Wisconsin Statewide Substance Abuse Prevention Training Wisconsin Dells June 12, 2015

Wisconsin Statewide Substance Abuse Prevention Training Wisconsin Dells June 12, 2015 1

Presenter Andrea Magermans Program Analyst of the Wisconsin PDMP Wisconsin Department of Safety and Professional Services 2

Agenda 1. Purposes for and Development of the WI PDMP 2. Statistics from the WI PDMP 3. WI PDMP Operations Overview and Demonstration 4. WI PDMP Enhancements 3

1. Purposes for and Development of the WI PDMP 4

The National Epidemic Motor Vehicle Traffic, Poisoning, and Drug Poisoning Death (Overdose) Rates Source: NCHS Data Brief, December 2011, Updated with 2009 and 2010 mortality data. 5

The National Epidemic 6

The National Epidemic Drug Overdose Death Rates per 100,000 (2010) Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2000-2010 on CDC WONDER Online Database. Extracted October, 2012. 7

The National Epidemic Amount of prescription painkillers sold by state per 10,000 people (2010) Source: Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), 2010 8

The National Epidemic 9

The National Epidemic World Population Global Opioid Supply Source: http://www.painphysicianjournal.com/2008/march/2008;11;s5-s62.pdf 10

The National Epidemic World Population Global Hydrocodone Supply Source: http://www.painphysicianjournal.com/2008/march/2008;11;s5-s62.pdf 11

The Problem in Wisconsin WI Drug Poisoning Deaths, All Intent - 2013 Type of Drug Number of Mentions % of Drug Mentions All Drug Mentions 847 100% Pharmaceutical opioids 387 46% Heroin 227 27% Methadone 77 9% Contributing Causes for Wisconsin Resident Deaths with a UCOD of Drug Poisoning (ISW7 Definitions, All Intents). Source: Office of Health Informatics and BCHP, WI Department of Health Services, February, 2015) 12

The State Problem Wisconsin Resident Opioid-Related Deaths, 2000-2012 13

Wisconsin Counties with no Opioid Deaths 40 35 30 25 20 15 10 5 0 The State Problem Wisconsin Counties with no opioid-related deaths, 2004-2012 36 28 22 22 24 2004 2005 2006 2007 2008 2009 2010 2011 2012 17 24 26 17 Source: Wisconsin resident death certificates; Department of Health Services, Division of Public Health, Office of Health Informatics 14

The State Problem 15

The Prescription Drug Epidemic Every day, 44 people in the US die from prescription painkiller overdose (over 16,000 annually). Source: Centers for Disease Control and Prevention, Policy Impact: Prescription Painkiller Overdoses, Nov. 2011 16

ONDCP s 2013 National Drug Control Strategy Preventing Prescription Drug Abuse: Pillar 1: Education Pillar 2: Monitoring Expand Prescription Drug Monitoring Programs and Promote Links among State Systems and to Electronic Health Records Pillar 3: Disposal Pillar 4: Enforcement

Part of the Solution: PDMP The PDMP is a tool that provides data that can be used to help address prescription drug abuse, addiction and diversion. The data can help healthcare professionals: evaluate a patient s use of monitored prescription drugs and make more informed decisions support access to legitimate medical use of controlled substances provide better coordination of care to patients seeing multiple professionals identify and treat persons addicted to prescription drugs inform public health initiatives 18

How PDMPs Work 1. Pharmacies and other dispensers of monitored prescription drugs collect and submit data to the PDMP. 2. The data is added to a statewide database. 3. Authorized users may obtain PDMP data to verify prescription information. 19

Status of State PDMPs VT WA OR NV CA ID AZ UT MT WY CO NM ND MN SD WI NE IA IL KS MO OK AR MS NY MI PA OH IN WV VA KY NC TN SC GA AL ME D.C. NH MA RI CT NJ DE MD States with operational PDMPs AK TX LA FL States with enacted PDMP legislation, but program not yet operational States with legislation pending HI

Development of the Wisconsin June 1, 2010 2009 Act 362 directs the creation of the PDMP PDMP June 1, 2013 PDMP Database is fully operational 2010 2011 2012 2013 October 1, 2011 Administrative rulewriting process begins January 1, 2013 Administrative rules, Phar 18, go into effect; dispensers begin collecting data October 1, 2013 WI PDMP Connects to the PMPi and begins sharing data with other states 21

2. Statistics from the WI PDMP 22

WI PDMP Operational Statistics Over 26 million R x records in the database Approximately 1,800 dispensers actively submitting data User Registration: Nearly 12,000 users with query accounts Healthcare Queries: Over 1.7 million recipient queries performed since June 1, 2013 Approximately 51,000 interstate queries performed since October 1, 2013

