maximizing use of prescription drug monitoring programs · 1 maximizing use of prescription drug...

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Maximizing Use of Prescription Drug Monitoring Programs

Christopher M. Jones, PharmD, MPH

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C stop e . Jo es, a D,

Division of Unintentional Injury PreventionNational Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Overview of Presentation• PDMP background

• Status of PDMPs

• PDMP effectiveness

• Current initiatives

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Current initiatives

• Other prescription drug monitoring options

• Conclusions

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CDC Goal

Reduce abuse and overdose of opioids and other controlled prescription drugs whileother controlled prescription drugs while ensuring patients with pain are safely and effectively treated.

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Motor vehicle traffic, poisoning, and drug poisoning (overdose) death rates

United States, 1980-2010

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Motor Vehicle Traffic Poisoning Drug Poisoning (Overdose)

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NCHS Data Brief, December, 2011, Updated with 2009 and 2010 mortality data

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1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Dea

ths

Year

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Drug overdose deaths by major drug type,US, 1999-2010

16,000

18,000

Opioids Heroin Cocaine Benzodiazepines

6,000

8,000

10,000

12,000

14,000

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CDC/NCHS National Vital Statistics System, CDC Wonder

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2,000

4,000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Year

Rates of Opioid Overdose Deaths, Sales, and Treatment Admissions, US, 1999-2010

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Opioid Sales KG/10,000 Opioid Deaths/100,000 Opioid Treatment Admissions/10,000

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3

4

5

6

7

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0

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Year

CDC MMWR. 2011. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60e1101a1.htm?s_cid=mm60e1101a1_w updated with 2009 mortality and 2010 treatment admission data

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CDC public health policy options

Prescription Drug Monitoring Programs (PDMPs)

Patient Review & Restriction Patient Review & Restriction Programs

Laws/Regulations/Policies

Insurers & Pharmacy Benefit Managers (PBM) mechanisms

Clinical Guidelines

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Substance Abuse Treatment

State databases that collect information on dispensed controlled prescriptions drugs by pharmacies (and dispensing physicians in some states)

What are PDMPs?

Data Collected CII-CIV prescriptions (some CV)

Prescriber

Dispenser

Patient

Date Dispensed

Drug

Strength

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Strength

Quantity

Refills

Method of Payment

Variation in state programs

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How can PDMPs be used?

Clinical

Regulatory Oversight y

Surveillance and Evaluation Tool

Law Enforcement

Passive vs Proactive

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• Status of PDMPs



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Current initiatives


• Conclusions

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Current status of PDMPs

49 States have legislation authorizing a PDMP

Operational in 42 states

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Best practices

Outlines a set of best practices

Research agenda

PDMP Funding

A f b iA few best practicesAllow access to prescribers and dispensers

Allow access to regulatory boards, state Medicaid and public health agencies, Medical Examiners, and law enforcement (under appropriate circumstances)

Provide real-time data and access

Share data with other states

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Share data with other states (interoperability)

Integrate with other health information technology to improve use among health care providers

Have ability to send unsolicited reports

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• Status of PDMPs



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Current initiatives


• Conclusions

PDMP effectiveness- peer-reviewed literature

Research consistently suggests PDMPs reduce prescribing of schedule II opioid analgesics.

One study found compensatory increases in schedule III opioids.

2009 study found states with PDMPs had lower opioid substance abuse treatment rates compared to states without PDMPs.

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1. Simeone R, Holland L. Washington, D.C.: U.S. Dept. of Justice, Office of Justice Programs2006 2006. http://www.simeoneassociates.com/simeone3.pdf2. Curtis LH, Stoddard J, Radeva JI, Hutchison S, Dans PE, Wright A, et al. Geographic variation in the prescription of schedule II opioid analgesics among outpatients in the United States. Health Serv Res. 2006 2006;41:837-55.3. Paulozzi L, Kilbourne E, Desai H. Prescription drug monitoring programs and death rates from drug overdose. Pain Medicine. 2011;12:747-54.4. Reisman RM, Shenoy PJ, Atherly AJ, Flowers CR. Prescription opioid usage and abuse relationships: an evaluation of state prescription drug monitoring program efficacy. Substance Abuse: Research and Treatment. 2009;3(SART-3-Shenoy-et-al):41.

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PDMP effectiveness- peer-reviewed literature

2012 analysis of poison control center data concluded states with PDMPs had lower annual increases in opioid misuse or abuse from 2003-2009

Use of PDMP data in an ED suggests it can change prescribing. PDMP data review changed prescribing in 41% of cases

61% received fewer or no opioids

39% received more opioid medication than previously planned

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Impact on overdose mortality has not been found, at least based on data through 2005.

1. Reifler L, Droz D, Bailey J, Schnoll S, Fant R, Dart R, et al. Do prescription monitoring programs impact state trends in opioid abuse/misuse? Pain Medicine. 2012;3(3):434-42.2. Baehren DF, Marco CA, Droz DE, Sinha S, Callan EM, Akpunonu P. A statewide prescription monitoring program affects emergency department prescribing behaviors. Ann Emerg Med. 2009 2009;doi:10.1016/j.annemergmed.2009.12.011.3. Paulozzi L, Kilbourne E, Desai H. Prescription drug monitoring programs and death rates from drug overdose. Pain Medicine. 2011;12:747-754.

