Transcript Slide 1

Partnership for Change: Decreasing
prescription drug diversion in Kennebec
County
Nancy Findlan
Charles J. Rumsey IV
Alison Jones Webb
2008 International Symposium on
Pharmaceuticals in the Home and
Environment: Catalysts for Change
November 10, 2008
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Partnership for Change: Decreasing
prescription drug diversion in Kennebec
County
Presentation overview

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

Prevention Framework
Community
Law Enforcement
Health Care Providers
Q&A
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Substance Abuse Prevention:
Why bother?
300
Kennebec County
Other opiates and
other synthetics
200
100
20
05
20
03
20
01
19
99
19
97
0
19
95
Number of
admissions
Treatment admissions for opioid dependence:
Kennebec County
Kennebec County
Heroin/Morphine
Year
Maine Office of Substance Abuse Treatment Data System:
https://portalx.bisoex.state.me.us/jav/osa_tdsreports/home.do accessed July 24, 2008
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Substance Abuse Prevention:
Why Bother?
Unintentional Drug Overdoses Kennebec County,
Top 5 Towns
140
120
100
80
60
40
20
Waterville
Augusta
20
06
20
05
20
04
20
03
20
02
0
Winslow
Oakland
Winthrop
Maine Health Information Center
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Substance Abuse Prevention:
Why bother?
Access to treatment

Nationwide, 15.2% of individuals with past-year
opioid use disorder received some form of
formal treatment or counseling in the past year.

If 437 individuals received treatment for opioid
use disorder in Kennebec County in 2006, then
2,875 did not receive treatment.
William C. Becker et al Opioid use disorder in the United States: Insurance status and treatment
access. Drug and Alcohol Dependence 94 (2008) 207-213.
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Universal, Selective and Indicated
Substance Abuse Prevention
Indicated
Prevention
Selective Prevention
Universal Prevention
Target: individuals with identified precursors of
alcohol or drug abuse. The targeted individuals
exhibit early signs of substance abuse and other problem
behaviors, such as falling grades among students,
known problem consumption or conduct disorders,
alienation from parents, etc.
Target: high risk groups. The targeted
groups may be distinguished by
characteristics such as age, gender,
family history, or economic status (e.g.
children of substance abusers).
Target: the entire population.
Interventions target an entire population
(local community, school district, etc.).
Karol L. Kumpfer, “Prevention of Alcohol and Drug Abuse: What Works?” in Strategic Plan for Interdisciplinary Faculty
Development, Association for Medical Education and Research in Substance Abuse, 2002.
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Environmental Substance Abuse
Prevention
•Reduce Access (server
trainings, enforcement of
laws, etc.)
Environmental
Prevention:
Regulatory or
community
level
interventions
to deter drug
consumption
Indicated
Selective
Universal
•Reduce Demand (health
education, warning labels,
etc.)
•Change community
environment (media
campaigns, counteradvertising, etc.)
Karol L. Kumpfer, “Prevention of Alcohol and Drug Abuse: What Works?” in Strategic Plan for Interdisciplinary Faculty
Development, Association for Medical Education and Research in Substance Abuse, 2002.
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Evidence-based interventions

Office of Substance Abuse SPF-SIG Strategy Approval Guide
http://www.maine.gov/dhhs/osa/prevention/community/spfsig/doc
uments/StrategyApprovalPacket_RevisedFinal_11-13-07.doc
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National Registry of Evidence-based Programs and Practices
(NREPP), a service of the Substance Abuse and Mental Health
Services Administration http://nrepp.samhsa.gov/

National Institute of Drug Abuse
www.nida.nih.gov/Prevention/Prevopen.html

The Community Guide http://www.thecommunityguide.org/
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Prevention Strategies Targeting Youth
Community

Greater Waterville Area Communities for Children and Youth
Prevention Coalition
 Community of Promise with the America's Promise
Network
 Recipient of Office of National Drug Control Policy’s Drug
Free Communities Grant
 Recipient of Maine Office of Substance Abuse Essential
Services Grant and Strategic Prevention Framework State
Incentive Grant
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Youth Prescription Drug Use in
Kennebec County
2002
2004
2006
Kennebec
County
14.4%
15.7%
11.7%
Maine
17.7%
16.6%
12%
In 2006, nearly 20% of high school seniors reported having “ever
used” prescription drugs (Kennebec County 19.2%; Maine 19.7%).
Maine Youth Drug and Alcohol Survey, 2002, 2004 and 2006
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Youth Prescription Drug Use in
Greater Waterville Area

Prescription Drug Use Students in grades 6 –12
 Smaller % of students reported misusing
prescription drugs in 2006 compared to 2002 and
2004.
 5% of students reported they have misused
prescription drugs 10 or more times in their
lifetime
Maine Youth Drug and Alcohol Survey, 2004 and 2006. Schools included Messalonskee Middle and High School,
Waterville junior high and high school, Winslow junior high and high school, Lawrence junior high and high school.
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Youth Prescription Drug Use in
Greater Waterville Area
Prescription Drug Misuse: All Grades (2004 and 2006
Previous 30-day
Lifetime Use
Use
Number of Times
2004
2006
2004
2006
Used
87.9
91.0
93.1
95.3
NO USE
5.4
3.2
4.7
2.1
1-2 TIMES
2.1
1.9
1.2
0.9
3-5 TIMES
1.9
0.8
0.9
0.5
6-9 TIMES
2.6
3.1
0.1
1.2
10 OR MORE
Maine Youth Drug and Alcohol Survey, 2004 and 2006. Messalonskee Middle and High School
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Environmental Prevention Strategies