Quarterly PDMP Statistics PDMP Operations January March 2015 2015 YTD Since January 2013 # of Dispensers 1,679 1,679 2,651 # of Prescriptions 2,638,851 2,638,851 24,293,294 Quantity Dispensed 161,348,081 161,348,081 Estimated Days Supply 5,810,8415 58,108,415 531,140,589 Top 15 Monitored Prescription Drug Prescriptions January - March 2015 Monitored Prescription Drug Doses Dispensed / County Population January March 2015 Drug Name Number of Prescriptions Percent of MPD Prescriptions HYDROCODONE/ACETAMINOPHEN 440,790 16.70% DEXTROAMPHETAMINE/AMPHETAMINE 209,087 7.92% TRAMADOL HCL 193,134 7.32% OXYCODONE HCL 191,225 7.25% ALPRAZOLAM 177,795 6.74% LORAZEPAM 175,849 6.66% OXYCODONE HCL/ACETAMINOPHEN 157,352 5.96% ZOLPIDEM TARTRATE 152,151 5.77% CLONAZEPAM 144,598 5.48% METHYLPHENIDATE HCL 102,877 3.90% MORPHINE SULFATE 77,192 2.93% DIAZEPAM 70,886 2.69% LISDEXAMFETAMINE DIMESYLATE 59,121 2.24% ACETAMINOPHEN WITH CODEINE 57,978 2.20% GUAIFENESIN/CODEINE PHOSPHATE 54,762 2.08% 24

Regional Statistics

Top 10 MPD Per Region Northern Northeastern Southeastern Southern Western HYDROCODONE/ACETA MINOPHEN HYDROCODONE/ACETA MINOPHEN HYDROCODONE/ACETA MINOPHEN HYDROCODONE/ACETA MINOPHEN HYDROCODONE/ACETA MINOPHEN TRAMADOL HCL DEXTROAMPHETAMINE/ AMPHETAMINE OXYCODONE HCL OXYCODONE HCL TRAMADOL HCL DEXTROAMPHETAMINE/ AMPHETAMINE ALPRAZOLAM OXYCODONE HCL/ACETAMINOPHEN LORAZEPAM ALPRAZOLAM LORAZEPAM LORAZEPAM ALPRAZOLAM DEXTROAMPHETAMINE/ AMPHETAMINE DEXTROAMPHETAMINE/ AMPHETAMINE ALPRAZOLAM TRAMADOL HCL ZOLPIDEM TARTRATE CLONAZEPAM LORAZEPAM ZOLPIDEM TARTRATE CLONAZEPAM TRAMADOL HCL ALPRAZOLAM ZOLPIDEM TARTRATE OXYCODONE HCL ZOLPIDEM TARTRATE DEXTROAMPHETAMINE/ AMPHETAMINE TRAMADOL HCL CLONAZEPAM CLONAZEPAM OXYCODONE HCL/ACETAMINOPHEN LORAZEPAM OXYCODONE HCL/ACETAMINOPHEN OXYCODONE HCL OXYCODONE HCL/ACETAMINOPHEN OXYCODONE HCL CLONAZEPAM ZOLPIDEM TARTRATE OXYCODONE HCL/ACETAMINOPHEN METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL

Location of Registered Users n= 9,789

Healthcare User Registration DEL, 20% POD, 0% MD/DO, 31% DN, 2% PA, 7% APNP, 9% RPh, 31%

Healthcare Queries Average Number of Healthcare Patient Queries Per Day 4000 3500 3000 2500 2000 1500 1000 500 0

Healthcare Queries 120000 Recipient Queries Performed by User Group 100000 80000 60000 40000 20000 0 Pharmacist Prescriber Prescriber/Pharmacist Delegate

Healthcare Queries Recipient Queries Performed by User Group Delegate 12% Prescriber 25% Pharmacist 59%

Healthcare Queries December 2014 Recipient Queries March 2015 Recipient Queries Delegate, 17274, 19% Delegate, 21794, 22% Prescriber, 20340, 23% Pharmacist, 51201, 58% Prescriber, 25264, 25% Pharmacist, 53515, 53%

PDMP Data Statistics 350 Number of patients obtaining Rx orders from 4 or more prescribers and monitored drugs from 4 or more dispensers per calendar month 300 250 200 150 R² = 0.5306 100 50 0

2013 Month PDMP Data Statistics Number of patients obtaining Rx orders from 4 or more prescribers and monitored drugs from 4 or more dispensers per calendar month Number of Number of 2013 to 2014 Monthly Recipients 2014 Month Recipients Change 2013 to 2014 Monthly Percent Change 26% Average Jan.13 282 Jan.14 224-58 -21% Feb.13 217 Feb.14 150-67 -31% Decrease Mar.13 285 Mar.14 181-104 -36% Apr.13 264 Apr.14 206-58 -22% May.13 287 May.14 205-82 -29% when comparing the month in Jun.13 218 Jun.14 172-46 -21% 2013 to the same month in 2104 Jul.13 309 Jul.14 217-92 -30% Aug.13 265 Aug.14 201-64 -24% Sep.13 221 Sep.14 169-52 -24%

3. WI PDMP Operations and Demonstration

PDMP Data Submissions Dispensers must collect and electronically submit specific data to the PDMP about each dispensing of a monitored prescription drug to a patient within 7 days of the dispensing. 36

