American Indian Health Commission for Washington State October 1, 2015

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1 American Indian Health Commission for Washington State October 1, 2015

2 States with more opioid pain reliever sales tend to have more drug overdose deaths Death rate, 2011, National Vital Statistics System. Opioid pain reliever sales rate, 2013, DEA s Automation of Reports and Consolidated Orders System

3 Nation Wide: Drug overdoses have surpassed motor vehicle crashes as the leading cause of injury death

4 Sources:, Death Certificates and Hospital Discharge Data

5 Dramatic increase in overdose deaths related to opioid pain relievers CDC, National Center for Health Statistics, National Vital Statistics System

6 Balloon Effect: squeeze a balloon in one place, it inflates elsewhere Accelerated increase in the number of deaths attributed to heroin overdose annually since 2008.

7 Key Surveillance Needs Respond to emerging issues

8 2011 Opioid deaths = X12= 4, X25= 10, X105= 42, X659= 263,600 Total 320,400

9

10 Prescriptions Dispensed Rank by most recent year Generic Name 2014 RX 2013 RX 2012 RX HYDROCODONE/ ACETAMINOPHEN 2,775,054 2,814,288 3,007,054 OXYCODONE HCL 1,043, , ,899 OXYCODONE HCL/ACETAMINOPHEN 847, , ,408 ZOLPIDEM TARTRATE 791, , ,823 ALPRAZOLAM 645, , ,064 LORAZEPAM 644, , ,306 DEXTROAMPHETAMINE/ AMPHETAMINE 580, , ,749 CLONAZEPAM 528, , ,671 METHYLPHENIDATE HCL 423, , ,848 MORPHINE SULFATE 336, , ,717 TRAMADOL HCL 308,524

11 WA Prescription Monitoring Program

12 History Legislation was passed in 2007 (RCW ) Federal funding was obtained in October 2010 to start implementing the program Rules were adopted in July 2011 (WAC ) DOH contracted with an application service provider for data collection and reporting in July 2011 An additional federal award was obtained in October 2011 to finalize implementation HB 1565 (2013) provided ongoing funding through the Medicaid Fraud Penalty Account. The signed operating budget included funding for the PMP from this account and from HCA.

13 System Overview - Weekly Submission Dispensers - Schedules II-V - ASAP 4.2 * Veterinarians have separate requirements Reports Data Submitted Pharmacists Sent State PMP Prescribers Reports Reports Sent Sent Law Enforcement & Licensing *Other groups may also receive reports other than those listed

14 DOH Goals for Washington s PMP Help Prevent Prescription Drug Overdoses! Give practitioners an additional tool that provides more information for making patient care decisions. Data can help healthcare providers recognize patterns of misuse and addiction ensuring SBIRT opportunities are not missed. Make sure those in need of scheduled prescription drugs receive them. Educate the population on the dangers of misusing prescription drugs. Curb the illicit use of prescription drugs.

15 Master Account Registrations Pharmacist 4,679 Nurse Practitioner 1,973 Medical Doctor 6,208 Dentist 1,377 Medical Limited 380 Dental Community Resident 0 Physician Fellowship 4 Dental UW Resident 6 Teaching/Research 3 Dental Faculty 1 Osteopathic Physician 628 Podiatric Physician 96 Osteopathic Limited 59 Naturopathic Physician 65 Physician Assistant 1,272 Optometrist 45 Osteopathic Phys. Assist. 23 Veterinarian 63 06/30/15 12,203 total prescribers registered (31.09% of DEA Registrants) 741 Provider Master Accounts Linked to at least 1 Delegate Account

16 WA DEA Registrants w/ and w/out PMP Accounts DEA Registrants by Level , , , DEA w/ No PMP Registered DEA & PMP 25,000 20,000 Mid Full , , , Less than half, only 31%, of WA prescribers are registered to access the PMP 69% of WA prescribers CANNOT verify their patient s CS history on PMP

