Participants will: Report their intent to support and/or actively work towards incorporating best practices in responsible prescribing guidelines into their everyday practice of medicine. Report an increased knowledge of the Michigan Automated Prescription System (MAPS) and the benefits of reporting regularly to MAPS. Report intent to support and/or actively work towards incorporating consistent use of the MAPS into their everyday practice of prescribing controlled substances. Report that at the training they received easy to use tools that can help them to better educate their patients on the importance of taking medications as prescribed. Gain an increased knowledge of local, state, and national substance abuse and mental health treatment resources.

1. Daniel M Alexander, RPh
BS Clinical Chemistry Michigan State Univ.
BS Pharmacy Ferris State Univ.
President/CEO Lakeshore Pharmacies, Inc.

2.  I have no financial relationships to disclose

3.  Why do we need tools to monitor patients?
 Discuss the most common pharmaceuticals of
abuse
 Identify a useful tool to identify those who many
be abusing and diverting prescription medications
(MAPS)
 MAPS its use and information to the health care
provider
 The MAPS Report
 MAPS Limitations

5. U.S. Drug Overdose Deaths By Major Drug Type, 1999-2010
Opioids
Benzo’s
Heroin
Cocaine
Source CDC/NCHS, NVSS

6. Prescription Drug Abuse
More Americans abuse prescription drugs than the number
of:
Cocaine, Hallucinogen, Heroin, and Inhalant abusers
Combined!!!

7. Teen Prescription Drug Abuse
- One in four teens (24%) reports having misused or
abused a prescription drug at least once in their
lifetime, which is approximately 5 million teens.
-In comparison, 18% of teens in 2008 and 24% of teens in 2012
reported the same
- Of those kids who said they abused prescription
medications, one in five (20%) has done it before
age 14.
-More than a quarter of teens (27%) mistakenly
believe that misusing and abusing prescription
drugs is safer than using street drugs.
-One in four teens (25%) says there is little or no risk
in using prescription pain relievers without a
prescription.
Source:2012 Partnership Attitude Tracking Study, Published 4/23/2013

8. Teen Prescription Drug Abuse
•One-Third of teens (33%) say they believe “it’s okay to use
prescription drugs that were not prescribed to them to deal
with an injury, illness, or physical pain”
•One in five teens (20%) says prescription pain relievers are
not addictive
•Almost one in four teens (23%) say their parents don’t care
as much if they are caught using prescription drugs without
a doctor’s prescription, compared to getting caught with
illegal drugs.
DEA Operations Division :Source 2012 Partnership Attitude Tracking Study, Published 04/23/2013

9. New Initiates 2011 -12 Years and older
Note: Numbers refer to persons who used a specific drug for the first time in the past year, regardless of
whether initiation of other drug use occurred prior to that year. Source 2011 NSDUH

10. 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Source: CDC/NCHS, National Vital Statistics System

11. Vital Signs is there a fifth Vital Sign?
Temperature
Heart Rate
Blood Pressure
Respiration
Pain?

12. MAPS
Michigan Automated
Prescription System

13.  Health Professional Boards. Investigation
 Employee or agent of the Department
 State, Federal, or Municipal employee or agent
whose duty is to enforce drug laws.
 State operated Medicaid program.
 Practitioner or pharmacist who certifies info is for
treatment of bona fide current patient.
 Insurance Company “Patient Safety” “Fraud”

14.  Received $20,000 grant to implement
automated letter generation.
 March 2012: 2144 letters.
 April 2012: 1799 letters
 2011 Shopper list at 6 or more: 530.
 2011 Shopper list at 10 or more: 49
 2012 Shopper list at 6 for more: 251
 2012 Shopper list at 10 or more: 9

15. October 15, 2008
«Company»
«FirstName» «Last Name»
«Address1»
«City», «State» «Postal Code»
Dear «Title»:
The Michigan Automated Prescription System (MAPS) program has identified your patient «Patient», «DOB», «Address2», who appears to be
seeking treatment from multiple physicians and obtaining controlled substance prescriptions of a similar nature from these practitioners.
It is suggested that you obtain controlled substance prescription data on the patient identified above and communicate with other health care
providers who are treating this patient. You may access MAPS data via a link on our website at: www.michigan.gov/healthlicense and click on
the MAPS link. Enclosed please find a listing of physicians in Michigan that provide an office based treatment program for opiate addiction
that may be shared with the patient. There are other options available in addition to opioid treatment such as referral to a pain specialist, or
requiring the patient to enter into an agreement which limits their treatment to a specific physician and pharmacy. Please consider all of the
options that are available to you and your patient.
If you have any questions or need additional information, please contact our office at the phone number listed below, or at our e-mail address:
mapsinfo@michigan.gov.
Sincerely,
Bureau of Health Professions
Health Investigation Division
(517) 373-1737

