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Controlled Substances Prescription Monitoring Program Dean Wright, RPh CSPMP Director

Controlled Substances Prescription Monitoring Program Dean Wright, RPh CSPMP Director Arizona State Board of Pharmacy. Controlled Substances Prescription Monitoring Program. Faculty Disclosure Declaration:

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Controlled Substances Prescription Monitoring Program Dean Wright, RPh CSPMP Director

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  1. Controlled Substances Prescription Monitoring Program Dean Wright, RPh CSPMP Director Arizona State Board of Pharmacy

  2. Controlled Substances Prescription Monitoring Program Faculty Disclosure Declaration: I have no actual or potential conflict of interest in relation to this program or presentation.

  3. Controlled Substances Prescription Monitoring Program Learning Objectives: • Describe the prevalence, roles and limitations of • Controlled Substance Monitoring programs • Explain how to gain access and general information • about the AZ Controlled Substance Prescription Monitoring Program (AZ CSPMP) • Review information on last year’s usage of the system • Describe learning lessons from AZ CSPMP screenings

  4. Controlled Substances Prescription Monitoring Program • Arizona’s Forty-eighth Legislature passed H.B. 2136 establishing a Controlled Substances Prescription Monitoring Program (CSPMP). The bill was signed by the Governor on July 2, 2007 and become effective on September 19, 2007. • The new statutes, A.R.S. Title 36, Chapter 28 are available on the Board’s website www.azpharmacy.gov under the “CS-Rx Monitoring Program” link. Our proposed rules are also available under the same link.

  5. Controlled Substances Prescription Monitoring Program • A.R.S. § 36-2602 requires the ASBP to establish a controlled substances prescription monitoring program that: • Includes a computerized central database tracking system track the prescribing, dispensing, and consumption of Schedule II, III, and IV controlled substances in Arizona, • Assists law enforcement in identifying illegal activity related to the prescribing, dispensing, and consumption of Schedule II, III, and IV controlled substances, • Provides information to patients, medical practitioners, and pharmacists to help avoid the inappropriate use of Schedule II, III, and IV controlled substances, and • Is designed to minimize inconvenience to patients, prescribing medical practitioners and pharmacies while effectuating the collection and storage of information.

  6. Controlled Substances Prescription Monitoring Program Purpose of the monitoring program: • Improve the State’s ability to identify controlled substance abusers or misusers and refer them for treatment • Identify and stop diversion of prescription controlled substance drugs Primary function of the Arizona State Board of Pharmacy: • Provide a central repository of all prescriptions dispensed for Schedule II, III, and IV controlled substances in Arizona

  7. Controlled Substances Prescription Monitoring Program A.R.S. § 36-2604 Use and release of confidential information C. The board may release data collected by the program to the following: • 1. A person who is authorized to prescribe or dispense a controlled substance to assist that person to provide medical or pharmaceutical care to a patient or to evaluate a patient.. • 2. An individual who requests the individual's own prescription monitoring information pursuant to section 12-2293. • 3. A professional licensing board established pursuant to title 32, chapter 7, 11, 13, 14, 15, 16, 17, 18, 21, 25 or 29. Except as required pursuant to subsection B of this section, the board shall provide this information only if the requesting board states in writing that the information is necessary for an open investigation or complaint. • 4. A local, state or federal law enforcement or criminal justice agency. Except as required pursuant to subsection B of this section, the board shall provide this information only if the requesting agency states in writing that the information is necessary for an open investigation or complaint. • 5. The Arizona health care cost containment system administration regarding persons who are receiving services pursuant to chapter 29 of this title. Except as required pursuant to subsection B of this section, the board shall provide this information only if the administration states in writing that the information is necessary for an open investigation or complaint. • 6. A person serving a lawful order of a court of competent jurisdiction.

