Using Prescription Drug Monitoring Program Data to Advance Prevention Planning

Transcription

1 September 13, 2016 Using Prescription Drug Monitoring Program Data to Advance Prevention Planning Emerging Drug Issues and Trends Chelsey Goddard, Director, SAMHSA s Center for the Application of Prevention Technologies Cecilia Willis, NPN, Delaware Phyllis Millspaugh, NPN, Kentucky Young Onuorah, NPN, Oklahoma

2 Presentations The Role of PDMPs in Preventing the Non-Medical Use of Prescription Drugs Chelsey Goddard, Director of SAMHSA s CAPT Delaware s Prescription Monitoring Program Cecilia Willis, NPN of Delaware Kentucky All Schedule Prescription Electronic Reporting (KASPER) Phyllis Millspaugh, NPN of Kentucky Oklahoma s Plan to Reduce Prescription Drug Abuse and Prevent Overdose Young Onuorah, SPF-Partnerships for Success Manager for Oklahoma 2

3 Objectives Describe the importance of tracking and monitoring strategies to prevent the non-medical use of prescription drugs (NMUPD) Define prescription drug monitoring program (PDMP) Describe the utility of PDMP data in prevention efforts Identify examples of approaches that state substance misuse prevention grantees are using to integrate PDMP data into their efforts to reduce NMUPD 3

4 The Role of PDMPs in Preventing the Non- Medical Use of Prescription Drugs Chelsey Goddard, MPH, CPS Director, SAMHSA s CAPT 4

5 Why Address NMUPD? According to the National Survey on Drug Use and Health (NSDUH), from : 4% of adults (ages 18 and older) and 4.67% of youth (ages 12-17) in the U.S. used pain relievers non-medically 9.84% of adults (ages 18 and older) and 9.41% of youth (ages 12-17) in the U.S. used illicit drugs 5 Photo source:

6 CAPT Tools Understanding Who Is at Risk Overview of Factors and Strategies Programs and Strategies Available at 6

7 Strategy Categories Education Enforcement Disposal Tracking and Monitoring Multi-Component 7

8 Tracking and Monitoring Strategies Physical exams prior to issuing prescriptions 2 Follow-ups prior to renewing prescriptions 3 Patient ID checks prior to dispensing prescriptions 4 PDMPs 5 Mandatory use of PDMPs 6 8

9 Overview of PDMPs State run, electronic databases for tracking and monitoring Rx drug prescriptions Help to identify doctor shoppers and other high-risk patients Authorized through legislation (49 states currently have PDMPs that are either operational or have been authorized through legislation but are not yet active) Users include prescribers and dispensers, and in some cases law enforcement, researchers, patients, treatment providers, etc. 9

10 What Data are Collected in PDMPs? Information on: Patients Prescribers Dispensing pharmacies Controlled prescription drugs Source of payment (not all states) 10

11 How PDMPs are Operationalized 11 Photo source:

12 PDMP Effectiveness 7,8 Implementation of PDMPs has resulted in: Changes in prescribing behaviors and availability of controlled prescription drugs Decreases in substance abuse treatment admissions and use of multiple prescribers by patients Improvements in health outcomes, including opioid overdose deaths 12

13 Examples of Approaches for Using PDMP Data in Prevention Efforts Strategic Prevention Framework Linking PDMP data to health outcome data Identifying prescribing behaviors and geographic variations Raising awareness of the dangers of overprescribing Targeting strategies and interventions (e.g., prescriber report cards) Identifying risk and protective factors, including Rx drug diversion 13

14 CAPT Contacts Director Chelsey Goddard EDC/Waltham West Resource Team Alyssa O Hair, Coordinator University of Nevada-Reno aohair@casat.org Southeast Resource Team Lourdes Vazquez, Coordinator EDC/Washington DC lvazquez@edc.org Northeast Resource Team Gisela Rots, Coordinator EDC/Waltham grots@edc.org Southwest Resource Team Marie Cox, Coordinator University of Oklahoma mariecox@ou.edu Central Resource Team Chuck Klevgaard, Coordinator EDC/Chicago cklevgaard@edc.org 14

15 References Substance Abuse and Mental Health Services Administration (2015) National Survey on Drug Use and Health: Model-Based Prevalence Estimates (50 States and the District of Columbia). Tables 1 & U.S. Centers for Disease Control and Prevention (CDC) (2015). Prescription drug physical examination requirements. Retrieved from: 3. Oliver, R. L. & Taylor, A. (2003). Chronic opioid rules: Prescribing opioids for chronic pain requires set rules, a written plan, periodic re-evaluation, and vigilance to prevent illegal diversion of controlled substances. Practical Pain Management, 3(2), CDC. (n/d). Menu of state prescription drug identification laws. Retrieved from: 5. Clark, T., Eadie, J., Kreiner, P., & Strickler, G. (2012). Prescription drug monitoring programs: An assessment of the evidence for best practices. Pew Charitable Trusts. 6. Haffajee, R. L., Jena, A. B. & Weiner, S. G. (2015). Mandatory use of prescription drug monitoring programs. Journal of the American Medical Association. Published online January 26, CDC. (n/d). Prescription Drug Monitoring Programs (PDMPs). Retrieved from: 8. Prescription Drug Monitoring Program Center of Excellence at Brandeis. (September 2014). Briefing on PDMP Effectiveness. 15