16.  New formulation by Purdue
 Patients calling for old formula. Canada
 Used callous shaver to “peel” tablets.
 Snorting new formula leaves a paste or gel.
 Oxy IR 30mg is popular. 50% to Florida
 Seeing Opana increase.
 Phenergan with Codeine (Purple)

17.  Oxymorphone long acting
 Expensive
 10,770 Scripts in 2010
 47,979 scripts in 2011

18.  50% to Florida
 31,689 Scripts in 2010
 113,973 Scripts 1n 2011

19.  Used for decades to treat drug addiction
 Increasingly prescribed for pain
 As increased use for pain so has methadone related fatal overdoses.
 Cheapest Narcotic Pain Reliever (Synthetic)
 Insurance companies love it
 The Problem? CDC Vital Signs Report July 2012. Almost one-third of prescription
painkiller overdose deaths involve methadone
 Six times as many people died of methadone overdoses in 2009 than a decade before.
 Methadone accounts for only 2 percent of painkiller prescriptions in the U.S. but is
involved in more than 30 percent of prescription painkiller overdose deaths.

20.  Fentanyl Patches, Fentanyl Citrate berry flavored lollipop
 Fentanyl 100 times more potent than morphine
 Intended to be used for chronic cancer pain and opioid tolerant
people
 Abused for its intense euphoric effects
 Laws changed in dispensing lollipops Must be on at least
60mg of morphine daily or 50MCG/Fentanyl Transdermal
daily. Used for breakthrough pain only.
 Pharmacists must sign off on following these guidelines to
purchase and dispense transmucosal immediate release
fentanyl called TIRF REMS
 This program is required to prescribe, distribute, or dispense
transmucosal immediate release fentayl

21.  alprazolam 1mg 539,215 Scripts in 2010
 alprazolam 1mg 582,656 Scripts in 2011
 alprazolam 2mg 139,400 Scripts in 2010
 alprazolam 2mg 188,134 Scripts in 2011

22.  One in Eight Teens (about 2.7 million) now report having
misused or abused prescription stimulants at least once
in their lifetime.
 9% of teens (1.9 million) report having misused or
abused these prescription stimulants in the past year
 6% of teens (1.3 million) report abuse of these
prescription stimulants in the past month
 One in four teens (actually 26%) believe that prescription
stimulants can be used as a study aid
 More than one in five teens (22% say there is little
or no risk in using Ritalin/Adderall without a
prescription
 Source 2012 Partnership Attitude Tracking Study, published 4/23/2013

23.  Popular in street culture
 Purp, Spritz,
 Wholesale price $11.00 Pint (480ml)
 Pharmacy sells for $300.00 Pint
 Dealer sells for $35-40 an ounce.
 Mixed with hydrocodone
 Grape Jolly Rancher

24.  264,210 Scripts in 2010
 298,492 Scripts in 2011
 Most scripts are for a Pint (480ml)

25.  Schedule IV in January 2012
 Reportable to MAPS
 Popular with hydrocodone combos
(Trinity, alprazolam)
 Higher dose appears to be alcohol.

26.  Eventually NABP wants to collect data.
 Leverage PMP’s with chains to run data reports
automatically when script dispensed.
 Incorporate into EMR open automatically.
 Talk of adding non-controlled drugs for disasters
and other emergencies such as visit to ER when
unconscious.

27.  Interstate data sharing is included in MAPS!
 Ohio now operational.
 Hub operated by NABP (National Association of
Boards of Pharmacy) located in Chicago Illinois.
 VA, IN, SC, WVA added. More coming

28.  Lack of knowledge.
 False beliefs (time consuming, staff)
 Laziness. Don’t want to be bothered.
 Stubborn. Practiced for years w/o database.
 Fear that knowledge will require action.
 Lack of reimbursement.
 Time consuming.

29. Prescription for Methadone 10mg #240 12/23
MAPS for New Patient
-Eight physicians have been writing for drug
-Noticed MAPS report showed Medicaid
-Using CHAMPS looked up Medicaid Number
-Billed Claim to Medicaid and Rejected (Too Soon)
-Claim for drug filled other pharmacy other Dr. two days
previous same quantity.
-Called other pharmacy to verify picked RX up
-Confronted Patient and Kept Prescription, hand
delivered prescription to prescribing physician

30. Patient enters pharmacy with prescription for
Methylpenidate 5mg #270 SIG: 3 t.i.d.
MAPS for new patient:
-Two physicians prescribing medication
-Paying cash with one physician’s prescription
-Pharmacy Billing Private Insurance with other
Individual was very popular hair stylist. Never
a problem obtaining clients. Co-workers
couldn’t understand why so popular,
not the best stylist in the salon.

