North Dakota Board of Pharmacy Updates on Drug Abuse Trends, the PDMP and Medical Marijuana Mark J. Hardy, Pharm D Executive Director
Disclosure Statement I have no conflict of interests to report
Objectives 1. Discuss trends and statistics on Drug Abuse across the state and nation. 2. Examine the opportunities for the PDMP as a tool to provide better patient care in pharmacies. 3. Describe the current status of the implementation of Medical Marijuana in North Dakota.
Questions Appropriate prescriptions need to be reported to the PDMP: Hourly Daily Weekly Monthly Pharmacy Technicians are allowed to have access to the PDMP on their own behalf? True False Which of the following Non controlled substance needs to be reported to the PDMP? HCTZ Strattera Gabapentin Lyrica Patients obtaining medical marijuana from a ND Compassionate care center need to get a prescription from their Dentist? True False
Drug Abuse Where are we?
Number of controlled substance prescriptions dispensed/year in ND or to ND residents 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 *Jul 31
Naloxone prescribing by Pharmacist History Process for pharmacist to complete to prescribe independently Naloxone Ability to prescribe to patients or caregiver Ability to provide to groups with a need to have naloxone GOAL: Have access to Naloxone to save lives www.nodakpharmacy.com/naloxone
Required Use of the Prescription Drug Monitoring Program 1. Prior to dispensing a prescription each dispenser licensed by a regulatory agency in the state of North Dakota who dispenses a controlled substance to a patient, for the treatment of pain or anxiety shall, at a minimum, request and review a Prescription Drug Monitoring Report covering at least a one year time period and/or another state s report, where applicable and available, if the dispenser becomes aware of a person currently: a. Receiving reported drugs from multiple prescribers; b. Receiving reported drugs for more than twelve consecutive weeks; c. Abusing or misusing reported drugs (i.e. over-utilization, early refills, appears overly sedated or intoxicated upon presenting a prescription for a reported drug, or an unfamiliar patient requesting a reported drug by specific name, street name, color, or identifying marks); d. Requesting the dispensing of a reported drug from a prescription issued by a prescriber with whom the dispenser is unfamiliar (i.e. the prescriber is located out-of-state or the prescriber is outside the usual pharmacy geographic prescriber care area); or, e. Presenting a prescription for reported drugs when the patient resides outside the usual pharmacy geographic patient population. 2. After obtaining an initial Prescription Drug Monitoring Report on a patient, a dispenser shall use professional judgment based on prevailing standards of practice in deciding the frequency of requesting and reviewing further Prescription Drug Monitoring Reports and/or other state reports for that patient. We encourage the use of Pharmacy Technician as delegates to the pharmacist in running patient searches in the PDMP.
Program Facts How does information flow into the PDMP? 8/21/2017 9
PDMP Program Facts Reported Drugs included: All controlled substances, schedules II-V, Addition of Gabapentin as a reportable drug August 2017 Patients include: all outpatients, residents in assisted living facilities, & residents of nursing homes. We now get reports for patients of the Indian Health Services and the Veterans Administration. We currently are unable to obtain information from hospital inpatient pharmacies and opioid treatment programs 8/21/2017 10
National Program Development. 8/21/2017 11
Number of Active Accounts Pharmacists and Medical Doctors 1400 1200 1000 800 600 702 1045 1053 951 968 9791003 901 917 858 806 1086 1105 1096 1007 940 902 770 790 821 849 734 1204 1196 1308 1220 400 200 0 R.Ph., PharmD MD, DO, DPM 2014 Q2 2014 Q3 2014 Q4 2015 Q1 2015 Q2 2015 Q3 2015 Q4 2016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2017 Q2
Active Accounts Pharmacy Technicians, Delegates, and APRNs 700 600 500 400 300 200 650 632 610 608 587583 561 561 542 495 498 472 457 441 422 432 381393 360 341 342 316 325 295 305 252 447 411 427 373 345 328 279 294 257 237 211 558559 100 0 APRN Pharamcy Technician Prescriber Delegates 2014 Q2 2014 Q3 2014 Q4 2015 Q1 2015 Q2 2015 Q3 2015 Q4 2016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2017 Q2
Utilization Rate - Dispensers 55.0% Utilization Rate of Dispenser Registrants in ND PMP 50.0% 49.8% 46.6% 49.5% 48.0% 45.0% 40.0% 45.4% 45.3% 42.1% 46.5% 44.7% 43.7% 45.0% 41.0% 44.5% 40.5% 45.8% 44.5% 42.2% 42.0% 42.5% 42.2% 41.8% 41.5% 41.4% 42.7% 37.9% 35.0% 36.5% 30.0% 2014 Q2 2014 Q3 2014 Q4 2015 Q1 2015 Q2 2015 Q3 2015 Q4 2016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2017 Q2 Pharmacists Pharmacy Technicians
Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 0 0 0 0 0 0 3 55 65 2 83 139 70 133 132 74 178 14 26 209 140 388 338 1725 4617 4509 4597 4423 4602 4954 4766 4751 5369 5346 5191 4951 5309 5020 5093 4863 5427 5603 Number of Dispenser Requests Per Month 6000 5000 Pharmacists Pharmacist-In-Charge Pharmacist Delegates Pharmacy Technicians IHS Pharmacist 4000 3000 2000 1000 0
Online Access 8/21/2017 17
Creating efficiencies while using the PDMP The PDMP allows prescribers to authorize and allow delegates to run patient profiles under their authority (nurses, pharmacy technicians) Each delegate has their own login credentials but only can run patient searches after approval through the PDMP by their practitioner The PDMP allows the ability to conduct multiple (bulk) patient searches Many practitioners use when they have their appointment list for the day
Compliance issues with the PDMP Reporting of a pharmacy s dispensing data daily to the PDMP Ensuring compliance with the rules on accessing the PDMP in certain circumstances. How can you as technicians help to take care of the task of running a report in your practice?
Partial Filling of CII prescriptions The Act specifically amends 21 United States Code 829 by adding subsection (f), which allows for the partial filling of a Schedule II prescriptions if the following conditions are met: It is not prohibited by state law; The prescription is written and filled in accordance with federal and state law; The partial fill is requested by the patient or the practitioner who wrote the prescription and; The total quantity dispensed in all partial fillings does not exceed the total quantity prescribed. The Act also provides that the remaining portion of a partially filled Schedule II prescription may be filled not later than 30 days after the date on which the prescription was written. However, if the partial filling of a Schedule II is the result of an emergency situation oral prescription, the pre-existing partial fill time frame of 72 hours after the prescription was issued remains. There is no prohibition on partial fill of Schedule II prescriptions in North Dakota Laws and Rules.
Compassionate Care Act (Medical Marijuana) Ballot initiative passed in 2016, legislature modified in 2017 Currently in process of being implemented by the ND Department of Health to have a workable program. What is the future? How does it involve our profession?
QUESTIONS/CONCERNS/ COMMENTS LETS HEAR FROM YOU!!
Questions Appropriate prescriptions need to be reported to the PDMP: Hourly Daily Weekly Monthly Pharmacy Technicians are allowed to have access to the PDMP on their own behalf? True False Which of the following Non controlled substance needs to be reported to the PDMP? HCTZ Strattera Gabapentin Lyrica Patients obtaining medical marijuana from a ND Compassionate care center need to get a prescription from their Dentist? True False
THANK YOU FOR ALL YOU DO!! Dr. Mark J. Hardy, Pharm D Executive Director ND Board of Pharmacy mhardy@ndboard.pharmacy 701-328-9535 Cell 701-520-0155