  8. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program • October 2008: Arizona began collecting data from resident and nonresident pharmacies. The first reports were due on or before Friday October 17, 2008 for the week ending October 11, 2008.Pharmacies were required to report their controlled substance data retroactively to April 1, 2008. • October 2009: Began collecting data for dispensing practitioners. • There are about 1691 resident and nonresident pharmacies reporting data and about 3800 dispensing practitioners reporting data.

  9. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program • Database access as of February 6, 2013: • Practitioners: 4436 (20.1%) • Pharmacists: 1928 (31.2%) • Law Enforcement Investigators: 293 • Board Investigators: 50 • Practitioners, pharmacists, and law enforcement and board investigators from another state may also request access.

  10. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program Who is using the database? Practitioners make 82.5% of the queries Pharmacists make 17.3% of the queries Law Enforcement make 0.13% of the queries Healthcare Boards make 0.07% of the queries

  11. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program Queries - By Quarter for 2010 Period RPh Practitioner LE Board 1/1/10-3/31/10 10709 69183 147 86 4/1/10-6/30/10 12731 91616 255 60 7/1/10-9/30/10 13668 113749 222 45 10/1/10-12/31/10 9516 120130 302 42 Queries – By Quarter for 2011 Period RPH Practitioner LE Board 1/1/11-3/31/11 9280 128796 338 54 4/1/11-6/30/11 9954 145456 344 110 7/1/11-9/30/11 13058 168562 233 101 10/1/11-12/31/11 14150 174802 231 73 Queries – By Quarter for 2012 Period RPH Practitioner LE Board 1/1/12-3/31/12 15744 199264 368 120 4/1/12-6-30-12 20532 232372 180 80 7/1/12-9/30/12 27422 167709 245 189 10/1/2012 36585 174230 240 131

  12. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program How often is the database being used? Practitioners average 1936 queries per day. Pharmacists average 407 queries per day. Law enforcement agents average 2.7 queries per day. Healthcare Boards average 1.5 queries per day. Interstate Queries? Practitioners made 1034 and Pharmacists made 803 in 4th Quarter 2012

  13. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program Unsolicited Reports Sent to Practitioners 8/09 126-41 5/11 92-13 9/09 179-34 7/11 89-11 10/09 121-19 8/11 116-15 12/09 177-25 9/11 115-15 1/10 142-24 10/11 157-21 2/10 154-24 11/11 67-9 3/10 98-15 12/11 70-10 4/10 134-18 1/12 152-18 5/10 123-17 2/12 180-21 7/10 140-22 3/12 143-16 8/10 135-21 4/12 195-23 9/10 159-26 5/12 154-19 10/10 127-18 6/12 143-15 11/10 201-25 7/12 191-20 12/10 183-23 9/12 99-10 1/11 133-16 10/12 105-13 2/11 107-14 11/12 188-23 3/11 93-9 12/12 105-12 4/11 90-11

  14. Practitioner/Pharmacist Procedures for Requesting Access

  15. Online Training Course • Once we receive a practitioner’s completed access request paperwork, we will assign the practitioner to our 20-minute online training course. The practitioner will receive an email from our training course at @careermap.net. • Once, the practitioner completes the training course, the practitioner will receive two emails from our tech staff at @hidinc.com with the practitioner’s user name and the database web link and the practitioner’s PIN number, temporary password, login instructions, and an 866 help desk phone number.

  16. Access Notification Welcome to the AZ CSPMP Database: for Practitioners This e-mail confirms you are APPROVED by the Arizona Board of Pharmacy to access the Controlled Substance Prescription Monitoring Program database. * To access the Practitioner/ Pharmacist website, click on the database link : https://azpmpph.hidinc.com Your username is your DEA Registration # with a prefix of AZ; AZ----- * User login and password accounts are never to be shared. All user account deletions, additions, access, permissions, and changes must be submitted in writing to: Dean Wright, CSPMP Director Arizona State Board of Pharmacy 1700 W. Washington, suite 250 Glendale, AZ 85007 (602) 771 2744 fax (602) 771 2748  You should receive a second email, within 4 hours, that will contain your account pin number, temporary password, login instructions, and a tech support phone number.

