Preventing Prescription Drug Abuse: Laws and Legislation

1. Preventing Prescription Drug Abuse: Laws and Legislation Hollie Hendrikson, MSc. Hollie.Hendrikson@ncsl.org 303-856-1525 Policy Specialist, Health Program National Conference of State Legislatures

2. Prescription Drug Overdose and Abuse: A Growing Problem Source: National Center for Health Statistics, Drug Poisoning Deaths in the United States Databrief, 2011.

3. Prescription Drug Abuse: Overdose Death Rates and Amount Sold Drug overdose death rates per 100,000 people (2008) Amount of prescription painkillers sold per 10,000 people (2010) Source: National Center for Injury Prevention and Control, 2011.

4. Impact of Opioid Use on Health Care For every 1 overdose death there are: Source: National Center for Injury Prevention and Control, 2011.

5. Where are the nonmedical users getting their drugs? Bought from friend or relative Took from friend or relative w/o asking 70% obtained from friend or relative Bought from drug dealer Other source Free from friend or relative From one doctor Source: SAMHSA, 2009 National Survey on Drug Use and Health (September 2010).

6. Common Legislative Issues • Prescription Drug Monitoring Programs (PDMP) • “Doctor Shopping” • Tamper-resistant prescription forms • Pain management clinic oversight • Immunity or “Good Samaritan” laws

7. Prescription Drug Monitoring Programs (PDMP) • Established to help prescribers, pharmacies, law enforcement agencies, etc., track who is writing, filling and receiving prescribed controlled substances. • In Oklahoma: • PDMP is housed in the Bureau of Narcotics (CA, NJ, PA, TX). • Prescriptions are required to be reported to PDMP. • Data collected daily. • Data accessible to: prescribers, pharmacists, pharmacies, law enforcement, licensing boards, the Attorney General and medical examiners.

8. States with Prescription Drug Monitoring Programs Source: National Center for Injury Prevention and Control, 2011.

9. 2012 Prescription Drug Monitoring Program Legislation Idaho House Bill 439: Allows licensed practitioners in other states to access data and information within the PDMP. Enacted, 2012. New Hampshire Senate Bill 215: Establishes a PDMP. Enacted, 2012. Utah House Bill 257: Provides a procedure for an emergency room employee to look up information in the PDMP. Enacted, 2012. Louisiana Senate Bill 112: Authorizes the sharing of PDMP information with PDMP located in other states. Enacted, 2012.

10. Doctor Shopping Laws • “Doctor Shopping” typically refers to a patient obtaining controlled substances from multiple providers without the prescribers’ knowledge of the other prescriptions. • Uniform Narcotic Drug Act of 1932 • Almost all states have adopted a general fraud statute that prohibit obtaining drugs by: fraud, deceit, misrepresentation, subterfuge or concealment of material fact.

11. Doctor Shopping Laws, cont. • Specific doctor shopping laws: • Prohibit patients from withholding prior prescription information from any health care provider. • Example: • South Dakota: any person who knowingly obtains a controlled substance from a medical practitioner and who knowingly withholds information from that medical practitioner that (s)he has obtained a controlled substance of similar therapeutic use in a concurrent time period from another medical practitioner.

12. States with Doctor Shopping Laws Source: National Center for Injury Prevention and Control, 2011.

13. Tamper-Resistant Form Laws • Requiring special tamper-resistant prescription forms for controlled substances. • As of 2008, all prescriptions covered by the Medicaid program are required to use special tamper-resistant prescription forms. • In Oklahoma: • Tamper-resistant prescription forms are required for all prescriptions. • All written prescriptions must conform with federal tamper-resistant prescription form regulations.

14. States with Tamper-Resistant Form Laws Source: National Center for Injury Prevention and Control, 2011.

15. 2012 Tamper-Resistant Legislation Tennessee Senate Bill 3003: Requires the board of pharmacy to publish a list of opioid drugs incorporating tamper-resistant technology. Enacted, 2012.

16. Pain Management Clinic Laws • Pain management clinics or “pill mills” are facilities that employ a physician who is primarily engaged in the treatment of pain by prescribing or dispensing controlled substance medications. • Pain clinic laws typically require oversight of clinic or describes specific regulations (patient registration, physician licensure, ownership requirements, payment methods, etc.).

17. States with Pain Management Clinic Laws Source: National Center for Injury Prevention and Control, 2011.

18. 2012 Pain Management Clinic Legislation Tennessee House Bill 1040: Establishes certain requirements for pain management clinics including allowed payment methods, limits on clinic ownership, and prescription limits. Enacted, 2012.

19. Immunity from Prosecution Laws • Provides a degree of immunity to an individual seeking help for themselves or for another person experiencing an overdose. • Examples: • A person experiencing an overdose and needing medical attention will not be prosecuted for possession resulting from evidence gained from the call for help (New Mexico and Washington). • Protection from prosecution will not extend to other criminal charges (Washington).

20. States with Immunity or “Good Samaritan” Laws Source: National Center for Injury Prevention and Control, 2011.

21. Hollie Hendrikson, MSc. Hollie.Hendrikson@ncsl.org 303-856-1525 http://www.ncsl.org/issues-research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx