The Role of the PDMP: Foundational Knowledge and Best Practices

Transcription

1 The Role of the PDMP: Foundational Knowledge and Best Practices Brent I. Fox, PharmD, PhD Health Outcomes Research and Policy Harrison School of Pharmacy Auburn University

2 DISCLOSURE I, Brent Fox, have no actual or potential conflicts of interest in relation to this program. 2

3 OBJECTIVES 1. Describe the role of Prescription Drug Monitoring Programs (PDMP) in combating drug misuse and abuse 2. Discuss and demonstrate the use of the PDMP 3. Summarize best practices for PDMP use to combat drug misuse and abuse

4 AGENDA PDMP introduction Prescriber s perspective Pharmacist s perspective

5 PRESCRIPTION DRUG MISUSE Defined as taking a medication in a manner other than that prescribed or for a different condition than for which the medication was prescribed.

6 PRESCRIPTION DRUG ABUSE Defined as the intentional and inappropriate use of prescription drugs for purposes other than that prescribed, or in a manner or in quantities other than directed.

7 FOUNDATIONS CMS says a central statewide electronic database that stores prescribing and dispensing records related primarily to medications classified as Federal controlled substances, but it may include any potential drug of abuse. Individuals authorized under State law to receive PDMP data, such as providers, pharmacies, or State law enforcement agencies, may access the database. The design, objectives, and organization of PDMPs vary among States. 7

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9 HISTORICAL PERSPECTIVE Abuse and misuse are real Recognized in 1930s 1939 CA established first PDMP CII vs CII-CV Others 2002 National Alliance for Model State Drug Laws Harold Rogers Prescription Drug Monitoring Program 2005 National All Schedules Prescription Electronic Reporting Act 9

10 NATIONAL PERSPECTIVE

11 PDMP OPERATING AGENCIES

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13 PDMP FUNDING

14 SUBSTANCES MONITORED

15 DATA COLLECTION INTERVAL

16 INTERSTATE SHARING OF DATA

17 REGISTRATION REQUIREMENT

18 TRAINING REQUIREMENT

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20 ACCESS REQUIREMENT

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22 PDMP SUPPORT Help Desk for login: For technical questions about the PDMP database contact technical support at or For password issues: or

23 Opioid Use Disorder and the PDMP S Nixon Gillespie, MD Fourth Congressional District Complete Family Care Eagle Consulting Enrichment Center Lawrence Medical Center Huntsville Hospital No financial disclosures for this topic

24 Our two opiate/opioid crises Harrison Narcotic Act (1914) Methadone Clinics DATA 2000 (buprenorphine and naltrexone)

25 Learning Objectives Opioids in the treatment of chronic pain What SUD looks like Who, what and when for accessing the PDMP Real patient example using the PDMP

26 Chronicity of Low Back Pain Acute: 2-4 weeks Subacute: up to 12 weeks Chronic: > 12 weeks 75-90% of patients with acute LBP in primary care improve within 1 month Exact etiology of LBP is identifiable in only 15% of patients Susie Jang, MD, Instructor HMS, Critical Care & Pain Medicine.

27 Predictors of Pain Chronicity Protective: College Education Risk: Unemployed Radiating/wide spread pain, radicular pain Inability to walk for an hour Insomnia, sleep disturbance Catastrophizing Kinesiophobia Tobacco use

28 CDC Guidelines - Opioids for Chronic Pain Use non-opioid therapies Exercise Cognitive Behavioral Therapy Non-opioid pharmacologic therapies Start low and go slow Lowest possible effective dose Start with IR vs. ER Smallest quantity Follow-up Regularly monitor Determine if benefit > harm. If not, work to taper/discontinue

29 Opioid dose change and pain score, meta analysis Pain score does not change with increasing opioid dosages. Lucy Chen, MD, Associate Professor, MGH Center for Pain Medicine

30 There are no long term studies looking at the efficacy of opioids in the treatment of chronic pain.

31 LBP and Opioids Retrospective cohort study of WC claims with acute disabling LBP Objective: examine the association between early opioid use for acute LBP and outcomes at 2 years Sample: 8443 claimants from 1/ /2003 Conclusion: Opioids counterproductive to recovery Longer length of disability More cost Increase risk of surgery Ongoing opioid use

32 Opioid Use Disorder DSM-5 A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following occurring during a 12-month period: 1. Opioids are often taken in a larger amount of over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or controlled opioid use.

33 Opioid Use Disorder DSM-5 3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects. 4. Craving, or a strong desire or urge to use opioids. 5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work school, or home.

34 Opioid Use Disorder DSM-5 6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids. 7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.

