Getting High on Prescription Drug Safety in Kentucky- Research to Policy

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1 Getting High on Prescription Drug Safety in Kentucky- Research to Policy Terry Bunn, PhD Svetla Slavova, PhD Kentucky Injury Prevention and Research Center University of Kentucky Kentucky Department for Public Health December 4, 2012

2 >50% of Kentucky adults surveyed reported being prescribed prescription pain relievers in last 5 years 1 in 3 Kentuckians (32%) surveyed reported they knew someone close who abused prescription pain relievers compared to 1 in 5 Ohioans. 40% of Kentuckians aged knew someone close who abused prescription pain relievers compared to 14% of those 65+. Foundation for a Healthy Kentucky, Misuse of prescription pain relievers in Kentucky, Kentucky Health Issues Poll, December 2011

3 Paulozzi et al. Vital signs: Overdoses of prescription opioid pain relievers- United States, MMWR, 60(43)

4 Paulozzi et al. Vital signs: Overdoses of prescription opioid pain relievers- United States, MMWR, 60(43)

5 IS THIS A WORK-RELATED ISSUE?

6 PRESCRIPTION DRUGS AND WORKER FATALITIES

7 Municipal Solid Waste Collector Dies after Falling from Solid Waste Vehicle Hopper Area Incident Number: 10KY006

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10 11KY023

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12 10KY073

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14 PRESCRIPTION DRUGS AND WORKER INJURIES

15 2011 Workers Compensation Claims Ie has not reported a claim/injury to insd. Insd has recvd calls from providers alledging ee was hurt while working. Ee refused to take drug test. While using table saw, was holding piece of wood on left side, saw blade pulled piece into blade and pulled finger into path of blade. Drug screen is positive Vol fire fighter who was trying to restrain a combative patient (on drugs and violent)(assisting police to hold patient) and while police flipped the patient and tried to handcuff him the patients shoulder struck the claimant in the chest causing injury. Employee was opening a test tube for drug toxicology work. Test tube contained urine from positive drug tested subject. Conducting k-9 drug search, walked around car slipped on wet pavement falling on his wrist Ee is a deputy sheriff who injured rt shoulder while fighting with a suspect. Ee was serving drug search warrant in the process of wrestling with suspect to place him under arrest, ee injured rt shoulder. Claimant bent over to pick up shoe to check for specimen before administering drug test on patient & strained back.

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17 Challenge Spring 2011 Only 32% of prescribers/dispensers of controlled substances enrolled in KASPER system Only 50% of pain management clinics owned by physicians

18 Project June 2011 Joint NCSL)/CDC meeting to address injury prevention at the state level KY Strategic injury prevention plan developed with a primary emphasis on the prevention of prescription drug abuse Key strategies introduction of legislation addressing low enrollment of controlled substance prescribers in the KASPER, and ownership of pain clinics by private individuals

19 KSPAN Prescription Drug Abuse Goals Workgroup 1. increased controlled substance prescriber KASPER enrollment 2. prescription drug takeback programs 3. pain clinic regulation 4. controlled substance provider training

20 Key Activities Informing: 1)Proposed legislation - Provision of data - Networking - Participation on policymaking committees 2)prescription drug takeback programs 3)healthcare provider-owned pain management clinics 4)formal training on prescription drug abuse

21 KSPAN Partners Kentucky Office of Drug Control Policy Operation UNITE KASPER staff Foundation for a Healthy Kentucky Kentucky Hospital Association Department for Behavioral Health, Developmental and Intellectual Disabilities.

22 Outcome Kentucky House Bill 1 passed/effective July 20, 2012 requires mandatory enrollment, and use of, KASPER by prescribers/dispensers of controlled substances all licensed practitioners shall maintain their KASPER registration ownership of pain management facilities by physicians with full active licenses. a 161% increase from 12/1/11 and 9/1/12 in number of eligible enrolled controlled substance prescribers/dispensers in KASPER.

23 PROFESSIONAL STANDARDS FOR PRESCRIBING/DISPENSING SCHEDULE II OR SCHEDULE III WITH HYDROCODONE Requirements Before Prescribing/Dispensing 1. Obtain complete medical history; document in record 2. Conduct physical examination; document in record 3. Query KASPER 4. Develop a written treatment plan set out objectives of treatment further diagnostic exams required 5. Discuss risks/benefits of controlled substance use risk of tolerance and dependence 6. Obtain written consent for treatment

24 Ongoing Evaluation Practitioner must review course of treatment at reasonable intervals Practitioner must provide patient with any new information about treatment Practitioner must query KASPER on patient at least once every 3 months Practitioner must review KASPER report before issuing any prescriptions or refills for these substances

25 "The full impact of House Bill 1 will not be realized for a while, however, the good news at this point is usage of our prescription monitoring program has increased from 3000 reports a day to 20,000. That increased usage is helping prescribers to make more informed prescribing decisions. "------Van Ingram, Executive Director of Kentucky Office of Drug Control Policy

26 Acknowledgements This work was supported in part by Cooperative agreement numbers 5U6OH from CDC-NIOSH and 5 U17/CE from the CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC or NIOSH.