1 / 47

Andrew Holt, PharmD. Controlled Substance Monitoring Database

Controlled Substance Monitoring Database Prescription Drug Abuse Prevention Conference September 19, 2014. Andrew Holt, PharmD. Controlled Substance Monitoring Database. Disclosure Information- Andrew Holt, PharmD. I have no financial relationships to disclose

raymond-booker
Download Presentation

Andrew Holt, PharmD. Controlled Substance Monitoring Database

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Controlled Substance Monitoring DatabasePrescription Drug Abuse Prevention ConferenceSeptember 19, 2014 Andrew Holt, PharmD. Controlled Substance Monitoring Database

  2. Disclosure Information- Andrew Holt, PharmD • I have no financial relationships to disclose • I will not discuss off label use and/or investigational use in my presentation

  3. Opioid Prescription Rates by County, TN 2007 Source: Tennessee Department of Health internal files, Baumblatt, et al

  4. Opioid Prescription Rates by County, TN 2008 Source: Tennessee Department of Health internal files, Baumblatt, et al

  5. Opioid Prescription Rates by County, TN 2009 Source: Tennessee Department of Health internal files, Baumblatt et al

  6. Opioid Prescription Rates by County, TN 2010 Source: Department of Health internal files, Baumblatt et al

  7. Opioid Prescription Rates by County, TN 2011 Source: Tennessee Department of Health internal files, Baumblatt et al

  8. C-II Controlled Substance Utilization by State RankStateRx per Capita 1 Delaware 0.8127 2 Tennessee 0.6828 3 District of Columbia 0.6329 4 Massachusetts 0.6330 5 Maine 0.6231 Source: IMS Health

  9. C-II Controlled Substance Growth by State2013 vs. 2012 RankStateChange 1 Wyoming 7.1% 2 South Dakota 6.1% 3 Idaho 5.1% 4 Louisiana 5.0% 31 Tennessee 0.3% Source: IMS Health

  10. Oxycodone Utilization by State RankStateRx per Capita 1 Delaware 0.36 2 District of Columbia 0.32 3 Tennessee 0.31 4 Massachusetts 0.29 5 Pennsylvania 0.29 Source: IMS Health

  11. Growth in Oxycodone Utilization by State RankStateChange 1 Wyoming 5.1% 2 Mississippi 2.7% 3 South Dakota 2.5% 4 Idaho 2.3% 37 Tennessee -4.4% Source: IMS Health

  12. C-III Controlled Substance Utilization by State RankStateRx per Capita 1 Alabama 1.10 2 Tennessee0.92 3 Mississippi 0.91 4 West Virginia 0.91 5 Kentucky 0.89 Source: IMS Health

  13. C-III Controlled Substance Growth by State2013 vs. 2012 RankStateChange 1 Vermont -0.2% 2 Arkansas -0.5% 3 South Dakota -0.9% 4 North Dakota -1.0% 31 Tennessee -5.0% Source: IMS Health

  14. Opioid Prescribing Analysis:Analysis of Specialty/Profession Type in Tennessee

  15. CSMD History • Law Enacted in 2002 • Began collecting data in 2005 • Became searchable by practitioners in 2006

  16. Controlled Substance Monitoring Database Committee • Board of Medical Examiners • Board of Nursing • Board of Pharmacy • Board of Osteopathic Examination • Committee on Physician Assistants • Board of Veterinary Medical Examiners • Board of Optometry • Board of Podiatric Medical Examiners • Board of Dentistry

  17. Most Commonly Prescribed CS in TN Source: CSMD Annual Report to the 108th General Assembly, 2014

  18. Prescription Safety Act of 2012 • Mandatory PDMP registration • Mandatory PDMP usage • Shortened PDMP reporting window • Mandatory reporting of doctor shoppers to law enforcement by practitioners • Enabled interstate data sharing • Established delegate accounts-”extenders” • Increased administrative staffing

  19. Prescriber CSMD Survey Results • 71% changed a treatment plan after viewing a CSMD report • 73% are more likely to discuss substance abuse issues or concerns with a patient • 57% are more likely to refer a patient for substance abuse treatment • 79% feel that the CSMD is useful for decreasing doctor shopping