17 Delegate Account Registrations Chemical Dependency Prof. 14 Med. Assistant Certified 702 Med Assist. Hemodialysis 0 Med Assist. Registered 51 Med Assist. Phlebotomist 11 Med Assist. Interim 32 Licensed Practical Nurse 141 Registered Nurse 763 Nursing Assistant Reg. 18 Nursing Assistant Cert. 13 Dental Assistant 8 06/30/15 1,824 total delegate accounts registered Dental Hygienists 4 Expanded Func. Dental Aux. 2 Mental Health Counselor 8 Marriage & Family Therapist 2 Psychologist License 24 Social Worker Advanced 12 Social Worker Associate 8 Counselor Agency Affiliated 5 X-Ray Technician 3 Athletic Trainer 3 Delegates are able to access the system and check patient records on behalf of the prescriber

18 Clinical Steps for Ensuring Safe Rx Use KNOW the patient s Rx history VERIFY the patient is receiving appropriate care PREVENT harmful drug interactions EVALUATE patients for risk of misuse/abuse of drugs PROTECT your practice by providing the best care EDUCATE patients on how to safely use their medications

19 2015 AMDG Guideline on Prescribing Opioids for Pain Updated guide from Washington State Agency Medical Director s Group Guide covers Prescribing Opioids: In the Acute and SubAcute Phases For Perioperative Pain For Chronic Non-Cancer Pain and many other related topics

20 Key PMP Benefits for Providers CHECK for misuse, multiple prescribers (coordinate care) CHECK for drug interactions or other harm USE reports for compliance with treatment contracts CHECK history of transactions linked to DEA number fraudulent scripts and monthly reporting

21 Key PMP Practices to Consider DELEGATE prescription look-up to other staff to save time TRAIN your staff by using a PMP champion REGISTER accounts for all appropriate staff with the PMP RETAIN documentation by placing a copy in the patient file or into an EHR system

22 Top 5 Times to Check the PMP 1. New patients 2. When prescribing a controlled substance 3. Patient is in substance abuse treatment 4. Chronic pain patients ensure treatment contract compliance 5. For evaluating episodic care

23 Post PMP Review Action Steps For at risk patients: TALK with the patient to determine reasons for at risk behaviors SBIRT opportunity? COORDINATE care with the other providers listed on the report CONSIDER using a patient treatment agreement VERIFY the prescriptions listed match your records REFER your patient to treatment or other specialty care EDUCATE patients on the risks of opioid overdose

24 Customer Satisfaction Survey Comments This has changed my practice as an ER Physician. No single thing in the last 10 years has had such a positive impact on my practice and my patients as this program, so thank you! I really am grateful to have the PMP active. It is absolutely essential for any Pain Management practice and essential for any physician prescribing controlled substances. I believe that this program has literally saved the lives of several of my patients. I have been floored by the number of narcotics dozens of teenaged girls have been obtaining (1500 to 2000 pills in 6 months). I have been able to have meaningful interventions with them and their families.

25 WA Prescription Monitoring Program

26 WAC Law enforcement, prosecutorial officials, coroners, and medical examiners' access to information from the program. Local, state, or federal law enforcement officers and prosecutorial officials may obtain prescription monitoring information for a bona fide specific investigation involving a designated person. A local, state, or federal coroner or medical examiner may obtain prescription monitoring information for a bona fide specific investigation to determine cause of death.

27 HB 1637 Authorizes law enforcement and prosecutorial officials of federally recognized Indian tribes access to prescription monitoring data. Adds tribal LE and Prosecutorial officials to the list of who can access the PMP for bona fide specific investigations. DOH/PMP prepared to move forward Access concurrent with rule making has been approved by AOG PMP vendor is looking for time available to do the work to create the appropriate access.

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35 Program Staff: Chris Baumgartner, Program Director Gary Garrety, Operations Manager Contact Info: PROGRAM CONTACTS Phone: Website:

2015 REPORT Steven W. Schierholt, Esq. Executive Director www.pharmacy.ohio.gov

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