Prescription Drug Monitoring Programs: Current and Potential Use in Drug Court Case Management

1. Prescription Drug Monitoring Programs:Current and Potential Use in Drug Court Case Management National Association of Drug Court Professionals Webinar March 21, 2014

2. Agenda • Status of PDMPs and drug courts • Prescription drug diversion and abuse • How a PDMP works • PDMPs and drug court case management • Drug courts working with PDMPs

3. Status of Prescription Drug Monitoring Programs and Drug Courts

4. What is a Prescription Drug Monitoring Program? • A prescription drug monitoring program (PDMP) is a state program that collects controlled substance prescription records from dispensers (e.g., pharmacies) state-wide and then provides prescription histories and other compiled and/or analyzed data to authorized end-users for use in clinical care, law enforcement, regulation of professional practice, research and evaluation.

5. Source: PDMP Training & Technical Assistance Center, Brandeis University

7. States Providing Solicited PDMP Reports to Drug Courts Source: Compiled from information provided by the PDMP Training and Technical Assistance Center, 2012, 2013

8. Potential Mechanisms for Drug Court Use of PDMPs • Direct statutory authority • Depending upon state laws and regulations: • Participant agreement • Working through law enforcement • Court order or subpoena • Working with a participant’s health care providers (i.e., prescribers and dispensers) • Consult with the state agency that administers the PDMP

9. Prescription Drug Diversion and Abuse Key Points

10. Motor vehicle traffic, poisoning, and drug poisoning (overdose) death ratesUnited States, 1980-2010 Source: CDC, NCHS Data Brief, December, 2011, Updated with 2009 and 2010 mortality data

11. Drug Overdose Deaths by Major Drug Type, U.S., 1999-2010 Source: CDC, National Center for Health Statistics, National Vital Statistics System. Updated with 2010 mortality data

12. Rates of opioid overdose deaths, sales and treatment admissions, U.S., 1999-2010 Source: National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS

13. Past Month Illicit Drug Use among Persons Aged 12 or Older Source: SAMSHA, National Survey on Drug Use and Health, 2012

14. Specific Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or older: 2012 Source: SAMSHA, National Survey on Drug Use and Health, 2012

15. Source: National Drug Court Institute, Painting the Current Picture, 2011

16. Drug Use in 6 Months before Drug Court Program Entry • Any use of drugs: 84% • Marijuana: 46% • Cocaine: 44% • Illegal prescription drugs: 16% • Amphetamines: 15% • Heroin: 11% • Hallucinogens or designer drugs 9% • Illegal methadone use: 4% Source: Urban Institute, The Multi-Site Adult Drug Court Evaluation, 2011

17. Opioid Epidemic – Iatrogenic • Opioid overdoses and deaths rise to epidemic proportions – first decade of 2000s • Different than any other drug epidemic: • Manufactured by pharmaceutical manufacturers • Distributed throughout our health care system • Prescribed by physicians and other licensed professionals • Dispensed by pharmacies • Challenge: Need to balance enabling medical use with preventing misuse and abuse

18. How does a PDMP work?

19. Prescription Drug Monitoring ProgramGOALS • Education & Information • Public Health Initiatives • Early Intervention & Prevention • Investigation & Enforcement Source: Alliance of States with Prescription Monitoring Programs

20. PDMP System Overview Data Submitted Reports Sent Reports Sent Reports Sent *Groups other than those listed may also receive reports

21. What PDMPs provide in a patient prescription history report • 3, 6 or 12 month prescription history, depending on state • Prescriber: • Name, address, and, some states, phone number • Date Rx issued • Description of drug: • Drug name, quantity, strength, days supply • Dispensing pharmacy: • Name and address • Date dispensed

22. KASPER Law Enforcement Request Source: Washington State PMP & PDMP Training and Technical Assistance Center

23. KASPER Patient Rx History Report Source: Washington State PMP & PDMP Training and Technical Assistance Center

24. PDMPs and Drug Court Case Management

25. Prescription Drug Monitoring Program Center of Excellence • Notes From the Field • _______________________________________________________________ • NF 2.4 Monitoring and Changing Behavior: The Role of PMP Data in Kentucky Drug Courts • August, 2011

27. Kentucky PDMP Kentucky All Schedule Prescription Electronic Reporting (KASPER) is Kentucky’s Prescription Drug Monitoring Program (PDMP). KASPER tracks Schedule II – V controlled substance prescriptions dispensed within the state as reported by pharmacies and other dispensers. Enhanced KASPER (eKASPER) is the real-time web accessed database that provides a tool to help address the misuse, abuse and diversion of controlled pharmaceutical substances. Source: KY Cabinet for Health and Family Services

28. KASPER OPERATION • KASPER tracks Schedule II – V substances dispensed in KY. • Approximately 11 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. Source: KY Cabinet for Health and Family Services

29. Goals of KASPER • KASPER was designed as a tool to help address the problem with prescription drug abuse and diversion by providing: • A source of information for health care professionals. • An investigative tool for law enforcement and regulatory agencies. • KASPER was not designed to: • Prevent people from getting prescription drugs for legitimate medical conditions. Source: KY Cabinet for Health and Family Services

30. Access by Law Enforcement Officers • KRS 218A.202(6): The Cabinet for Health and Family Services shall be authorized to provide data to: • a Kentucky peace officer; • Commonwealth’s attorneys and county attorneys; • a certified or full-time peace officer of another state; • a federal peace officer whose duty is to enforce the laws of this Commonwealth, of another state, or of the United States relating to drugs; • and who is engaged in a bona fide specific investigation involving a designated person Source: KY Cabinet for Health and Family Services

31. Access by Drug Court Judges • KRS 218A.202(6): The Cabinet for Health and Family Services shall be authorized to provide data to: • a judge or probation or parole officer administering a diversion or probation program of a criminal defendant arising out of a violation of this chapter or of a criminal defendant who is documented by the court as a substance abuser who is eligible to participate in a court-ordered drug diversion or probation program.