  20. Technological Innovations • Color-coded risk icons on patient report for: • Pharmacy Shopper • Doctor Shopper • High MME Dose • Automated username and password retrieval • Batch requests for high-volume clinics

  21. CSMD Technology

  22. CSMD Technology – Risk Indicators

  23. Mandating CSMD Checking Resulted in More Queries in Tennessee Mandated checking began April 1, 2013 Mandated registration began April 1, 2013 Source: Tennessee Department of Health Internal Files, February 2014

  24. Number of High Utilization Patients* in PDMP 2012-2014

  25. More PDMP Queries, Fewer High Utilization Patients

  26. Statistics

  27. Reducing Neonatal Abstinence Syndrome Pink NAS reminder messaging on all females of childbearing age

  28. NAS Messaging in CSMD • Pink cautionary statement on patient report for females of childbearing age • “Please remember that narcotic prescriptions for women of child bearing age could result in Neonatal Abstinence Syndrome (NAS) should pregnancy occur; please discuss with your patient methods to prevent unintended pregnancy.”

  29. Future CSMD Activities • Integrate into clinical workflow • Enhanced analysis • $1.4 million CDC grant awarded in 2014 • Increased interstate data sharing

  30. Chronic Pain Management GuidelinesPrescription Drug Abuse Prevention ConferenceSeptember 19, 2014 Andrew Holt, PharmD. Controlled Substance Monitoring Database

  31. Public Chapter 430 • Chronic Pain Guidelines written by January 1, 2014 • All prescribers with DEA 2 hours CME every 2 years • Prescribe 30 days at a time Schedule II-IV

  32. Process Began on January 28, 2013 • Selected the Panel of Experts • Selected the Steering Committee • First Meeting Steering Committee Meeting July 1, 2013

  33. Chronic Pain Guidelines Steering Committee • Board of Medical Examiners • Dr. Michael Baron • TN Department of Mental Health • Rodney Bragg, M.A., M.Div. • Tennessee Medical Foundation • Dr. Roland Gray • Special Thanks To: • Ben E. Simpson, J.D. • Tracy Bacchus Worker’s Compensation Abbie Hudgens Office of General Counsel Andrea Huddleston, J.D. Controlled Substance Monitoring Database Andrew Holt, D.Ph. Department of Health Bruce Behringer, MPH David Reagan, M.D. Larry Arnold, M.D. Mitchell Mutter, M.D. Department of TennCare Vaughn Frigon, M.D.

  34. Chronic Pain Guideline Panel Members • Michael O'Neil, D.Ph. • Paul Dassow, M.D. • Raymond McIntire, DPh • Rett Blake, M.D. • Stephen Loyd, M.D. • Ted Jones, PhD • Thomas Cable, M.D. • Tracy Jackson, M.D. • W. Clay Jackson, M.D. • William Turney, M.D. Autry Parker, M.D. Brett Snodgrass, APN C. Allen Musil, M.D. Carla Saunders, APN Charles McBride, M.D. James Choo, M.D. Jason Carter, DPh Jeffrey Hazlewood, M.D. Jim Montag, PA-C John Culclasure, M.D. Katie Liveoak, D.Ph.

  35. Chapters of the TN Treatment Guidelines • Appendices • Pain Medicine Specialist • Risk Assessment Tools • Pregnant women • Use of Opioids in Worker's Compensation Medical Claims • Tapering protocol • Sample Informed consent • Sample Patient Agreement • Controlled Substance Monitoring Database • Medication Assisted Treatment Program • Morphine equivalents dose • Psychological Assessment Tools • Prescription Drug Disposal • Safety Net • Definitions • Table of Frequently Prescribed Pain Medications • Urine Drug Testing • Special Consideration: Women of Child Bearing Age • Introduction • Before initiating chronic opioid therapy (over 90 days) • Screening (including TN risk model), non-opioid therapies, referral to MH, others • Informed consent • Women's special considerations • Initiating chronic opioid therapy • Standard therapy, combination therapy • Special considerations • Methadone/buprenorphine • UDS - qualitative & quantitative • CSMD • Documentation in decision making • Follow up therapy • UDS - qualitative & quantitative • CSMD • ED visits for OD • What constitutes a failure of standard therapy? • Referral to pain specialist • Taper / discontinuation of opioids • Documentation of decision making

