PDMP Workshop: New PDMP Developments National Rx Drug Abuse Summit April 2-4, 2013 Presentation by LCDR Chris Jones,

1. New
PDMP
Developments
LCDR
Chris
Jones,
PharmD,
MPH
Prescrip3on
Drug
Overdose
Team,
Division
of
Uninten3onal
Injury
Preven3on,
Centers
for
Disease
Control
and
Preven3on
Josh
Bolin
Government
Affairs
Director,
Na3onal
Associa3on
of
Boards
of
Pharmacy
Marty
Allain
Director,
INSPECT

2. Learning
Objec3ves
1. Explain
a
Prescrip3on
Drug
Monitoring
Program
(PDMP)
2. Inves3gate
the
efficiency
and
effec3veness
of
state-­‐level
programs
to
make
improvements.
3. Outline
strategies
to
enhance
collabora3ons
with
law
enforcement,
prosecutors,
treatment
professionals,
the
medical
community,
pharmacies,
and
regulatory
boards
to
establish
a
comprehensive
PDMP
strategy.

3. Prescrip;on
Drug
Monitoring
Programs
The
Na;onal
Perspec;ve
Christopher
M.
Jones,
PharmD,
MPH
LCDR,
US
Public
Health
Service
Centers
for
Disease
Control
and
Preven3on
April
2
–
4,
2013
Omni
Orlando
Resort
at
ChampionsGate

4. Learning
Objec;ves
• Describe
the
current
PDMP
landscape
in
the
US
• Discuss
the
role
of
PDMPs
in
reducing
prescrip3on
drug
abuse
and
overdose
• Describe
the
evidence-­‐base
suppor3ng
PDMPs
• Describe
PDMP
best
prac3ces
• Discuss
new
opportuni3es
for
PDMPs

5. Presenta;on
overview
• PDMP
background
and
role
• PDMP
best
prac;ces
Overview
of
Presenta;on
• PDMP
effec;veness
• Current
ini;a;ves
5

6. Prescrip;on
Drug
Abuse
Preven;on
Plan
• Blueprint
for
Federal
Agency
efforts
on
prescrip3on
drug
abuse
• 4
focus
areas
– Educa3on
– Prescrip3on
Drug
Monitoring
Programs
– Proper
Medica3on
Disposal
– Enforcement

7. What
are
PDMPs?
• State
databases
that
collect
informa3on
on
controlled
prescrip3ons
drugs
dispensed
by
pharmacies
(and
dispensing
physicians
in
some
states)
• Data
Collected
– CII-­‐CIV
drugs
(some
CV)
– Prescriber
– Dispenser
– Pa3ent
– Date
dispensed
– Drug
– Strength
– Quan3ty
– Refills
– Method
of
payment
• Varia3on
in
state
programs

8. How
can
PDMPs
be
Used?
• Clinical
• Regulatory
Oversight
• Surveillance
and
Evalua;on
Tool
• Law
Enforcement
• Passive
vs
Proac;ve
8

9. Current
Status
of
PDMPs
 49
States
have
legisla;on
authorizing
a
PDMP
 Opera;onal
in
43
states
9

10. Presenta;on
Overview
• PDMP
background
and
role
• PDMP
goals
and
best
prac;ces
Overview
of
Presenta;on
• PDMP
effec;veness
• Current
ini;a;ves
10

11. PDMP
Goals
• All
states
have
PDMPs
• Mechanisms
in
place
for
communica3on
between
states
(interoperability)
• Incorporated
in
to
normal
workflow
by
leveraging
HIT
(EHRs/HIEs)
• High
u3liza3on
among
healthcare
providers
• Improved
clinical
care
and
reduced
misuse,
abuse,
and
overdose
from
controlled
substances