16 Using Prescription Drug Monitoring Program Data to Advance Prevention Planning: State Approaches Cecilia Willis, NPN, Delaware Phyllis Millspaugh, NPN, Kentucky Young Onuorah, SPF-PFS Manager, Oklahoma 16

17 Delaware s Prescription Monitoring Program Dr. Cecilia Douthy Willis, NPN

18 Office of Controlled Substances (OCS)

19 Delaware Division of Professional Regulation Office of Controlled Substances 2015 Delaware Prescription Monitoring Program The Delaware Prescription Monitoring Program (PMP) is a system that collects daily information on all controlled substance (schedules II-V) prescriptions within the State. Prescribers and dispensers can obtain immediate access to an online report to review a patient's controlled substance prescription history in order to better manage patient care and promote improved professional practice.

20 Delaware Division of Professional Regulation Office of Controlled Substances 2015 Delaware Prescription Monitoring Program (cont.) Access to the Delaware PMP is limited to the following: Practitioners (other than veterinarians) who hold a valid Delaware controlled substance registration Delegates who are authorized by a Delawareregistered practitioner to access the PMP on the practitioner's behalf Delaware-licensed professional counselors of mental health and chemical dependency professionals Delaware-licensed pharmacists

21 Delaware Division of Professional Regulation Office of Controlled Substances 2015 Mandatory Registration All practitioners who hold an active Delaware Controlled Substance Registration (with the exception of veterinarians) are required, by Delaware law, to register with the PMP.

22 Source: Delaware Prescription Monitoring Program (DE PMP)

23 Source: Delaware Prescription Monitoring Program (DE PMP)

24 Delaware Division of Professional Regulation Office of Controlled Substances 2015 Prescription Behavioral Surveillance System The Division of Professional Regulation is contracted with the Brandeis Prescription Drug Monitoring Program Center of Excellence. Brandeis created the Prescription Behavior Surveillance System (PBSS) to analyze PMP data at a state and multistate level.

25

26

27

28 Prescription Drug and Substance Abuse Change Approach for Delaware How are prescription drug patterns related to neighborhood demographics, disadvantage, health, crime, and disorder? How is prescription drug use patterned across neighborhoods and communities in Delaware? How can merged data be used to inform policies and best practices? How can first responders help us interpret the results so we can improve the use of the findings?

29 Goals, Strategies, and Activities Geocode address data in Delaware PMP to Census Tract (advantage over Zip Code geocodes) Reorganize individual records ~140,000 monthly prescriptions PMP data to-date best from January 2013 March 2015 Merge PMP data with external data: Neighborhood demographics (U.S. Census Data 2010 and American Community Survey 2012) Crime (arrests and offenses) data Health data (e.g., overdose deaths and toxicology reports, treatment admissions)

30 Between 2013 and the 1 st quarter of 2015, DE neighborhoods averaged 2,113.8 opiate prescriptions per 1,000 residents The map shows 3% of the neighborhoods shaded red- where opiate prescription rates were 50% to 300+% larger than the state average

31 Between 2013 and the 1 st quarter of 2015, DE neighborhoods averaged 70.8 fentanyl prescriptions per 1,000 residents The map shows 2% of the neighborhoods shaded red- where fentanyl prescription rates were 100+ % larger than the state average

32

33

34 Logic Model Progress: Examples Decrease # of patients misusing or abusing Rx drugs, particularly opiates and increase public and professional perception of DE PMP Program and its use to both CJ and public health partners. Presented to State committees/agencies: State Epidemiological Outcome Workgroup and Prescription Drug Advisory Council (PDAC) Motivated PDAC in new legislation; put CDC guidelines into practice Motivates stakeholders to share information with other practitioners and help expedite outstanding requests to enhance PMP Established a connection with the Philadelphia area High Intensity Drug Trafficking Area program (PCHIDTA) Joined the Delaware Virtual Forum (an online exchange for combatting the opiate problem)

35 Logic Model Progress: Examples (cont.) Decrease # of providers inappropriately prescribing Rx drugs, particularly opiates. Computed various over prescription- and doctor shopping-type variables and mapped them across the state; maps were presented to the PDAC Delaware Virtual Forum. Develop interventions for prescription drug hotspots. Identified preliminary hot spots with PMP data Subsequently examined institutional facilities, major pain clinics, miscoding, etc. to verify these preliminarily identified locations Maps and tables in this presentation highlight some of Delaware s opiate abuse hot spots

36 Delaware Opioid Reduction Goals Moving Forward 1. Improve PMP functionality to document and summarize patient and prescriber patterns to inform clinical decision-making 2. Use the PMP for public health surveillance and evaluation 3. Continue and enhance efforts to monitor opioid use and opioid-related morbidity and mortality 4. Monitor progress towards goals and strategies, and evaluate the effectiveness of interventions

37 Contact Information Dr. Cecilia Douthy Willis, NPN Division of Substance Abuse and Mental Health, Delaware Health and Social Services Fax: