Transcript Using the Maine PMP to Improve Prescribing Practices for

Using the Maine PMP to Improve
Prescribing Practices for Potentially
Addictive Prescription Medications
Patricia Lapera, MPH
Prescription Monitoring
Program Coordinator,
Office of Substance Abuse,
DHHS
State of Maine
Susan Payne, MPH, PhD
Research Professor
Institute for Health Policy,
Muskie School of Public
Service,
University of Southern Maine
Objectives of the session
Provide an overview of the misuse and
abuse of potentially addictive prescription
medications in Maine
 Describe the Maine Prescription
Monitoring Program (PMP)
 Describe how health care providers use
the PMP to improve prescribing
 Provide contact information on the PMP
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Potentially addictive or “controlled”
prescription medications
“Controlled” medications include pain
relievers, stimulants, sedatives,
tranquilizers, sleep aids, and hormone
supplements (Oxycodone, Vicodin,
Alprazolam).
 They are commonly prescribed.
 They have legitimate therapeutic uses and
can be used safely with medical oversight.
 They also have the potential to be addictive.
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Maine has serious problems with the
use of controlled medications
Deaths/100,000 People
16.00
14.00
12.00
10.00
8.00
6.00
4.00
2.00
0.00
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
YEAR
Source: Office of the Chief Medical Examiner; Marcella Sorg, UMaine/Smith Pol. Center
2008
Use of controlled medications is
increasing in Maine
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From 2005-2009, the number of prescriptions for
controlled medications in Maine increased by
24%.
Use of Schedule II medications (with highest
potential for addiction) grew faster than Schedule
III or IV (with lower potential).
Use of pain relievers is growing fast; they are often
used for non-medical reasons and are most
commonly obtained by diversion.
Prescriptions filled in Maine Age and
Year, 2005-2008
Source: Epidemiologic Study 2005-2008, Dr. Susan Payne
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Admissions to substance abuse treatment for
opiate abuse Maine: 1999-2008
4,500
4,000
3,500
3,000
2,500
Heroin/Morphine
Other Opiates
2,000
1,500
1,000
500
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
www.maine.gov/pmp
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“Doctor shopping” & “pharmacy
hopping”
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Most patients get their controlled medications
from only 1 or 2 prescribers.
However, some people use many prescribers or
pharmacies, so that it is harder to monitor and
control their medication use.
For example, in 2008, 1% of the people with
prescriptions for controlled medications in
Maine used 5 or more prescribers. Some
individuals used 50 or more prescribers.
The Maine Prescription Monitoring
Program (PMP)
What is the Maine PMP?
 What are the PMP goals?
 How does the PMP work?
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What is the Maine PMP?
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The Maine PMP provides information to
prescribers and pharmacists to identify
suspicious activity related to prescribing and
dispensing controlled substances.
It is under the Maine Office of Substance Abuse
(OSA).
It collects information from all pharmacies for
all prescriptions filled in Maine for medications
In US DEA Schedules II -IV.
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Prescribers and pharmacists can access the
information, after appropriate registration
processes are completed, through a secure,
password-protected PMP website.
They can verify patients’ reports on their use of
PMP-tracked medications and identify
questionable activity.
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PMP legislation passed in Maine in 2003.
-There are PMPs in more than 30 US states
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Data collection began July 2004.
Data are submitted once per week from over
600 pharmacies
All information is saved in a centralized
database, available online to data
requesters/sub-account users.
What are the goals of the PMP?
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To improve patient care by giving health care
providers comprehensive information
To curb misuse of prescription drugs
To ensure that those who do need
prescription medications still receive them
To get those who are addicted into
appropriate treatment
To help stop prescription drug overdoses and
overdose deaths
To educate the public on the dangers of
prescription drug misuse and abuse
How does the PMP work?
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Who has access to the data?
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Prescribers, other licensed providers and medical
office assistants (new)
Pharmacists
Licensing boards
Patients
OSA staff members
Law enforcement- through grand jury subpoena
Office of MaineCare Services
Office of the Chief Medical Examiner
Two useful PMP reports
Requested reports
 Health care professionals can register with
the PMP to request online patient history or
prescriber history reports for their patients.
 Prescribers, dispensers, licensed providers
and medical office assistants (new) can
register.
Notification (threshold) reports
 Sent automatically to prescribers and dispensers
 Monthly patient threshold reports
 Monthly buprenorphine/narcotics concurrent
usage reports
 Monthly acetaminophen threshold reports
Examples of how prescribers are using
the PMP
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Summary of results from a study of the PMP
conducted by the Muskie School in 2010
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Prescribers and pharmacists can play a key
role in monitoring medication use, reducing
the chance of diversion and misuse,
assuring patient safety, and improving
quality of care.
To do this, they need information on their
patients’ medication use.
We asked health care professionals
registered with the PMP about when and
how they use it to improve prescribing and
patient care.
When do prescribers use the PMP?
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With new patients
With unfamiliar or unknown patients (drop ins)
With patients with suspicious behavior
(aggressive or belligerent, “lost prescription,”
needs emergency refill)
With patients seeking pain relievers
With patients already prescribed pain relievers
or Suboxone® (to avoid potential drug-drug
interactions)
What do they do with the information
if they see a potential problem?
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Counsel the patient
Discuss the patient with other health care
professionals
Modify the treatment plan
Contact the police
Examples of steps taken to improve
prescribing
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Conduct substance abuse (SA) screening and
brief intervention
Refer patient to a pain specialist
Establish a controlled substances agreement
(“narcotics contract”) with patient
Refer the patient to an substance abuse
professional
Discharge patient from the practice
“Best practices” to institutionalize use
of the PMP
Standardize use: Access the PMP for all patients
meeting certain criteria, such as having a
prescription for a pain reliever or suboxone
This de-stigmatizes the PMP use – patients don’t
feel singled out.
Pre-visit planning: Access the PMP prescribing
history for patients before the visit and put it in
the chart, so information is available to provider
during the visit
“Best practices”
Communication: Use the PMP information to
initiate conversations about possible
dependency, addiction, or clinically
inappropriate medication usage
New patients: Compare patient’s reported
medication use to PMP information, to test
veracity and begin honest conversation about
medication use
Conclusions
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There is a significant prescription drug
misuse problem in Maine.
The PMP is a tool to prevent and detect
prescription drug abuse.
The PMP can be used to effectively enhance
patient care.
EVERYONE is at risk!
www.maine.gov/pmp
Contact information
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PMP registration:
http://www.hidinc.com/mainepmp/rxsentry-datarequester-forms.html
Patricia Lapera: [email protected] or
www.maine.gov/pmp or 207-287-3363
Susan Payne: [email protected] or
207-780-5104