12. PDMP
Best
Prac;ces
• Outlines
a
set
of
best
prac;ces
• Research
agenda
• PDMP
Funding
• A
few
best
prac;ces
• Allow
access
to
prescribers
and
dispensers
• Allow
access
to
regulatory
boards,
state
Medicaid
and
public
health
agencies,
Medical
Examiners,
and
law
enforcement
(under
appropriate
circumstances)
• Provide
real-­‐3me
data
• Share
data
with
other
states
(interoperability)
• Integrate
with
other
health
informa3on
technologies
to
improve
use
among
health
care
providers
• Have
ability
to
send
unsolicited
reports
• Use
PDMP
data
to
iden3fy
high-­‐risk
pa3ents
• Use
PDMP
data
to
iden3fy
outlier
prescribers
12

13. Presenta;on
Overview
• PDMP
background
and
role
• PDMP
goals
and
best
prac;ces
Overview
of
Presenta;on
• PDMP
effec;veness
• Current
ini;a;ves
13

14. PDMP
Effec;veness
peer-­‐reviewed
literature
• Research
consistently
suggests
PDMPs
reduce
prescribing
of
schedule
II
opioid
analgesics.
• One
study
found
compensatory
increases
in
schedule
III
opioids.
• 2009
study
found
states
with
PDMPs
had
lower
opioid
substance
abuse
treatment
rates
compared
to
states
without
PDMPs.
• A
recent
randomized
trial
of
use
of
proac;ve
repor;ng
by
an
insurer
rather
than
a
PMDP
suggests
such
repor;ng
reduces
the
number
of
prescribers
and
prescrip;ons.
1.
Simeone
R,
Holland
L.
Washington,
D.C.:
U.S.
Dept.
of
Jus3ce,
Office
of
Jus3ce
Programs2006
2006.
hgp://www.simeoneassociates.com/simeone3.pdf
2.
Cur3s
LH,
Stoddard
J,
Radeva
JI,
Hutchison
S,
Dans
PE,
Wright
A,
et
al.
Geographic
varia3on
in
the
prescrip3on
of
schedule
II
opioid
analgesics
among
outpa3ents
in
the
United
States.
Health
Serv
Res.
2006
2006;41:837-­‐55.
3.
Paulozzi
L,
Kilbourne
E,
Desai
H.
Prescrip3on
drug
monitoring
programs
and
death
rates
from
drug
overdose.
Pain
Medicine.
2011;12:747-­‐54.
4.
Reisman
RM,
Shenoy
PJ,
Atherly
AJ,
Flowers
CR.
Prescrip3on
opioid
usage
and
abuse
rela3onships:
an
evalua3on
of
state
prescrip3on
drug
monitoring
program
efficacy.
Substance
Abuse:
Research
and
Treatment.
2009;3(SART-­‐3-­‐Shenoy-­‐et-­‐al):41.
5.
Gonzalez
A,
Kolbasovsky
A.
Impact
of
a
managed
controlled-­‐opioid
prescrip3on
monitoring
program
on
care
coordina3on.
Am
J
Manag
Care.
2012;18(9):516-­‐24.
14

15. PDMP
Effec;veness
peer-­‐reviewed
literature
• 2012
analysis
of
Poison
Control
Center
data
concluded
states
with
PDMPs
had
lower
annual
increases
in
opioid
misuse
or
abuse
from
2003-­‐2009
• Use
of
PDMP
data
in
an
ED
suggests
it
can
change
prescribing.
PDMP
data
review
changed
prescribing
in
41%
of
cases
• 61%
received
fewer
or
no
opioids
• 39%
received
more
opioid
medica3on
than
previously
planned
• Impact
on
overdose
mortality
has
not
been
found,
at
least
based
on
data
through
2005.
1.
Reifler
L,
Droz
D,
Bailey
J,
Schnoll
S,
Fant
R,
Dart
R,
et
al.
Do
prescrip3on
monitoring
programs
impact
state
trends
in
opioid
abuse/misuse?
Pain
Medicine.
2012;3(3):434-­‐42.
2.
Baehren
DF,
Marco
CA,
Droz
DE,
Sinha
S,
Callan
EM,
Akpunonu
P.
A
statewide
prescrip3on
monitoring
program
affects
emergency
department
prescribing
behaviors.
Ann
Emerg
Med.
2009
2009;doi:10.1016/j.annemergmed.2009.12.011.
3.
Paulozzi
L,
Kilbourne
E,
Desai
H.
Prescrip3on
drug
monitoring
programs
and
death
rates
from
drug
overdose.
Pain
Medicine.
2011;12:747-­‐754.
15

