Transcript The Diversion Alert Program: A Promising Approach to

Maine
Diversion Alert Program
PMP
Rx abuse in Maine
Drug Overdose Deaths By State - 2008
Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. 2011.
Rx abuse in Maine
Source: Maine Treatment Data System, Maine Office of Substance Abuse and Mental Health Services (2013).
So, why is the problem
so big here?
Kilograms of prescription painkillers sold,
rates per 10,000 people
Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention 2011.
Source: Substance Abuse and Mental Health Services Administration (2010.
What is the Diversion
Alert Program?
 Monthly emailed/mailed alerts to health care
providers showing individuals arrested for illegal
drug related crimes;
 Online, password protected drug arrest
database; and
 Educational resources to assist in responding to
patients charged with illegal drug related crimes.
Is it legal to distribute
arrest information?
Yes.
Under Maine’s Criminal History Record
Information Act, a criminal justice agency
may disclose to the public criminal history
record information related to an offense for
which a person is currently within the
criminal justice system. This includes recent
arrests that are actively being prosecuted
[16 M.R.S. § 612(3)(A)].
Arrest, summons,
conviction
Arrest: gives notice to an individual that
he/she is being charged with a crime.
Person is detained.
Summons: gives notice to an individual
that he/she is being charged with a crime.
Conviction: formal declaration by a court
that a person has been found to have
committed (is “guilty” of) a crime.
How does the
program work?
Law enforcement agencies submit data.
Data is entered into online database.
Public health district and statewide reports
are emailed or mailed to registered
participants.
Districts Reports
 Aroostook
 Washington/Hancock
 Penobscot/Piscataquis
 Kennebec/Somerset
 Lincoln, Waldo, Knox, Sagadahoc
 Androscoggin, Franklin, Oxford
 Cumberland
 York
 Statewide
Who can register to access
Diversion Alert data?
• Pharmacists
• Licensed Maine prescribers (e.g. NPs, MDs, DOs,
PAs, dentists, podiatrists)
• Sub-recipients authorized by licensed prescribers
or pharmacists (e.g. medical office managers,
social service providers)
• Law enforcement personnel
Data accuracy
• Data cannot be guaranteed without error.
• You may also wish to confirm the identity
of the individual through:
– Booking photo included in monthly reports
– Contacting law enforcement agency that
arrested the individual
Participant
responsibilities
• Use of data in a manner consistent with
professional/ethical standards;
• Treat data as sensitive information;
• Keep data in a safe location;
• Using other resources confirm that a
positive identification has been made.
Data should not be
used as:
• as a data source for academic research;
• as the sole source for clinical decisionmaking.
Why use
Diversion Alert?
• Helps you make informed decisions about
patient care;
• Identifies patients:
– In need of substance abuse treatment
– Who may be drug seeking for the purpose of
diversion
• Assist in compliance with rules/guidelines
recommended by professional boards.
Responding to patients
charged with prescription or
illegal drug related crimes.
Tips are based on the recommendations of:
James A. Owen (PharmD, Assoc. Vice President, Professional Practice, American
Pharmacists Association) and Crespi Lofton, (MS), in conjunction with staff from
the American Pharmacists Association. The recommendations were published in
the Journal of the American Pharmacists Association, January/February 2014,
Volume 54(1) under the title “Pharmacists’ role in addressing opioid abuse,
addiction and diversion.”
Find out as much info as needed
to make an informed decision
about how to respond to your pt.
Talk to your patient to determine the issue behind
the arrest (i.e. addiction, profit, helping a friend).
Check PMP for atypical or concerning patterns.
Talk to prescribers and pharmacists who share the
patient’s treatment with you.
Contact the arresting agency for more information
about the criminal charge.
If you suspect misuse,
abuse or diversion…
Notify the patient’s prescriber and local law
enforcement.
Refuse to fill the prescription.
ME regulation pertaining to
refusal to fill and reporting to
law enforcement:
2. Refusal to fill prescription, dispense drug or sell targeted
methamphetamine precursor; law enforcement reporting. A pharmacist or
person acting at the direction of a pharmacist may exercise discretion and
refuse to fill any prescription, dispense any drug or sell any targeted
methamphetamine precursor if unsatisfied as to the legitimacy or
appropriateness of any prescription presented, the validity of any photographic
identification or the identity of any patient presenting a prescription or any
person acting on behalf of the patient, or the intention of the customer to use
the drug or targeted methamphetamine precursor according to the instructions
for use. A pharmacist or person acting at the direction of a pharmacist may
make a report to a law enforcement agency when that person has reasonable
cause to suspect that a prescription is not legitimate or appropriate, that a
person has presented photographic identification that is not valid or that a
customer has the intention to use a drug or targeted methamphetamine
precursor in a manner inconsistent with the instructions for use.
Maine Regulations—32 M.R.S.A, Section 13795 [ 2005, c. 430, §10 (AFF); 2005, c. 430, §7 (AMD) .]
ME regulation pertaining to refusal to
fill and reporting to law enforcement
con’t:
3. Immunity; presumption of good faith. A pharmacist or
person acting at the direction of a pharmacist who in good faith
and pursuant to subsection 2 refuses to fill any prescription,
dispense any drug or sell any targeted methamphetamine
precursor or who makes a report to a law enforcement agency
is immune from any civil liability that might otherwise result
from that action, including, but not limited to, any civil liability
that might otherwise arise under state or local laws or rules
regarding confidentiality of information. In a proceeding
regarding immunity from liability, there is a rebuttable
presumption of good faith.
• [ 2005, c. 430, §10 (AFF); 2005, c. 430, §7 (NEW) .]
Federal Regulations
A pharmacist is required to exercise sound professional judgment when
making a determination about the legitimacy of a controlled substance
prescription. Such a determination is made before the prescription is
dispensed. The law does not require a pharmacist to dispense a
prescription of doubtful, questionable, or suspicious origin. To the contrary,
the pharmacist who deliberately ignores a questionable prescription when
there is reason to believe it was not issued for a legitimate medical
purpose may be prosecuted along with the issuing practitioner, for
knowingly and intentionally distributing controlled substances. Such action
is a felony offense, which may result in the loss of one’s business or
professional license (see United States v. Kershman, 555 F.2d 198 [United
States Court Of Appeals, Eighth Circuit, 1977]).
Source: DEA Pharmacist’s Manual: An Information Outline of the
Controlled Substances Act of 1970
Document your response to the
criminal charges against
your patient:
Document that you received the information,
investigated the allegations, and had a discussion
with your patient.
Come up with a tentative plan about how to respond
before you talk to your patient.
Document your final plan and the reasoning behind
it.
Follow through on your plan and document that you
did.
If you modify your initial plan, document that you did
so and why.
References:
Centers for Disease Control and Prevention. Policy Impact: Prescription
Painkiller Overdoses. Atlanta, GA: US Department of Health and Human
Services; 2011.
Substance Abuse and Mental Health Services Administration. Results from the
2010 National Survey on Drug Use and Health: volume 1: summary of national
findings. Rockville, MD: Substance Abuse and Mental Health Services
Administration, Office of Applied Studies; 2011. Available from URL:
http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16External
Web Site Icon.
Owen, JA & Lofton, C. (2014). Pharmacists’ role in addressing opioid abuse,
addiction and diversion. Journal of the American Pharmacists Association, 54(1).
DEA. Pharmacist’s Manual: An Information Outline of the Controlled Substances
Act of 1970. Washington, DC: DEA; 2010.
http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_manual.htm.
Accessed March 5, 2014.
Contact information
Clare Desrosiers, Program Director
[email protected]
207-521-2408
www.diversionalert.org