PDMP Effectiveness –Grey Literature

Surveys indicate prescribers find PDMPs to be a useful clinical tool.

Surveys find clinicians in many cases report altering their prescribing after reviewing a PDMP report.

Proactive reporting reduces doctor shopping by increasing awareness among providers about at-risk

i l di h i ibi b h i

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patients leading to changes in prescribing behaviors.

1. PMP Center of Excellence, “Trends in Wyoming PMP prescription history reporting: evidence for a decrease in doctor shopping?” 2010, http://www.pmpexcellence.org/sites/all/pdfs/NFF_wyoming_rev_11_16_10.pdf2. PMP Center of Excellence, “Nevada’s Proactive PMP: The Impact of Unsolicited Reports” October, 2011. http://www.pmpexcellence.org/sites/all/pdfs/nevada_nff_10_26_11.pdf4. Alliance of States with Prescription Monitoring Programs, “An Assessment of State Prescription Monitoring Program Effectiveness and Results” Version 1, 11.30.07, http://pmpexcellence.org/pdfs/alliance_pmp_rpt2_1107.pdf5. Kentucky Cabinet for Health and Family Services and Kentucky Injury Prevention and Research Center, 2010 KASPER Satisfaction Survey. 6. Lambert D. Impact evaluation of Maine’s prescription drug monitoring program. Muskie School of Public Service, University of Southern Maine: Portland, Maine, March, 2007.7. Communication from LA PMP to PMP Center of Excellence.

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PDMP Effectiveness –Grey Literature

Public safety officials have endorsed the utility of PDMPs.A 2010 survey found 73% of KY law enforcement officers who law enforcement officers who used PDMP data strongly agreed that the PDMP was an excellent tool for obtaining evidence in the investigative process.”2002 GAO report concluded

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2002 GAO report concluded that PDMPs are a useful tool to reduce drug diversion.

1. PMP Center of Excellence. Perspective from Kentucky: using PMP data in drug diversion investigations. May, 2011. http://www.pmpexcellence.org/sites/all/pdfs/NFF_kentucky_5_17_11_c.pdf2. U.S. General Accounting Office. Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion. Washington, DC: U.S. General Accounting Office; 2002. Report No. GAO-02-634


• Status of PDMPs



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Current initiatives


• Conclusions

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Current PDMP Initiatives

ONC – SAMHSA – ONDCP – CDC Health Information Technology and PDMP Pilot programs

SAMHSA – CDC PDMP Interoperability and Electronic Health Record Integration Project

ONDCP Interagency Working Group subcommittee on PDMP integration

Providing technical assistance to states and others to:Focus efforts on patients at highest risk of abuse and overdose

Focus on prescribers deviating from accepted medical practice

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p g p p

Maximize surveillance and evaluation capabilities of PDMPs

Bureau of Justice Assistance – CDC MOU

Various PDMP evaluations

Interoperability

RxCheck (formerly PMIX)AL, KY and FL are connected

ME working on MOUs with AL, KY, MA, WA, VT

MA working on MOU with KY and ME

PMPi (NABP)AZ, CT, IN, KS, MI, NM, ND, OH, SC, VA are connected

Several other states currently working on connecting or MOUs

HID AL and ME are connected (data sharing unclear)

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( g )

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• Status of PDMPs



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Current initiatives


• Conclusions

What about other monitoring programs?

Insurer and pharmacy benefit manager claims dataIdentify high-risk patients

Identify inappropriate prescribing

Identify geographic patterns

Drug utilization review programs can alert to high-dose opioid prescribing and other potential risky medication combinations at the point of care and point of dispensing

A recent randomized trial of use of proactive reporting by an insurer rather than a PMDP suggests such reporting reduces the number of prescribers and

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reporting reduces the number of prescribers and prescriptions.

1. Gonzalez A, Kolbasovsky A. Impact of a managed controlled-opioid prescription monitoring program on care coordination. Am J Manag Care. 2012;18(9):516-24.

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Conclusions

PDMPs are a promising intervention to address prescription drug abuse, diversion, and overdoseprescription drug abuse, diversion, and overdose

Serve multiple purposes – clinical, surveillance, evaluation, regulatory and enforcement

Multiple efforts at the Federal and state level to maximize utility of PDMPs

Current research will further inform evidence-base

i l b i d

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State support to implement PDMP best practices and evaluate impact is critical

Additional information

http://www.cdc.gov/HomeandRecreationalSafety/pdf/PolicyImpact-PrescriptionPainkillerOD.pdf

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6126a5.htm?s_cid=mm6126a5_w

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Christopher M. Jones, PharmD, MPH

Thank You

p , ,[email protected]

The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.

maximizing use of prescription drug monitoring programs · 1 maximizing use of prescription drug...

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