinical tool to improve care • OH study of Emergency Department • 41% of prescribes who received PMP report altered prescribing for  patients receiving multiple simultaneous narcotics prescriptions.  • Of these providers, 63% prescribed no narcotics or fewer • 39% prescribed more 39% ib d California Physician Survey  Have you changed your prescribing practicing to Have you changed your prescribing practicing to  a patient as a result of the PDMP Reports?  Yes No No Opinion 0% 20% 40% 60% 80% 11 3/1/2011 Kentucky Survey – Physicians How important is a KASPER patient report in helping you  make your decision about which drug to prescribe?  Very Important Somewhat Important Neutral Somewhat Unimportant Not Important 0% 10% 20% 30% 40% 50% Kentucky Survey – All Users KASPER (KY PMP) is an excellent tool for identifying potential  ‘doctor shoppers’? Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree 0% 20% 40% 60% 80% 100% 12 3/1/2011 Louisiana PMP ‐ 5 Doctor Shoppers’ Prescriptions per Month Sept. Announcement  to  Jan.PMP Implementation Prescriptions 30 25 EJ 20 MH 15 CK 10 DP CQ June July Aug Sept Oct Nov Dec 2008 Notes from the Field :   Wyoming PMP Unsolicited Prescription Histories per Month, M th 10/2008 – 9/2009 Solicited Prescription p Histories per p Month, 10/2008 – 9/2009 70 1000 66 Numb bers of histories Numb bers of histories 60 50 40 40 39 30 32 27 31 28 33 26 26 20 18 15 10 949 900 800 750 700 681 682 400 685 651 600 500 773 730 726 541 524 459 300 Source: Wyoming PDMP Source: Wyoming PDMP 13 3/1/2011 MA PMP - Prescriber Survey: Preliminary Findings 162 baseline surveys received thus far • 91% of respondents said unsolicited reports “very” or “somewhat helpful” • Only 14% said they were “aware of all or most of other prescribers” in report • O l 13% said Only id “b “based d on currentt kknowledge, l d iincluding l di report, t patient ti t appears to have legitimate medical reason for Rxs from multiple prescribers” MA data, preliminary – decreased # of Rx, prescribers and  pharmacies for probable doctor shoppers Source: MA PMP and P Kreiner et 27al., Brandeis University Quantities of Pain Relievers  50 000 50,000 • XPDMP =  Proactive  PDMPs (issue  unsolicited  reports) 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 1997 non-XPDMP 1998 1999 2000 2001 XPDMP 2002 2003 • Non Non‐XPDMP =  XPDMP = Non‐Proactive  PDMPs Source: An Evaluation of  Prescription Drug  Monitoring Programs;  Simeone Associates;  2006  14 3/1/2011 Death rates for drug overdoses that were unintentional or of  undetermined intent by state, 2007 12.3 9.7 10.5 3.7 5.3 11.1 7.1 9.2 3.1 4.8 4.1 16.0 12.7 8.2 18.4 8.7 12.5 10.8 21.1 11.7 12.5 7.4 10.5 9.8 7.6 16.8 20.4 10.4 7.1 15.1 10.0 14.2 10.5 9.4 10 10.0 10 10.2 86 8.6 NH VT MA RI CT NJ DE MD DC 11.7 7.9 12.5 11.1 11.1 7.5 9.8 12.5 8.8 8.2 17.9 13.6 9.0 9.9 Age-adjusted rate per 100,000 population 3.1-9.0 9.1-11.4 11.5-21.1 Source:  National Vital Statistics System, accessed through WONDER underlying cause mortality files, PMP Data ‐ Assists Investigations & Reduce Time • KY PMP Survey – 73% Law Enforcement Officers find PMP is  an excellent tool for obtaining evidence • GAO Report – PMPs reduce average time for doctor shopper  investigations: • KY  ‐ from 156 to 16 days • NV  NV – from from 120 to 20 days 120 to 20 days • 2010 National Law Enforcement PMP Meeting ‐‐ Unanimously concurred PMPs are an important law  enforcement tool.   15 3/1/2011 PMPs Save Law Enforcement Costs & Monitor Treatment • NV NV Pre‐Criminal Intervention Program Pre Criminal Intervention Program – enrolls & monitors doctor  enrolls & monitors doctor shoppers in rehab – saving investigative and prosecution $ • See PMP Center of Excellence Notes from the Field • Drug Courts in KY use PMP data to monitor compliance • Drug Treatment Programs in ME use PMP data at patient intake  and periodically thereafter to monitor compliance d i di ll th ft t it li • Medical Director – Opioid Addiction Treatment Program – PMP  data very important • See PMP Center of Excellence Notes from the Field Other Ways a PMP Can Help Georgia  16 3/1/2011 R ates o f D o ctor S hoppin g Associated w ith O xyCo ntin in M A, 1996 Rates p er 00 o f d octor sh op p ing , by qu in tile 0-8 - 14.29 14 29 - 40 40 - 100 "Source: Massachusetts Dept of Public Health in partnership with Brandeis University" R ates of D octor Shopping Associated w ith O xyC ontin in M A, 1998 R ates t o f d cto t r sho h p pin i g x 100, 100 per qu in i tile til 0 - 1.69 1.69 - 3.19 3.19 - 8.11 8.11 - 73.3 "Source: Massachusetts