Educate parents about their responsibilities with
regards to limiting access of prescription drugs,
proper use of prescription drugs and proper
disposal

Parent Media Campaign

Social Hosting
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Indicated Prevention Strategies

Educate youth about the dangers of misusing
prescription drugs and the risks associated with
misuse or abuse

Boomerang

Diversion to Assets Program
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Environmental Prevention
Strategies
Law Enforcement
Forging Partnerships to Reduce Access/
Abuse of Pharmaceuticals
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Working Together

Waterville Police Department:
 31 sworn officers
 2 officers assigned exclusively to drug investigations
 Networking with numerous law enforcement/
community health organizations
 Education about current trends in street level abuse
 Serve as source of information to medical
community
 Foster relationships to improve open
communication
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Working Together

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Kennebec Valley Drug Task Force:
 Includes members from 5 municipal/county law
enforcement agencies
 Share intelligence, manpower, equipment
 Mainly target prescription and “hard” drugs
Northern Kennebec Underage Drinking Task Force:
 Numerous agencies and community partners
 Conduct enforcement/compliance
 Education around underage drinking
 Encounter/enforce various drug violations
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Working Together

Maine Chiefs of Police Association
 This fall, MCOPA endorsed the efforts of the
Maine e-Prescribing Interest Group to advocate
for Maine’s doctors to be able to prescribe
controlled substances in a paperless environment:
 Reduces/eliminates use of paper prescriptions
 May reduce opportunity for theft, forgery and/or
diversion
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Innovative Programs

Waterville Police Department’s Crime Tip
Information Form:
 Allows area citizens to report illegal drug activity
anonymously
 Information is forwarded to on-duty supervisors for
review and action
 Can be accessed through:
 www.waterville-me.gov
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Innovative Programs

Waterville Police Department’s Prescription Drug
Diversion Program:
 Monthly mailing/email
 Maintains up-to-date list of offenders charged in
northern Kennebec County for prescription or
“hard” drug crimes or diversion crimes
 Mailing includes picture and other public
information
 Made available to doctors, emergency department
staff, pharmacists
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Prescription Drug Diversion Program

A tool for healthcare professionals to consider when
determining whether/how to prescribe
pharmaceuticals
 Partnership with local law enforcement, District
Attorney’s Office, healthcare professionals
 Enthusiastically received by community
 The program is being replicated by numerous law
enforcement agencies across the state
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Prescription Drug Diversion Program
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Moving Forward

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Key for law enforcement is continued investigation
and enforcement to disrupt supply
Waterville Police Department will continue to seek
ways to engage our healthcare partners in dialogue
to affect the problem
We will continue to cooperate with community efforts
such as “take back” programs
Please contact us for more information!
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Environmental Prevention Strategies
Health Care Providers
MaineGeneral Medical Center’s Prevention Center
 Recipient of Strategic Prevention Framework State
Incentive Grant
 Reduce Access: Prescription Monitoring Program
 Reduce demand: Alcohol/drug screening [brief
intervention, referral, treatment]
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Maine’s Prescription Monitoring Program
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Legislation passed in 2003
Scheduled drugs (II, III, and IV)
All transactions saved in centralized, relational
database
Data collection began in July of 2004
Data is submitted twice a month from over 300
pharmacies (both in and out of state)
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Maine’s Prescription Monitoring Program

Free service for registered prescribers

Online access to database for background check (patient
history report) on prescriptions of Schedule II, III, and IV
drugs for current and new patients

red flags of potential addiction and/or diversion
(e.g., “doctor-shopping”)
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Automatically generated Threshold Reports
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Coordinate care with other prescribers
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Sub-accounts for use by non-prescribers
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How do Prescribers use PMP in Kennebec
County?
90.2
Add info to
patient file
Call
pharmacist
25.5
29.4
23.5
Discharge
from
practice
39.2
Establish
pain
agreement
58.8
Discuss
with patient
100
80
60
40
20
0
Call other
prescribers
Percentage of
respondents
If you find through PMP that a patient is receiving
prescriptions from multiple providers, what is your
typical course of action?
2008 survey of MaineGeneral Medical Staff
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How do Prescribers use PMP in Kennebec
County?
Percentage of respondents
What criteria do you use when you consider
checking a patient record in PMP?
80.00%
74.50%
64.70%
60.00%
40.00%
29.40%
20.00%
0.00%
New patient
Monitor current
patient
Other
Most common “other” responses:

Suspicious patient behavior

New patients requesting narcotics
2008 survey of MaineGeneral Medical Staff
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Alcohol/drug Screening

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Promote evidence-based
screening tools
Educate health care
providers about substance
abuse treatment options
Promote substance abuse
treatment services
Promote treatment access
lines
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Alcohol/drug Screening
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Alcohol/drug Screening

Promote on-line self-assessment at worksites,
schools, in the community, etc.
www.alcoholscreening.org
www.drugscreening.org
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Contact Information

Nancy Findlan, Project Director, Greater Waterville Area
Communities for Children and Youth Prevention Coalition
[email protected]

Charles J. Rumsey IV, Deputy Chief of Police, Waterville
Police Department [email protected]

Alison Jones Webb, Public Health Specialist, MaineGeneral
Prevention Center [email protected]
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