Dispensers Dispensers of monitored prescription drugs, defined as: 1. pharmacies 2. practitioners who dispense monitored prescription drugs *A dispenser is not required to compile or submit data when the monitored prescription drug is administered directly to a patient 37

Monitored Prescription Drugs Monitored Prescription Drugs* are: State Controlled Substances in Schedules II, III, IV or V that require a prescription order Federally Controlled Substances in Schedules II, III, IV or V that require a prescription order Tramadol * Drugs that the Pharmacy Examining Board identifies as having a substantial potential for abuse may be added through rule-making 38

Data Elements Prescriber Dispenser Drug Patient Name Name NDC Number Last Name DEA Number DEA Number Name, Strength, Form NPI Number NPI Number Quantity Dispensed First Name Address State License Number State License Number Estimated Days Supply Date of Birth Location Location Rx Number Gender Key: Bold: Submitted by most dispensers Green: Obtained using submitted data Red: Beginning April 2016 or after Refills Authorized Dates Prescribed and Dispensed Payment Method ID of Person Picking up Rx 39

Confidentiality of Data All PDMP data is protected by federal HIPAA laws and Wisconsin health record confidentiality laws In general, other than patients and their representatives, only people who have created user accounts with the Board may obtain data from the PDMP 40

Current Limitations of Data Data may be up to 7+ days old Data may be incomplete or contain errors The PDMP does not contain data about: Drugs directly administered to patients Drugs dispensed by veterinarians, opioid treatment programs, or the military Schedule V non-narcotic drugs dispensed in less than 7- day supplies 41

Accessing/Obtaining Data Only Dispensers, Prescribers, and their Delegates can directly access the data Other users can obtain data upon request to the Pharmacy Examining Board Other users include: Patients and their Representatives Law Enforcement Authorities Governmental Agencies County Coroners and Medical Examiners Researchers (de-identified data only) 42

Database Access http://dsps.wi.gov/pdmp 43

Database Access 44

PDMP Queries 45

Creating Queries 46

Recipient Query 47

Recipient Query 48

Recipient Report 49

Map Results 50

Recipient Report 51

Recipient Query Alert 52

Recipient Query Alert 53

Other Alerts 54

New Alert Notification 55

Multiple State Query 56

Integration of PDMP Data PMPi October 2013 Connection 57

Current Interstate Data Exchange KEY Green: Active Yellow: Pending 58

Multiple State Query 59

4. WI PDMP Enhancements

Ongoing Enhancements 2014 Enhancements to the PDMP: 1) Integrate PDMP data into the Wisconsin Statewide Health Information Network (WISHIN) and EHR and pharmacy software systems. 2) Provide Unsolicited reports to prescribers and pharmacists. 3) Develop the Public Health Portal 61

Integration of PDMP Data September 2014 Connections PMPi PMP Gateway October 2013 Connection 62

Ongoing Enhancements 2014 Enhancements to the PDMP: 1) Integrate PDMP data into the Wisconsin Statewide Health Information Network (WISHIN) and EHR and pharmacy software systems. 2) Provide Unsolicited reports to prescribers and pharmacists. 3) Develop the Public Health Portal 63

Unsolicited Reports

Ongoing Enhancements 2014 Enhancements to the PDMP: 1) Integrate PDMP data into the Wisconsin Statewide Health Information Network (WISHIN) and EHR and pharmacy software systems. 2) Provide Unsolicited reports to prescribers and pharmacists. 3) Develop the Public Health Portal 65

Public Health Portal Purpose: To give public health officials and other researchers access to de-identified data collected as part of the Prescription Drug Monitoring Program (PDMP). Overview: The PDMP Public Health Portal will be a secure webbased database that authenticated users can query for specific de-identified information about the PDMP. The information will be loaded into the database periodically and will not contain any patient-specific or other personally identifiable information. Example: http://dsps.wi.gov/pdmp/s

(Potentially) Forthcoming Changes

SB 21- Executive Budget Bill Transfers oversight of the PDMP to the Wisconsin Controlled Substances Board (CSB) Changes the membership of the CSB to include representatives from prescriber boards Gives the CSB new powers: Disclose PDMP information to boards and agencies, including law enforcement, under circumstances of suspicious or critically dangerous conduct Refer non-compliant pharmacies and practitioners to disciplinary boards or law enforcement for investigation and possible prosecution 68

Possible Legislation 69

Law Enforcement Queries 70

Public Safety Use Number of Agencies with Accounts: Federal Law Enforcement/Government: 3 State Law Enforcement/Government: 3 County Law Enforcement/DA: 24 County Coroner/Medical Examiner: 10 Municipal Law Enforcement: 30 Requests for PDMP Data Per Month 71

PDMP Contact Information Technical Help Desk: Phone: 1-855-729-8918 E-Mail: wipdmp-info@hidinc.com Administrative Assistance: E-Mail: PDMP@wisconsin.gov Chad Zadrazil: (608) 266-0011 chad.zadrazil@wisconsin.gov Andrea Magermans: (608) 261-6546 andrea.magermans@wisconsin.gov 72