35 Opioid Use Disorder DSM-5 8. Recurrent opioid use in situations in which it is physically hazardous. 9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely you have been caused were exacerbated by the substance.

36 Opioid Use Disorder DSM Tolerance: more drug to achieve the same effect or diminished effect with continued use of the same amount of the opioid. 11. Withdrawal: the characteristic of your withdrawal symptoms for opioids are taken relieve or avoid withdrawal symptoms

37 Opioid Use Disorder DSM-5 Modifiers: Mild: 2 to 3 symptoms Moderate: 4 to 5 symptoms Severe: 6 or more symptoms Early remission Sustained remission On maintenance therapy In a control environment

38 What s in the PDMP? Patient s identification Name of the controlled substance dispensed. The quantity and date the drug was dispensed. The prescriber, practitioner. The dispenser, pharmacy.

39 How is the PDMP useful? Identify those at risk for SUD Identify potential diversion Monitor treatment compliance Research

40 Who is privileged to access the PDMP? Physicians plus two designees Dentists Nurse Practitioners Physician Assistants Podiatrists Veterinarians Researchers

41 The PDMP is not a legal document. You can print it to study, then immediately destroy. It is not part of the patient s medical record. No sharing the PDMP information. There must be a legitimate patient need to access the patient s PDMP file.

42 When should the Prescriber consult the PDMP? The State is allowing each prescribing institution to self monitor the prescribers. The Board of Medical Examiners and the Dental Board have established minimal standards rules. Other prescriber boards are still in the process of developing minimal standards.

43 Alabama is a one prescriber, one dispenser state.

44 The PDMP is questionable and OUD is diagnosed. What next? If you re DATA 2000 Wavered, treat OUD. If not DATA 2000 Wavered, refer for treatment.

45 Because of the Harrison Narcotics Act of 1914, it is still against Federal Law to prescribe opiates/opioids to an addict for addiction without a DATA 2000 waiver.

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47 Patient Example using the PDMP Patient with stable chronic pain on 30 MME daily Fractures kneecap 3/3/2018 additional 50 tablets 3/9/2018 additional 40 tablets 3/16/2018 additional 40 tablets 3/23/2018 additional 40 tablets 3/26/2018 regular 90 tablets Total number dispensed for March 290 tablets or 14,000 MME

48 Putting a face on OUD.

49 CONQUERING THE CRISIS: FIGHTING SUBSTANCE MISUSE IN ALABAMA BEST PRACTICES 1

50 A Pharmacist s Perspective Chris Phung, RPh

51 DISCLOSURE I, Chris Phung, RPh, have no actual or potential conflict of interest in relation to this program. 3

52 OBJECTIVES Identify patient scenarios in which the PDMP is beneficial Utilize PDMP best practices Effectively communicate with patients and prescribers after gaining PDMP knowledge 4

53 IDENTIFYING PATIENT SCENARIOS Use the PDMP as a tool for helping patients, NOT an excuse to turn them away. We have a real opportunity to help patients, inform prescribers of patients activity, and limit problems before they occur. 5

54 IDENTIFYING PATIENT SCENARIOS Suspicious Scenarios: First time filling for a patient Dropping off an Rx for another patient Long lapse in filling history Pain management patients with new MD 6

55 IDENTIFYING PATIENT SCENARIOS Tricks a patient may try to use Paying with cash Frequent Urgent Care visits Faking an injury 7

56 UTILIZING THE PDMP Check using their first or middle name If no data, could be a forgery indicator Type in the first three letters of the first name and last name Place a check mark in the use partial spelling criteria

57 UTILIZING THE PDMP Multiple pharmacies Multiple doctors Multiple fills

58 UTILIZING THE PDMP EXAMPLE 1 10

59 UTILIZING THE PDMP EXAMPLE 2 11

60 UTILIZING THE PDMP Not every patient will have an issue with their profile PDMP allows us to search by date ranges Written date, filled date, insurance provider 12

61 EFFECTIVELY COMMUNICATING WITH PATIENTS AND PRESCRIBERS AFTER ACCESSING PDMP Tell them the TRUTH. Manner in which the information is communicated is KEY. 13

62 EFFECTIVELY COMMUNICATING WITH PATIENTS AND PRESCRIBERS AFTER ACCESSING PDMP What to say some DOs and DON Ts DO Be respectful Be honest Be non-judgmental Be firm DON T Pass it off for someone else to explain Use insurance won t cover it Say we don t have it in stock 14

63 WHAT WE CAN DO Make notes under patient profiles to check PDMP Have the PDMP saved as a FAVORITES tab USE the PDMP!!! (The more you use it, the easier and faster it becomes.) Communicate with doctors and other healthcare professionals Communicate with our patients 15

64 Thank you! 16