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Initiatives to Combat Prescription Drug Abuse in Kentucky: a n Update on KASPER

Initiatives to Combat Prescription Drug Abuse in Kentucky: a n Update on KASPER. David R. Hopkins KASPER Program Manager Office of Inspector General Kentucky Cabinet for Health and Family Services The Different Faces of Substance Abuse January 28, 2014. Contents. Pill Mills

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Initiatives to Combat Prescription Drug Abuse in Kentucky: a n Update on KASPER

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  1. Initiatives to Combat Prescription Drug Abuse in Kentucky: an Update on KASPER David R. Hopkins KASPER Program Manager Office of Inspector General Kentucky Cabinet for Health and Family Services The Different Faces of Substance Abuse January 28, 2014

  2. Contents • Pill Mills • KASPER Program Review • House Bill 1 Preliminary Results and Evaluation Cabinet for Health and Family Services

  3. Pill Mills

  4. Jeff and Chris George Photos from Palm Beach Post Cabinet for Health and Family Services

  5. Dr. Paul H. Volkman Story: Bill Estep, Lexington Herald-Leader, February 14, 2012. AP Photo released by U.S. Marshals Service (undated) Cabinet for Health and Family Services

  6. Care More Pain Management Clinic Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012 Cabinet for Health and Family Services

  7. Care More Pain Management Clinic Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012 Cabinet for Health and Family Services

  8. Ernest William Singleton Photo: Lexington Community Corrections, January 2013 Cabinet for Health and Family Services

  9. Kitson Clothing Collection Story: WXIX Fox 19 Digital Media Staff, June 21, 2013 Cabinet for Health and Family Services

  10. Kitson Clothing Collection Cabinet for Health and Family Services

  11. KASPER Program Review

  12. Status of Prescription Drug Monitoring Programs (PDMPs) VT ME WA NHMARICTNJDEMD DC MT ND MN NY OR WI SD ID MI WY PA IA NE OH IL IN NV WV UT VA CO KS KY CA MO NC TN OK SC AZ NM AR GA AL MS TX LA AK FL Operational PDMPs Enacted PDMP legislation, but program not yet operational Legislation pending HI GU Research is current as of February 1, 2012

  13. 2011 KASPER Reports Requested Cabinet for Health and Family Services

  14. KASPER Operation • KASPER tracks most Schedule II – V substances dispensed in KY • Over 10 million controlled substance prescriptions reported to the system each year • KASPER data is 1 to 3 days old • Dispensers have 1 business day to report • Reports available to authorized individuals • Available via web typically within 15 seconds (97% of requests) • Available 24/7 from any PC with Web access Cabinet for Health and Family Services

  15. Annual KASPER Records Total / Per Person 2.39 2.43 2.65 2.65 2.72 2.72 2.47 Number of Controlled Substance Prescriptions per Person Cabinet for Health and Family Services

  16. KASPER Reports Requested Cabinet for Health and Family Services

  17. Top Prescribed Controlled Substances byTherapeutic Category by Doses - 2013 Lorazepam 4.0% Ativan Testosterone 3.5% AndroGel Zolpidem 3.4% Ambien Amphetamine 3.1% Adderall Hydrocodone 41.3%Lortab Lorcet Vicodin Diazepam 4.3% Valium Clonazepam 6.7% Klonopin Tramadol 6.8% Ultram Alprazolam 11.2% Xanax Oxycodone 15.4%OxyContin Percodan Percocet Cabinet for Health and Family Services

  18. KASPER Stakeholders • Licensing Boards – to investigate potential inappropriate prescribing by a licensee. • Practitionersand Pharmacists – to review a current patient’s controlled substance prescription history for medical or pharmaceutical treatment. • Law Enforcement Officers, OIG employees, Commonwealth’s attorneys, county attorneys - to review an individual’s controlled substance prescription history as part of a bona fide drug investigation or drug prosecution. • Medicaid – to screen members for potential abuse of pharmacy benefits and to determine “lock-in”; to screen providers for adherence to prescribing guidelines for Medicaid patients. • A judge or probation or parole officer – to help ensure adherence to drug diversion or probation program guidelines. • Medical Examiners engaged in a death investigation Cabinet for Health and Family Services

  19. House Bill 1 Preliminary Resultsand Evaluation

  20. Controlled Substance Dispensing – One Year Comparison Figures shown in doses dispensed Cabinet for Health and Family Services

  21. Hydrocodone Cabinet for Health and Family Services

  22. Oxycodone Cabinet for Health and Family Services

  23. Alprazolam Cabinet for Health and Family Services

  24. Methadone Cabinet for Health and Family Services

  25. Oxymorphone Cabinet for Health and Family Services

  26. Tramadol Cabinet for Health and Family Services

  27. Buprenorphine Cabinet for Health and Family Services

  28. Controlled Substance Prescribing 2013 Cabinet for Health and Family Services

  29. Controlled Substance Usage 2013 Cabinet for Health and Family Services

  30. House Bill 1 Impact Study • Comprehensive assessment of HB1’s impact on patients, prescribers, and other stakeholders • Overall goals: • Evaluate the impact of HB1 on reducing prescription drug abuse and diversion in Kentucky • Identify unintended consequences associated with implementation of HB1 that impact patients, providers and citizens of the Commonwealth • Develop recommendations to improve effectiveness of HB1 and mitigate identified unintended consequences • Final study report planned for July 2014 Cabinet for Health and Family Services

  31. Kentucky Pharmacists Non-KYPharmacists

  32. Kentucky

  33. Stakeholder interviews were conducted to inform the development of a KASPER registrant survey instrument • Board of Pharmacy • Board of Nursing • Board of Medical Licensure • Board of Dentistry • Kentucky Coalition of Nurse Practitioners and Nurse Midwives • Kentucky Dental Association • Kentucky Pharmacists Association • Kentucky Medical Association • Operation UNITE • National Association Drug Diversion Investigators (NADDI) • Medicaid, Office of Inspector General • Kentucky Sheriff’s Association • Kentucky Narcotic Officers Association

  34. Initiatives to Combat Prescription Drug Abuse in Kentucky: an Update on KASPER Van Ingram Executive Director Office of Drug Control Policy Kentucky Justice and Public Safety Cabinet The Different Faces of Substance Abuse January 28, 2014

  35. Contents • Legislative Update • 2013 National Survey on Drug Use and Health • HB1 Provider Training • Kentucky Overdose Data Justice & Public Safety Cabinet

  36. Legislative Update

  37. HB 1 – Pain Management Facilities • Physician ownership requirement on all pain management facilities (PMF) • Exception for those health facilities operating as a PMF on April 24, 2012 • No sanctions or convictions imposed on facility or employees Justice & Public Safety Cabinet

  38. PMF Oversight • KBML responsible for licensure standards for physician-owned pain management facilities. • OIG, Division of Health Care is responsible for licensure standards for existing pain management facilities that qualify for the physician-ownership exemption of HB 1. Justice & Public Safety Cabinet

  39. Non-Physician Owned PMFs • 29 non-physician owned PMFs were identified  April 24, 2012 (HB1 passage date)  • 8 closed prior July 20, 2012 (HB1 effective date) • 12 closed after the HB1 effective date • 2 illegal or non-physician owned PMFs discovered after HB 1 effective date • 4 PMFs were sent cease and desist letters • 7 PMFs are being reviewed for compliance and certification by the Cabinet for Health and Family Services Justice & Public Safety Cabinet

  40. KASPER Reporting KRS 218A.202 • Controlled substance administration or dispensing must be reported within one day effective July 1, 2013 Justice & Public Safety Cabinet

  41. KASPER Accounts – KRS 218A.202 • KASPER registration is mandatory for Kentucky practitioners or pharmacists authorized to prescribe or dispense controlled substances to humans. Justice & Public Safety Cabinet

  42. KASPER Prescriber Usage - KRS 218A.172 • Query KASPER for previous 12 months of data: • Prior to initial prescribing or dispensing of a Schedule II controlled substance, or a Schedule III controlled substance containing hydrocodone • No less than every three months • Review data before issuing a new prescription or refills for a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone • Additional rules/exceptions included in licensure board regulations Justice & Public Safety Cabinet

  43. KASPER Regulations – Licensure Boards • 201 KAR 5:130 • Kentucky Board of Optometric Examiners KASPER requirements • 201 KAR 8:532 • Kentucky Board of Dentistry KASPER requirements • 201 KAR 9:230, 201 KAR 9:260 • Kentucky Board of Medical Licensure KASPER requirements • 201 KAR 20:057 • Kentucky Board of Nursing KASPER requirements • 201 KAR 25:090 • Kentucky Board of Podiatry KASPER requirements. Justice & Public Safety Cabinet

  44. KASPER Institutional Accounts - KRS 218A.202 • Hospitals and long term care facilities can establish “facility” KASPER accounts • eKASPER institutional master account established by Chief Medical Officer or designated employee • If no CMO, a designated physician employee may create master account • 79 institutional master accounts currently established Justice & Public Safety Cabinet

  45. KASPER Prescriber Reports – KRS 218A.202 • CS prescribers can obtain a KASPER report on themselves: • To review and assess the individual prescribing patterns • To determine the accuracy and completeness of information contained in KASPER • To identify fraudulent prescriptions Justice & Public Safety Cabinet

  46. Providing Reports to Patients – KRS 218A.202 • KASPER reports can be shared with the patient or person authorized to act on the patient’s behalf • KASPER reports can be placed in the patient’s medical record, with the report then being deemed a medical record subject to disclosure on the same terms and conditions as an ordinary medical record Justice & Public Safety Cabinet

  47. Federal Actions - Hydrocodone • Hydrocodone combination products to be rescheduled from CIII to CII • Approved by FDA • Pending recommendation to HHS and approval by HHS and DEA • FDA approved CII pure hydrocodone product • Zohydrotm ER manufactured by Zogenix, Inc. • Available 1Q 2014 • Not abuse-resistant formulation Justice & Public Safety Cabinet

  48. National Survey onDrug Use and HealthJanuary 8, 2013

  49. NATIONAL TRENDS States with Rates between 5.33 and 6.37 1 Oregon 6.37 5.25-7.71 2 Colorado 6.00 4.96-7.24 3 Washington 5.75 4.76-6.92 4 Idaho 5.73 4.74-6.91 5 Indiana 5.68 4.68-6.89 6 Arizona 5.66 4.60-6.94 7 Nevada 5.62 4.57-6.89 8 Delaware 5.61 4.61-6.82 9 Arkansas 5.55 4.60-6.68 10 New Mexico 5.45 4.47-6.64 Justice & Public Safety Cabinet

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