16. PDMP
Effec;veness
grey
literature
• Surveys
indicate
prescribers
find
PDMPs
to
be
a
useful
clinical
tool.
• Surveys
find
clinicians
in
many
cases
report
altering
their
prescribing
a]er
reviewing
a
PDMP
report.
• Proac;ve
repor;ng
reduces
doctor
shopping
by
increasing
awareness
among
providers
about
at-­‐risk
pa;ents
leading
to
changes
in
prescribing
behaviors.
1.
PMP
Center
of
Excellence,
“ Trends
in
Wyoming
PMP
prescrip3on
history
repor3ng:
evidence
for
a
decrease
in
doctor
shopping?”
2010,
hgp://www.pmpexcellence.org/sites/all/pdfs/NFF_wyoming_rev_11_16_10.pdf
2.
PMP
Center
of
Excellence,
“Nevada’s
Proac3ve
PMP:
The
Impact
of
Unsolicited
Reports”
October,
2011.
hgp://www.pmpexcellence.org/sites/all/pdfs/nevada_nff_10_26_11.pdf
4.
Alliance
of
States
with
Prescrip3on
Monitoring
Programs,
“An
Assessment
of
State
Prescrip3on
Monitoring
Program
Effec3veness
and
Results”
Version
1,
11.30.07,
hgp://
pmpexcellence.org/pdfs/alliance_pmp_rpt2_1107.pdf
5.
Kentucky
Cabinet
for
Health
and
Family
Services
and
Kentucky
Injury
Preven3on
and
Research
Center,
2010
KASPER
Sa3sfac3on
Survey.
6.
Lambert
D.
Impact
evalua3on
of
Maine’s
prescrip3on
drug
monitoring
program.
Muskie
School
of
Public
Service,
University
of
Southern
Maine:
Portland,
Maine,
March,
2007.
7.
Communica3on
from
LA
PMP
to
PMP
Center
of
Excellence.
16

17. PDMP
Effec;veness
grey
literature
• Public
safety
officials
have
endorsed
the
u3lity
of
PDMPs.
• A
2010
survey
found
73%
of
KY
law
enforcement
officers
who
used
PDMP
data
strongly
agreed
that
the
PDMP
was
an
excellent
tool
for
obtaining
evidence
in
the
inves3ga3ve
process.
• 2002
GAO
report
concluded
that
PDMPs
are
a
useful
tool
to
reduce
drug
diversion.
1.
PMP
Center
of
Excellence.
Perspec3ve
from
Kentucky:
using
PMP
data
in
drug
diversion
inves3ga3ons.
May,
2011.
hgp://www.pmpexcellence.org/sites/all/pdfs/
NFF_kentucky_5_17_11_c.pdf
2.
U.S.
General
Accoun3ng
Office.
Prescrip3on
Drugs:
State
Monitoring
Programs
Provide
Useful
Tool
to
Reduce
Diversion.
Washington,
DC:
U.S.
General
Accoun3ng
Office;
2002.
Report
No.
GAO-­‐02-­‐634
17

18. Presenta;on
Overview
• PDMP
background
and
role
• PDMP
goals
and
best
prac;ces
• PDMP
effec;veness
• Current
ini;a;ves
18

19. Current
PDMP
Ini;a;ves
• Interoperability
• Health
Informa;on
Technology
and
PDMP
Pilot
programs
• PDMP
Interoperability
and
Electronic
Health
Record
Integra;on
Project
• Interagency
Working
Group
subcommi^ee
on
PDMP
integra;on
• Providing
technical
assistance
to
states
and
others
to:
• Focus
efforts
on
pa3ents
at
highest
risk
of
abuse
and
overdose
• Focus
on
prescribers
devia3ng
from
accepted
medical
prac3ce
• Maximize
surveillance
and
evalua3on
capabili3es
of
PDMPs
• PDMP
evalua;ons
19

