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3/1/2011
1
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?
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Controlled Substances Dosage Units Prescribed by Georgia Prescribers but
Dispensed in Other States AK
WA*ME
NH
VT
AL
AR
CACO
ID
IL INIA
MN
MO
MT
NENV
ND
OH
OK
OR
TN
UT
AZ
SD
NM
VA
WYMI
GA
KS
MS
WINY
PA
KYNC
SC
NHMARICTNJDEMD
WV
0 4 Million Dosage Units
DC
HI
TX LAFL
*Washington has temporarily suspended its PMP operations due to budgetary constraints.
0.4 Million Dosage Units
3.0 Million Dosage Units
9.8 million Dosage Units
12.5 Million Dosage Units
Average Number of Patients per GA Prescriberfor Prescriptions Filled in SC in 2009,
by GA Zip Code
Legend
Average number of
patients per prescriber0.000 - 1.429
1.430 - 6.250
6.251 - 19.000
19.001 - 41.412
41.413 - 73.500
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Average Number of Patients per GA Prescriberfor Prescriptions Filled in AL in 2009,
by GA Zip Code
Legend
Average number of
patients per prescriber0.00 - 5.22
5.23 - 18.50
18.51 - 46.83
46.84 - 148.00
148.01 - 437.50
Average Number of Prescriptions per Patient, 2009Prescriptions 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
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GA Zip Codes with More Than 100 Patients per Prescriberand 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 criteria0
1
What are
Prescription Monitoring Programs (PMPs)?
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Prescription Monitoring ProgramGOALS
• Education & Information
• Public Health Initiatives
• Early Intervention& Prevention
• Investigation & Enforcement• Investigation & Enforcement
PMP System Overview
Dispensers
Overview
State PMP
PrescribersPharmacists
Data Submitted
Reports Sent
Reports Sent
Reports
Law Enforcement & Professional
Licensing Agencies
Reports Sent
*Other groups may also receive reports other than those listed
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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 Substances13 collect carisoprodol (Soma®)13 collect carisoprodol (Soma )
6 collect tramadol (Ultram®)
• Electronic Data Collection ‐ Batch Reporting
• Reporting Frequency varies ‐ 7 to 30 days
Prescription Information Collected
P ti t id tifi ti• Patient identification:
• Name & Address
• DOB & Gender
• Prescriber Information
• Dispensing Pharmacy Informationp g y
• Drug Information, e.g.
• NDC # = name, type, strength, manufacturer
• Quantity & date dispensed
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Statutorily Authorized State PMPs, 1939 ‐201044
Harold Rogers Program Started
PMPs
Status of PMPs—September 2010AK
ID
MNMT ND
OR
WA*
SDWY
MI
ME
WINY
PA
NHMARICTNJ
VT
AL
AR
CACO
IL INIA
MO
NENV
OH
OKTN
UT
AZ NM
VA
WY
GA
KS
HITX
MS
PA
LA
KYNC
SC
FL
NJDEMD
DC
WV
Research is current as of May 28, 2010
Operational PDMPs
Enacted PDMP legislation, but program not yet operational
Legislation pending
*Washington has temporarily suspended its PMP operations due to budgetary constraints.
GU
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PMP STATISTICS
P l ti St t ith th i d PMP• Population ‐ States with authorized PMPs
2004 2010
Number 145 million 273 million
% of US 50% 89%
• Prescription Records ‐ during 2008
• 29 Operational PMPs
• 285 million Controlled Substances Prescriptions
Number of PDMP Reports Produced Per Year4,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
2,596% Increase from 2003
Harold Rogers Program Started
‐
500,000
1,000,000
1,500,000
2001 2002 2003 2004 2005 2006 Est. 2007 Est. 2008
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PDMP REPORTS BY TYPE OF USER2006 - 2007
0.4
0.6
0.8
1
0
0.2
CA ID KY NV OH OK VA
Prescribers & Pharmacists Law Enf . & Regulatory
Percent of PMP Reports to Prescribers and PharmacistsbyTypeofPMPAgencyPharmacists by Type of PMP Agency
# of Type of % Reports to
PDMPs Agency Prescribers &Pharmacists
3 Boards of Pharmacy 90% ‐ 96%
3 Law Enforcement 90% 96%3 Law Enforcement 90% ‐ 96%
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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 EpidemicFebruary 2011
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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% ib d• 39% prescribed more.
California Physician Survey Haveyou changed yourprescribing practicing toHave you changed your prescribing practicing to a patient as a result of the PDMP Reports?
No
Yes
0% 20% 40% 60% 80%
No Opinion
No
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Kentucky Survey –PhysiciansHow important is a KASPER patient report in helping you make your decision about which drug to prescribe?
Neutral
Somewhat Important
Very Important
0% 10% 20% 30% 40% 50%
Not Important
Somewhat Unimportant
Neutral
Kentucky Survey –All UsersKASPER (KY PMP) is an excellent tool for identifying potential
‘doctor shoppers’?