  36. Section I: Prior to Initiating Opioid Therapy • Non Opioid Treatment if Possible • All Newly Pregnant Women Should • Complete evaluation: History and Physical • Testing documented in medical record prior • Chronic Pain shall not be treated via telemedicine • Co-Morbid Mental Conditions • There shall be the establishment of a current diagnosis that justifies a need for opioid therapy

  37. Section I: Prior to Initiating Opioid Therapy (cont.) • Risk for Abuse • Validated Risk Tools • CSMD • UDT • Goals for Treatment • Treatment plan for opioid and non-opioid treatment • Increase function, not to eliminate pain • Documentation in medical record

  38. Section II: Initiating Opioids • Maximum four doses of short-acting opioids per day • Non pain medicine specialist should not prescribe methadone • Prescribers shall not prescribe buprenorphine in oral or sublingual for chronic pain • Avoid benzodiazepines • Document reasons for deviation from guidelines in record

  39. Section II: Initiating Opioids (cont.) • Therapeutic trial • Lowest possible dose • Opioid Naïve • Informed Consent • Treatment Agreement female patient • Continually monitor for abuse, misuse, or diversions • CSMD and UDT

  40. Section II: Initiating Opioids (cont.) • Women’s Health • Birth Control Plans • Informed Consent • Ask regarding pregnancy each visit • Before starting opioids – in women shall have pregnancy test

  41. Section III: Treatment with Opioids • Single provider and pharmacy • Opioids used at lowest effective dose • Ongoing Therapy • Greater than 120 MEDD (Morphine Equivalent Dose) should refer to Pain Specialists • Greater than 120 MEDD shall refer • UDT twice/year • Continual assessment via 5A’s UDT, CSMD • Emergency Physician, Primary Provider Communication • Discontinue when risk greater than benefits

  42. ABPM • Recognizes boards in the following certification as qualified to sit for Board Exam • Anesthesia • Psychiatry • Neurology • Neurosurgery • Physical Medicine and Rehabilitation • 50 hours CME in Pain Medicine past two (2) years • Substantial, recent and comprehensive clinical practice experience

  43. Pain Specialist • Board of Medical Specialties (ABMS) primary physician certification organization in US • ABMS certifies pain medicine fellowship programs in Anesthesia, Physical Medicine and Neurology • American Board of Pain Medicine (ABPM) is not ABMS and does not oversee fellowship training programs. • ABPM offers practice – related examinations to qualified candidates. Diplomates of ABPM have certification in Pain Medicine • AOA Certification

  44. Pain Specialist (cont.) • Patients requiring less than 120 MEDD • Must have valid license by respective board and DEA • CME pertinent to pain management directed by regulatory board • Recommend (do not require) 3 year residency and be ABMS eligible or certified

  45. Pain Specialist (cont.) • Patients requiring ≥ 120 MEDD • 11 times more likely to have adverse event such as overdose death • Consultation with pain consultant who has additional in pain medicine is recommended • Pain Consultant up to 7/1/2016 shall have unencumbered license with no prior actions unless an exception is approved by the respective board • Two year experience • Minimum 25 CME hours in pain management every 12 months • Pain consultants after 7/1/2016 shall have ABPM diplomate status or ABMS Boards

  46. Websites Prescription for Success http://tn.gov/mental/prescriptionforsuccess/ Pain Clinic Website http://health.state.tn.us/Boards/PainClinicRegistry.shtml Pain Clinic Guidelines http://health.state.tn.us/Downloads/ChronicPainGuidelines.pdf 2014 Legislative Report http://health.state.tn.us/boards/Controlledsubstance/PDFs/CY%202013%20CSMD%20Report%20to%20the%20General%20Assembly%20Post.PDF

  47. Questions and Contact Information Andrew Holt, PharmD Controlled Substance Monitoring Database Tennessee Department of Health Andrew.Holt@tn.gov 615-253-1300

More Related