31.  Department of Licensing and Reg. Affairs
 Bureau of Health Professions
 Health Investigation Division
 www.michigan.gov/healthlicense
 www.michigan.gov/mimapsinfo
 517-373-1737

32. 
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33. The MAPS Report Information:
_____________________________________________________________________________________
Patient’s Name Date of Birth Medication Name Rx Number Practitioner Dispenser
Address Issue Date Form/ Quantity RX TYPE Transmission DEA DEA
Fill Date Strength Auth Refills Payment Address Address
_____________________________________________________________________________________
Doe, John 01/01/1990 Hydrocodone/Acetam 4600001 Bad, Joe Narcotics R US
123 Anywhere 06/14/2013 TAB / 120.00 Original Written AB1234563 AN1234563
06/14/2013 5mg/500mg 0 Medicaid 123rd
St Easy Way DR.
Holland, MI 49423 Holland, MI Holland, MI
_____________________________________________________________________________________
Doe, John 01/01/1990 Hydrocodone/Acetam 6874512 Bad, Joe Cartel Apothecary
123 Anywhere 06/14/2013 TAB / 120.00 Original Faxed AB1234563 AC1234563
06/14/2013 5mg/500mg 0 Private Pay 123rd
St South Border
Holland, MI 49423 Holland, MI Holland, MI
______________________________________________________________________________________
Doe, John 01/01/1990 Hydrocodone/Acetamin 9876541 Fix, I Can Fill’em Now RX
123 Anywhere 06/13/2013 TAB / 240.00 Refill Written AF1234563 AF1260734
06/13/2013 5mg /325mg 4 Private Pay 56 Michigan Skid Row
Holland, MI 49423 Holland, MI Holland, MI
_______________________________________________________________________________________
Page 1 of 30

34.  Q. Do practitioners have to dispense controlled
substances to be able to register to MAPS Online?
A. No. All practitioners who prescribe controlled substances have
the ability to register to MAPS Online to request patient reports on
their patients.Q. If a practitioner requests a MAPS report
and detects possible illegal activity, can the practitioner
give the MAPS report to a law enforcement agency?
A. No, the practitioner cannot give a MAPS report to
anyone. The practitioner can call their local law enforcement
agency and state their concerns. Law enforcement agencies have
the ability to request MAPS reports for cases that involve illegal
activity, ie, drug diversion.
 Q. Can a practitioner request a MAPS report on any
individual?
A. No. MAPS reports can only be requested for individuals that are
a bona fide current patient of the practitioner.

35.  Q. Can a practitioner request a MAPS
report on other practitioners?
A. No. Practitioners may not request reports on
other practitioners.
 Q. Is MAPS compliant with the HIPAA
Privacy Act?
A. Yes. All data is received and transmitted behind
the State of Michigan firewall, which allows
practitioners to comply with HIPAA security
requirements. All data in the MAPS database is
protected and only released to practitioners who
certify they are treating the patient.

36.  Q. What is the definition of a "dispensing
practitioner"?
A. A dispensing practitioner is a practitioner who gives a
prescription drug to a patient (to be consumed at a later
date) in a container with written labeling instructions as to
usage. Dispensing practitioners who dispense controlled
substances in Schedules 2-5 must report this prescription
data to MAPS.
 Q. Does a practitioner that administers controlled
substances need to report to MAPS?
A. No. When a practitioner administers a prescription
drug, the full dose of the prescription drug is administered
in the practitioner's office; no doses of the prescription
drug leave the practitioner's office with the patient.

37.  Q. If a practitioner dispenses controlled substances and
does not have online computer capabilities, how does the
practitioner report dispensed controlled substances to
MAPS?
A. A MAPS waiver form is available for practitioners who do not
have online computer capabilities. If the waiver is approved, a paper
claim form is completed by the dispensing practitioner for each
controlled substance that is dispensed, which is then mailed to the
MAPS program for manual entry into the MAPS database. Waivers
are only granted for practitioners in remote areas and/or who do not
have computer equipment.
 Q. How often do pharmacies and dispensing practitioners
report prescription data to MAPS?
A. Submission of prescription data are currently required on the 1st
and 15th of every month. Pharmacies and practitioners may report
more frequently than twice a month, for example, weekly or daily.