Neutral
Somewhat Agree
Strongly Agree
0% 20% 40% 60% 80% 100%
Strongly Disagree
Somewhat Disagree
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Louisiana PMP ‐ 5 Doctor Shoppers’ Prescriptions per MonthSept. Announcement to Jan.PMP Implementation
15
20
25
30
rescriptions
EJ
MH
CK
0
5
10
June July Aug Sept Oct Nov Dec
P
2008
DP
CQ
Notes from the Field : Wyoming PMPUnsolicited Prescription Histories
M th 10/2008 9/2009Solicited Prescription Histories per
66
39
32 31
40
3330
40
50
60
70
ber
s o
f h
isto
ries
per Month, 10/2008 – 9/2009
681 682
750726
685
730
651
773
949
600
700
800
900
1000
ber
s o
f h
isto
ries
p pMonth, 10/2008 – 9/2009
27 2826
18
26
15
0
10
20
Nu
mb
Source: Wyoming PDMP
524
459
541
300
400
500
Nu
mb
Source: Wyoming PDMP
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MA PMP - Prescriber Survey: Preliminary Findings162 baseline surveys received thus far162 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% id “b d t k l d i l di t ti t
27
• Only 13% said “based on current knowledge, including report, patient appears to have legitimate medical reason for Rxs from multiple prescribers”
MA data, preliminary – decreased # of Rx, prescribers and pharmacies for probable doctor shoppersSource: MA PMP and P. Kreiner et al., Brandeis University
Quantities of Pain Relievers
50 000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
• XPDMP = Proactive PDMPs (issue unsolicited reports)
• Non XPDMP =
0
5,000
10,000
1997 1998 1999 2000 2001 2002 2003
non-XPDMP XPDMP
• Non‐XPDMP = Non‐Proactive PDMPs
Source: An Evaluation of Prescription Drug Monitoring Programs; Simeone Associates; 2006
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12.3
Death rates for drug overdoses that were unintentional or of undetermined intent by state, 2007
8.2
7.4
4.8
8.7
3.1
3.7
4.1
5.3
10.57.1
10 0
7.6
10.8
9.8
20.4
10 2
9.2
10.0
16.8
8 6
7.111.7
15.1
9.7
18.4
10.5
12.5
11.1
14.2
12.7
21.1
12.5
10.5
10.4
16.0 NH 11.7VT 7.9MA 12.5RI 11.1CT 11.1NJ 7.5DE 9.8MD 12.5DC 8 8
9.4
3.1-9.0 9.1-11.4 11.5-21.1
Age-adjusted rate per 100,000 population
8.2
10.0
17.9
10.2 8.6
9.9
13.6
9.0
DC 8.8
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 – from 120 to 20 daysNV from 120 to 20 days
• 2010 National Law Enforcement PMP Meeting ‐‐Unanimously concurred PMPs are an important law enforcement tool.
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PMPs Save Law Enforcement Costs & Monitor Treatment
• NV Pre Criminal Intervention Program enrolls & monitors doctor• NV Pre‐Criminal Intervention Program – 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 d i di ll th ft t it liand periodically thereafter to monitor compliance
• Medical Director – Opioid Addiction Treatment Program – PMP data very important• See PMP Center of Excellence Notes from the Field
Other Ways aPMP Can Help Georgia
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Rates of Doctor Shopping Associated with OxyContin in MA, 1996
Rates per 100 of doctor shopping, by quintileRates per 100 of doctor shopping, by quintile00 - 88 - 14.2914.29 - 4040 - 100
"Source: Massachusetts Dept. of Public Health in partnership with Brandeis University"
Rates of Doctor Shopping Associated w ith OxyContin in M A, 1998
R t f d t h i 100 i tilRates of doctor shopping x 100, per quintile00 - 1.691.69 - 3.193.19 - 8.118.11 - 73.33
"Source: Massachusetts Dept. of Public Health in partnership with Brandeis University"
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2005 Prescriptions Associated with Questionable Activity(Rates per 100,000 Prescriptions) by Pharmacy Town
Questionable activity rates01 10951 - 10951096 - 18971898 - 28822883 - 14184
"Source: Massachusetts Dept. of Public Health in partnership with Brandeis University"
2005 Opioid-related Health ProblemsRate per 100,000 by Town
Overdose
Rate per 100,000 Quintiles00 01 19 820.01 - 19.8219.82 - 37.537.5 - 56.9256.92 - 225.51
"Source: Massachusetts Dept. of Public Health in partnership with Brandeis University"
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A Georgia PMP Can
Id tif h t i t tIdentify where to intervene to:
• 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 meeting DMS IV criteria for dependence on or abuse of• Persons 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 criteriameeting 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.
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Georgia PMP Can Help Save Lives
• Persons meeting criteria for dependent on or abuse of opioids are• Persons 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,
2002‐092002 09
4.3
4.2
4.5
4.1
4.2
3.9
4.24.3
1.5 1 4 1 4 1.5 1.6
1.7 1.71.9
1.5 1.5 1.6 1.5 1.7
1.6 1.4
2
3
4
5
be
rs in
Mill
ion
s Marijuana
Pain Relievers
Cocaine
1.5 1.4 1.41.1
0
1
2002 2003 2004 2005 2006 2007 2008 2009
Nu
mb
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Positive Identification for CS Prescriptions ‐1
Step 1: Pharmacies required to check photo ID of person pickingStep 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 ID of person picking up CS RxStep 2: PMPs require reporting ‐ 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
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How PMP Center of Excellence and
Training and Technical Assistance Centerat Brandeis University
CanAssistCan Assist
www.pmpalliance.org
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Prescription Monitoring Program Center of Excellence
Notes From the Field_____________________________________________________________________________________
Prescription Monitoring Program Center of Excellence
PMP Management ToolsPMP Management Tools _____________________________________________________________________________________
Prescription Monitoring Program Center of Excellence
PMP Study Analysis _______________________________________________
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Contact Information
John Eadie, MPA
Director
PMP Center of Excellence
Brandeis University
518‐429‐6397