32. Access by Drug Court Judges (cont’d) • Management of Reports • A judge may discuss the information in a KASPER report with the Drug Court participant, but does not provide a copy of the report to anyone including the Drug Court participant. • After review the judge may shred the report. • Each report has a number that will allow access to the report at any time.

33. Kentucky Drug Courts Use of PDMP Data • Used to track a participant’s non-medical use or diversion of controlled substances. • Rise in prescription drug diversion, abuse and addiction means that an increasing number of drug court participants are enrolled due to involvement with controlled prescription drugs. • Information on a participant’s prescription history for controlled substances can play a valuable role in monitoring and changing the participant’s behavior. • Approximately two thirds of Kentucky drug courts currently make use of PDMP data in a variety of situations.

34. PDMP Data Use by Kentucky Drug Courts Source: Kentucky Administrative Office of the Courts, data collected July 2011

35. Kentucky Drug Courts Use of PDMP Data (cont’d) • Periodic and random drug tests (drug screens) that analyze hair, blood or urine samples are routinely used to detect illicit and non-medical drug use. • However, these tests aren’t completely reliable in detecting the presence of all prohibited substances, and are subject to evasion by resourceful and determined drug users. • Courts must take other steps to monitor participant behavior to ensure they uphold agreements to remain drug free, or in the case of prescription drugs, use them only as medically indicated.

36. Kentucky Drug Courts Use of PDMP Data (cont’d) • A typical drug court program in Kentucky consists of 3 phases that gradually give participants more autonomy, plus a post-graduation aftercare phase • In the drug court supervised by Vice-Chief Regional Circuit Judge Charles Hickman, PDMP reports are run on participants when they move from one phase of the program to another in order to help confirm that their purchases of controlled substances, if any, are consistent with good clinical care. • PDMP data can reveal patterns of prescribing that indicate a participant might be using controlled medications non-medically or diverting them to friends, family or paying customers.

37. Kentucky Drug Courts Use of PDMP Data (cont’d) • PDMP reports are also run if, at any point in the program, a participant seems to be having unexpected or unexplained setbacks, or if evidence comes to light suggesting illicit drug use (e.g., a positive drug screen) or diversion activity (e.g., unexplained cash in hand). • A participant can move on to the next phase only if their behavior as monitored by the court, including the prescription purchases listed in PDMP reports, passes muster.

38. Kentucky Drug Courts Use of PDMP Data (cont’d) • While a drug screen can’t detect drug diversion, only drug use, PDMP data showing medically unnecessary prescriptions are a prima facie indicator of possible diversion. • PDMP reports are only indicators, not proof, of diversion or misuse. The pharmacies and doctors listed are contacted and records reviewed to confirm that the individual in question actually received the prescriptions dispensed.

39. Purposes of PDMP Data Use by Kentucky Drug Courts Source: Kentucky Administrative Office of the Courts, data collected July 2011

40. Drug Courts Working with PDMPs

41. Prescription Monitoring Program Model Act of 2010 • Section 7, Providing Prescription Monitoring Information • (b) The [designated state agency] is authorized to provide information in the prescription monitoring program upon request only to the following persons. • (VII) Personnel of the [designated state agency] for purposes of administration and enforcement of this Act, or [insert state controlled substances act], [if any other state statute is applicable, insert “or” and reference the other statutes]. • [Note: A state may determine to authorize additional agencies to request and receive prescription information including substance abuse treatment providers, worker’s compensation board reviewers who are health care professionals, drug court judges, department of corrections’ health care professional staff, and probation departments, if they cannot receive information under other provisions already authorized in (I) through (VII)] Source: Alliance of States with Prescription Monitoring Programs

42. White Paper on PDMP Best Practices Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices September 20, 1012 • atwww.pdmpexcellence.org • Developed with BJA and Pew Charitable Trusts • 35 Best and Promising Practices

43. PDMP Best Practice Recommendations Relevant to Drug Courts • Enable access to PDMP data by drug courts • Provide education to drug court professionals to promote awareness and utilization • Link PDMPs with other public health and public safety systems, including drug courts • Enact and implement interstate data sharing among PDMPs

44. How to find contact information for astate’sPDMP? Go to www.pdmpassist.org - website of PDMP Training & Technical Assistance Center at Brandeis University • Go to the left column of Homepage; under “State Contact Information and click on the link for “State Contacts” • That will bring up the name of the primary PDMP contact(s) in each state. • Click on a name and the individual’s contact information will appear.

45. www.pdmpassist.org

46. How to find other information about a state’s PDMP • On the homepage of www.pdmpassist.org, click the top tab marked “Resources” • On drop down menu, click “State Profiles” • On the next webpage, click the state’s name. • For each state, there is: • The state agency administering the PDMP • Information about the state • Drug schedules monitored • Who may request patient information • Legislation and regulations

47. Resources

48. Handout Drug Court Case Management: A Guide to Exploring Current and Potential Use of Reports from Prescription Drug Monitoring Programs

49. PDMP Center of Excellence Components • Web site/clearinghouse • Problem Statement – user friendly • Evaluate PDMP effectiveness, including: • Analysis of BJA performance measures • Case studies of start-up PDMPs and innovative enhancements • Identify best practices • Develop innovative uses of PDMP data • Support Substance Abuse Prevention • Assist Substance Abuse Treatment • Assist medical and pharmaceutical education and research • Expert panel to guide Center work

50. www.pdmpexcellence.org