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

National Association of Drug Court Professionals Webinar

March 21, 2014

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

Status of Prescription Drug Monitoring Programs and Drug

Courts

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.

Source: PDMP Training & Technical Assistance Center, Brandeis University

States Providing Solicited PDMP Reports to Drug CourtsState In state Out of state Authorization Mechanism

Alaska Court order or participant release

Idaho Under law enforcement and special prosecutors

Illinois Under law enforcement and prosecutors

Indiana Policy for probation officers and drug court staff

Kentucky Direct statutory authority

Mississippi Court order

Utah Via law enforcement or participant release

Wyoming Participant release (probation only)

Source: Compiled from information provided by the PDMP Training and Technical Assistance Center, 2012, 2013

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

Prescription Drug Diversion and Abuse

Key Points

Motor vehicle traffic, poisoning, and drug poisoning (overdose) death ratesUnited States, 1980-2010

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 20100

5

10

15

20

25

Motor Vehicle Traffic Poisoning Drug Poisoning (Overdose)

Year

Deat

hs p

er 1

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00 p

opul

ation

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

Drug Overdose Deaths by Major Drug Type, U.S., 1999-2010

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

Opioids Heroin Cocaine Benzodiazepines

Year

Num

ber

of D

eath

s

Source: CDC, National Center for Health Statistics, National Vital Statistics System. Updated with 2010 mortality data

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

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

1

2

3

4

5

6

7

8

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

Year

Rate

Past Month Illicit Drug Use among Persons Aged 12 or Older

Source: SAMSHA, National Survey on Drug Use and Health, 2012

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

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

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

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

How does a PDMP work?

Prescription Drug Monitoring ProgramGOALS

• Education & Information• Public Health Initiatives• Early Intervention & Prevention• Investigation & Enforcement

Source: Alliance of States with Prescription Monitoring Programs

PDMP System Overview

State PDMP

Dispensers

Prescribers

Law Enforcement &

Professional Licensing Agencies

Pharmacists

Data Submitted

Reports Sent

Reports Sent

Reports Sent

*Groups other than those listed may also receive reports

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

KASPER Law Enforcement Request

Source: Washington State PMP & PDMP Training and Technical Assistance Center

KASPER Patient Rx History Report

Source: Washington State PMP & PDMP Training and Technical Assistance Center

PDMPs and Drug Court Case Management

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

Kentucky PDMPKentucky 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

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

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

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

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.

• 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.

Access by Drug Court Judges (cont’d)

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.

PDMP Data Use by Kentucky Drug Courts

Source: Kentucky Administrative Office of the Courts, data collected July 2011

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.

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.

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.

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.

Purposes of PDMP Data Use by Kentucky Drug Courts

Source: Kentucky Administrative Office of the Courts, data collected July 2011

Drug Courts Working with PDMPs

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

White Paper on PDMP Best Practices

Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best PracticesSeptember 20, 1012

• at www.pdmpexcellence.org • Developed with BJA and Pew Charitable Trusts• 35 Best and Promising Practices

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

How to find contact information for a state’s PDMP?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.

www.pdmpassist.org

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

Resources

Handout

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

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

www.pdmpexcellence.org

Prescription Drug Monitoring ProgramCenter of Excellence

Brandeis University

Supported by the Bureau of Justice Assistance

www.pdmpexcellence.org

PDMP COE Contact InformationPDMP Center of Excellence of Brandeis University

www.pdmpexcellence.org781-736-3909

John Eadie, MPA, Directorjeadie@brandeis.edu

518-429-6397

Peter Kreiner, Ph.D., Principal Investigatorpkreiner@brandeis.edu

781-736-3945

Webinar Contact Information• Judge Charles Hickman

Vice-chief Regional Circuit Judge and Chief Circuit JudgeKentucky Circuit Court 53, Shelbyville, KentuckyPattiMowery@kycourts.net

• Grant Carrow, Ph.D.Project ConsultantPrescription Drug Monitoring Program Center of ExcellenceBrandeis University, Waltham, MassachusettsGCarrow@brandeis.edu

• Ashley Harron, Psy.D., J.D.Associate Chief of Science, Law and PolicyNational Association of Drug Court Professionals, Alexandria, VAAHarron@nadcp.org