Transcript Slide 1

Prescription Drug Monitoring Programs:
Current and Potential Use in Drug Court
Case Management
National Association of Drug Court Professionals
Webinar
March 21, 2014
Agenda
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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 Courts
State
In state
Out of state Authorization Mechanism
Alaska
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Idaho
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Illinois
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Indiana
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Policy for probation officers and drug court
staff
Kentucky
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Direct statutory authority
Mississippi
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Court order
Utah
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Via law enforcement or participant release
Wyoming
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Participant release (probation only)
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Court order or participant release
Under law enforcement and special
prosecutors
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Under law enforcement and prosecutors
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:
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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 rates
United States, 1980-2010
Motor Vehicle Traffic
Poisoning
Drug Poisoning (Overdose)
Deaths per 100,000 population
25
20
15
10
5
0
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
Year
Source: CDC, NCHS Data Brief, December, 2011, Updated with 2009 and 2010 mortality data
2004
2006
2008
2010
Drug Overdose Deaths by Major Drug Type, U.S., 1999-2010
Opioids
Heroin
Cocaine
Benzodiazepines
18,000
16,000
Number of Deaths
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Year
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
Opioid Sales KG/10,000
Opioid Deaths/100,000
Opioid Treatment Admissions/10,000
8
7
6
Rate
5
4
3
2
1
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Year
Source: National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS
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
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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:
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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 Program
GOALS
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Education & Information
Public Health Initiatives
Early Intervention & Prevention
Investigation & Enforcement
Source: Alliance of States with Prescription Monitoring Programs
PDMP System
Overview
Dispensers
Data
Submitted
Reports
Sent
State
PDMP
Pharmacists
Reports
Sent
Law
Enforcement
& Professional
Licensing
Agencies
*Groups other than those listed may also receive reports
Prescribers
Reports
Sent
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
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NF 2.4
Monitoring and Changing Behavior: The Role of
PMP Data in Kentucky Drug Courts
August, 2011
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
KASPER OPERATION
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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:
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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.
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.
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
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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 Practices
September 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:
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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 Program
Center of Excellence
Brandeis University
Supported by the
Bureau of Justice Assistance
www.pdmpexcellence.org
PDMP COE Contact Information
PDMP Center of Excellence of Brandeis University
www.pdmpexcellence.org
781-736-3909
John Eadie, MPA, Director
[email protected]
518-429-6397
Peter Kreiner, Ph.D., Principal Investigator
[email protected]
781-736-3945
Webinar Contact Information
• Judge Charles Hickman
Vice-chief Regional Circuit Judge and Chief Circuit Judge
Kentucky Circuit Court 53, Shelbyville, Kentucky
[email protected]
• Grant Carrow, Ph.D.
Project Consultant
Prescription Drug Monitoring Program Center of Excellence
Brandeis University, Waltham, Massachusetts
[email protected]
• Ashley Harron, Psy.D., J.D.
Associate Chief of Science, Law and Policy
National Association of Drug Court Professionals, Alexandria, VA
[email protected]