20. Conclusions
• PDMPs
can
be
very
useful
for
clinical,
surveillance,
evalua;on,
and
regulatory
purposes
• Best
prac;ces
need
to
be
implemented
to
maximize
u;lity
of
PDMPs
• Incorpora;on
into
clinical
workflow
can
increase
u;liza;on
among
health
care
providers
• Public
health
and
public
safety
must
partner
to
make
the
most
use
of
PDMP
data
20

21. Thank
You
Christopher M. Jones, PharmD, MPH
cjones@cdc.gov
The findings and conclusions in this report are those of the author and do not necessarily
represent the views of the Centers for Disease Control and Prevention.

22. Josh Bolin
Government Affairs Director

23. PMIX
Architecture
• Harold
Rogers
Prescrip3on
Drug
Monitoring
Program
Grants
• Sponsored
by
the
Bureau
of
Jus3ce
Assistance
• Prescrip3on
Monitoring
Program
Informa3on
Exchange
(PMIX)
Architecture
is
an
interoperability
infrastructure
that
seeks
to
facilitate
interstate
data
sharing
between
PMPs
or
“Hubs”

24. Problems
with
PMPs:
• Persons
engaging
in
doctor
shopping
don’t
stay
in
one
state,
par3cularly
areas
that
border
other
states
• Querying
the
state
PMP
may
not
give
a
complete
picture
to
a
physician
or
pharmacist
of
the
controlled
substances
a
person
is
obtaining
• Low
U3liza3on/Lack
of
Integra3on
• PMPs
lack
func3on
and
Analy3cal
Tools

25. • Creates
interoperability
for
individual
state
PMPs
via
a
hub
system
• Authorized
users
log
into
their
own
state
PMP
and
check
boxes
for
other
par3cipa3ng
states
from
which
they
want
data
• The
hub
routes
the
requests
to
the
various
states
and
the
informa3on
back
to
the
authorized
user
in
one
collated
report

30. • All
protected
health
informa3on
is
encrypted
and
not
visible
to
the
hub,
secure,
and
HIPAA
compliant
– No
protected
health
informa3on
stored
by
the
hub,
just
a
pass
through
from
one
state
to
the
authorized
requestor
in
another
state
• Easy
for
states
– Only
sign
one
memorandum
of
understanding
(MOU)/contract
with
NABP
–
do
not
have
to
sign
one
for
every
other
state
to
exchange
data
– Each
state’s
rules
about
access
are
enforced
automa3cally
by
the
hub
• Governed
by
states
via
PMP
InterConnect
Steering
Commigee
• July
2011
went
live
and
today…since
launch,
PMP
InterConnectTM
has
processed
nearly
1.5
million
requests
in
an
average
of
7.8
seconds
to
process
a
request.

31. Cost
for
States
to
Par3cipate
• $0
par3cipa3on
costs,
although
may
incur
some
costs
by
their
own
PMP
sovware
companies
• NABP
paying
from
its
own
revenues
(exams/
accredita3ons)
• Harold
Rogers
Prescrip3on
Monitoring
Program
Grants
• NABP
Founda3on
Grants

32. • 14
PMPs-­‐-­‐Arizona,
Connec3cut,
Illinois,
Indiana,
Kansas,
Michigan,
New
Mexico,
North
Dakota,
Ohio,
South
Carolina,
South
Dakota,
and
Virginia
are
ac3vely
sharing
data
• Colorado,
Delaware,
Louisiana,
Tennessee
and
West
Virginia
should
all
be
connected
and
sharing
data
by
the
end
of
Q2
• Arkansas,
Idaho,
Minnesota,
Mississippi,
Nevada
and
Utah
have
executed
agreements
to
par3cipate