  17. Access notification • Arizona State Board of Pharmacy • Controlled Substance Prescription Monitoring Program (CSPMP) • Second email • This is your temporary password: [kse93DbJg] • Click on the Database link in the first email, click on login, enter your user name and temporary password. Click on Practitioner/Pharmacist Query and in the popup box create a permanent password. Then login with your new permanent password. • This email confirms that your PIN # is [8776]. • This number is required if you call our support center to assist you with forgotten passwords. • The number to call for this assistance is 1-866-792-3149. • It is recommended that you keep this PIN # in a secure, retrievable location.  • If you do not know your PIN # when you call for assistance we will not be able to help you and you will be required to contact AZ CSPMP and start the application process from the beginning again.

  18. PMP Queries Multi-State access is here. Allows access to data from other states and AZ in one report. Click on Multi-State Query to make a request. Pick AZ and other states needed. Put in patient name and DOB and time-frame for search. Note: DO NOT use Multi-State Query, if you only need data for Arizona, use Practitioner/Pharmacist Query.

  19. PMP Report Only one factorin prescriber’s evaluation of patient history.

  20. PMP Report Only one factorin prescriber’s evaluation of patient history.

  21. PMP Report Only one factorin prescriber’s evaluation of patient history.

  22. PMP Report Only one factorin prescriber’s evaluation of patient history.

  23. PMP Report Only one factorin prescriber’s evaluation of patient history.

  24. PMP Report Only one factorin prescriber’s evaluation of patient history.

  25. PMP Report Only one factorin prescriber’s evaluation of patient history.

  26. PMP Report Only one factorin prescriber’s evaluation of patient history.

  27. PMP Report Only one factorin prescriber’s evaluation of patient history.

  28. Other Factors that should be documented • Diagnosis (pain is a symptom) • Chief complaint at visit • Changes since last visit • Urine/Blood Drug screen results • Compliance with treatment plan • Other medical conditions and drugs prescribed • Other known prescribers for this patient

  29. Review the patient’s history and patterns of drug use • What a patient received over the last 6-12 months is more important than what they got last week. • Most abuse did not start within the last 10 days.

  30. PMP Reports • Use the PMP report as a tool. • Review any additional records available • Compare with patient charts • Validate unexpected information • Contact prescribers or pharmacies listed, for more details

  31. Problems with PMPs • Patient identity • No unique identifier for all persons • Common names, same DOB • Computer search functions • Michael/Michelle; Terry/Terri • Pharmacy data entry errors • Date of dispensing entered in Date of Birth field • Wrong prescriber selected

  32. PMP Report Issue is ALWAYS Appropriate Medical Care. Quantity alone is never the issue.

  33. Scenario 4 PMH: cancer increasing pain and out of pain medication early Prescription data base search alerted provider that patient was obtaining controlled substances from multiple sources Provider discussion with patient that for safety all his pain medication should be coming from one location. New treatment plan for pain control developed. Importance of contacting provider when pain not controlled with current medication emphasized. Learning Lesson: talk with your patient closely & frequently

  34. QUESTIONS? Arizona State Board of Pharmacy Web page: www.azpharmacy.gov Dean Wright, CSPMP Director Arizona State Board of Pharmacy 1700 W. Washington, Suite 250 Phoenix, AZ 85007 602-771-2744 Fax: 602-771-2748 dwright@azpharmacy.gov

  35. QUESTIONS? Arizona State Board of Pharmacy Web page: www.azpharmacy.gov Dean Wright, CSPMP Director Arizona State Board of Pharmacy 1616 W. Adams, Suite 120 P.O. Box 18520 Phoenix, AZ 85005 602-771-2744 Fax: 602-771-2748 dwright@azpharmacy.gov

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