Dept of Public Health in partnership with Brandeis University" 17 3/1/2011 2005 Prescriptions Associated w ith Questionable Activity (Rates per 100,000 Prescriptions) by Pharmacy Tow n Questionable activity rates - 1095 1096 - 1897 1898 - 2882 2883 - 14184 "Source: Massachusetts Dept of Public Health in partnership with Brandeis University" 2005 Opioid-related Health Problems Overdose Rate per 100,000 by Tow n Rate per 100,000 Quintiles 0 01 - 19.82 0.01 19 82 19.82 - 37.5 37.5 - 56.92 56.92 - 225 51 "Source: Massachusetts Dept of Public Health in partnership with Brandeis University" 18 3/1/2011 A Georgia PMP Can Id tif h Identify where to intervene to: t i t t • Stop Doctor Shopping • Stop Forgeries • Stop Pill Mills • Hold Drug Take Back initiatives • Intensify Substance Abuse Prevention efforts • Assign Opioid Abuse Treatment Programs Georgia PMP will be a Disease Reporting System • Persons Persons meeting DMS‐IV criteria for dependence on or abuse of  meeting DMS IV criteria for dependence on or abuse of opioids in US are increasing • Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM‐ IV) (American Psychiatric Association [APA], 1994) • This diagnosis includes persons who are addicted • GA PMP ‐ a diagnostic tool to help prescribers identify cases  meeting these DMS IV criteria meeting these DMS IV criteria • Like other diseases, persons who meet criteria are at high risk  for acute episodes leading to overdoses and deaths • Many deaths  • are preventable with proper intervention 19 3/1/2011 Georgia PMP Can Help Save Lives  • Persons Persons meeting criteria for dependent on or abuse of opioids are  meeting criteria for dependent on or abuse of opioids are at high risk of death.  • US death rate among nonmedical pain reliever users – estimated:     192.3 per 100,000 or 22 times higher than general population in  2005 • PMPs can identify many of these people • If PMPs identify them and intervene, many lives can be saved Dependence on or Abuse of Illicit Drugs, Marijuana, Cocaine, and  Pain Relievers in the Past Year ‐ Persons Aged 12 or Older – NSDUH,  2002 09 2002‐09 4.5 Numb bers in Millions 4.3 4.2 4.2 4.2 4.3 4.1 3.9 Pain Relievers Marijuana 1.5 1.5 1.5 1.6 1.5 1.7 1.7 1.7 14 1.4 14 1.4 1.5 1.6 1.6 1.4 1.9 Cocaine 1.1 2002 2003 2004 2005 2006 2007 2008 2009 20 3/1/2011 Positive Identification for CS Prescriptions ‐ Step 1: Pharmacies required to check photo ID of person picking  Step 1: Pharmacies required to check photo ID of person picking up Controlled Substances (CS) Prescriptions • Multiple States require this  • But most waive requirement when pharmacist “knows”  person (Board of Pharmacies’ laws or regulations) • MA PMP with COE assistance found 40% of Schedule II Rx are  dropped off or picked up by person other than patient • MA  is expanding the required check from Schedule II to all  Schedules ‐ 1/1/2011 Positive Identification for CS Prescriptions ‐2 Step 2: PMPs require reporting ‐ Step 2: PMPs require reporting ID of person picking up CS  Rx ID of person picking up CS Rx • Some PMPs require reporting of ID #, e.g. MA, MI and OK   • MA is expanding requirement from Schedule  II to all  Schedules  ‐ 1/1/2011 • BACDS  opposed  • But MA is proceeding • OK is experimenting with card swipe systems • Capture ID info and add to Rx record to PMP • Verify ID is valid • ASAP Versions 4.0 & 4.1 have fields for good reporting – ID #,  type of ID, issuing authority, relationship to patient, and name   21 3/1/2011 How    PMP Center of Excellence and  Training and Technical Assistance Center at Brandeis University  Can Assist Can Assist  www.pmpalliance.org 22 3/1/2011 Prescription Monitoring Program Center of Excellence Notes From the Field _ Prescription Monitoring Program Center of Excellence PMP Management Tools _ Prescription Monitoring Program Center of Excellence PMP Study Analysis _ 23 3/1/2011 Contact Information John Eadie, MPA Director PMP Center of Excellence Brandeis University 518‐429‐6397 johnleadie@aol.com 24 ... PMPs Are Effective! Prescription Monitoring Program Center of Excellence Briefing on PMP Effectiveness _ 2.1 Prescription Monitoring Programs: An Effective Tool in Curbing the Prescription. .. www.pmpalliance.org 22 3/1/2011 Prescription Monitoring Program Center of Excellence Notes From the Field _ Prescription Monitoring Program Center of Excellence PMP... Than Two Prescriptions per Patient, on Average, for Prescriptions Filled in AL in 2009 Legend GA Zip Codes meeting (1) or not meeting (0) the criteria What are  Prescription? ?Monitoring? ?Programs? ?