34. Integra3on
Projects
• Leveraging
our
growing
“na3onal
network”
• Guidance
from
PMP
InterConnect
Steering
Commigee
• ONC
Pilots
• 3rd
Party
Inquiries
– Networks
– Electronic
Medical
Records
– Pharmacy
– Health
Informa3on
Exchanges

35. MAPS/Electronic
Prescribing
Sovware

36. MAPS/Electronic
Prescribing
Sovware

37. PDMP
Workshop:
Data
Integra;on
April
2
–
4,
2013
Omni
Orlando
Resort
at
ChampionsGate

38. Topics
for
Discussion
• Status
of
Indiana
PDMP
pre-­‐data
integra3on
and
mo3va3on
to
increase
use;
• Challenges
to
using
program
via
Web;
• Integra3on
efforts
and
INPC
partner;
• Pilot
I
results;
• Integra3on
efforts
+
NarxCheck;
and
• Pilot
II
results.

39. LICENSE
TYPE
UNREGISTERED
REGISTERED
TOTAL
%
REGISTERED
CLINICAL
NURSE
SPECIALIST
61
73
134
54%
CSR-­‐CERTIFIED
NURSE
MIDWIFE
42
16
58
28%
CSR-­‐OSTEOPATHIC
PHYSICIAN
680
524
1204
44%
CSR-­‐PHYSICIAN
10885
5256
16141
33%
DENTIST
2030
1149
3179
36%
NURSE
PRACTITIONER
1599
1382
2981
46%
PHARMACIST
7002
2903
9905
29%
PHYSICIAN
ASSISTANT
362
250
612
41%
PODIATRIST
229
101
330
31%
RESIDENT
1204
95
1299
7%
VETERINARIAN
1360
34
1394
2%
TOTALS
25454
11783
37237
32%

40. Username:
Mallain
Password:
27%9874M

45. Workflow
Ready

47. Pilot
I
Survey
Results
• There
was
a
58%
reduc;on
in
either
prescrip3ons
wrigen
or
number
of
pills
prescribed.
• In
72%
of
cases
there
was
more
informa;on
in
the
report
than
the
physician
was
aware
of.
• 100%
reported
that
integrated
report
was
easier
to
use.
• 2
out
of
3
accessing
report
in
INPC
not
registered
w/
INSPECT
• Worst
offenders
are
less
ac3ve
• Requests
increased
from
5,000
to
9,000
daily
• “I
have
to
say
that
this
is
probably
one
of
the
more
genius
moves
of
the
21st
century.
Having
easy
access
to
INSPECT
without
going
to
a
totally
different
website
and
have
it
pop
up
instantly
has
taken
a
lot
of
Eme
off
of
decision
making
for
me.
Thanks
for
spearheading
it.”
Wishard
ER
Physician

48. #
Pts.
w/
8+
Rxs.
in
60
days
WEEK END
START
8+
8+
9+ 10+
START 9+ END
8+
10+9+ 10+
DATE DATE DATE DATE
1 -23 -20 -12
1
2 1/8/2012
11/9/2011
-13
146 66 33
-24 -32
2 3
11/16/2011 1/15/2012 134 -19
67 37 2 -27
11/14/2012 1/13/2013 116-42
51 25
3 4
11/23/2011 1/22/2012 135 -21
71 38 3 -49
11/21/2012 1/20/2013 109-26
52 22
4 5
11/30/2011 1/29/2012 136 -14
59 39 4 -25
11/28/2012 1/27/2013 107-37
30 29
5 6 2/5/2012
12/7/2011 125 -21
63 41 5 -36
12/5/2012 2/3/2013 107-46
47 26
6 7
12/14/2011 2/12/2012 133 -22
61 35 6 -46
12/12/2012 2/10/2013 105-62
39 19
7
8
12/21/2011 2/19/2012
-29
130 71 37 7
-33
12/19/2012 2/17/2013
-59
101 38 14
8 12/28/2011 2/26/2012 143 64 32 8 12/26/2012 2/24/2013 102 43 13

50. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male

51. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male

52. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male

53. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male

54. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male

55. Pilot
II
Preliminary
Findings