OPIOID TASK FORCE Introduction to Texas PMP AWARx

OPIOID TASK FORCE Introduction to Texas PMP: AWARx. E Texas Prescription Monitoring Program Dr. Joy P. Alonzo, M. Engineering, Pharm. D Mental & Behavioral Pharmacotherapy Specialist Texas A&M Health Science Center Director of Spring Outreach Services

Learning Objectives Current TX Medical & Pharmacy Board Regulations regarding PMP How to establish account & requirements How to establish prescriber delegate What kinds of information is in PMP Emerging Issues & Best Practices Regarding PMP OPIOID TASK FORCE

What is the Texas PMP? PMP = Prescription Drug Monitoring Program : AWARx. E § Collects & Monitors Prescription Data for all C-II, C-IV, and C-Vs dispensed by a pharmacy in TX or to a TX resident from a pharmacy in another state. § Provides information for monitoring a patient’s controlled substance prescription history. § ALL TX licensed pharmacies are required to report all dispensed controlled substance records to the TX PMP no later than the next business day after the prescription is filled. § Beginning MARCH 1, 2020, pharmacists and prescribers (MD, DO, NP, PA, DMD, Rph, Pharm. D, others) will be required to check the patient’s PMP history before dispensing or prescribing ANY controlled substance § INCLUDES: § § Opioids/Partial Opioid agonists : Includes Codeine, Tramadol, Hydrocodone, Buprenorphine containing products § § § Amphetamines: Includes methylphenidate & analogs, methamphetamine & amphetamine analogs § Anabolic Steroids, Ketamine, Marinol, Paregoric, Benzphetamine, Carisprodol, Difenoxin, Modafanil, Pregabalin (Lyrica), lacosamide (Vimpat), Cannabidiol (Epidiolex), retigabine (Potiga) OPIOID TASK FORCE Benzodiazepines: Includes Alprazolam (Xanax), Clobazam (Onfi), Clonazepam (Klonopin), Clorazepate (Tranxene), Diazepam (Valium), Lorazepam (Ativan) Barbiturates: Includes Pentobarbital, Nembutal, Secobarbital, Phenobarbital Certain Sleep agents: Includes: Zolpidem (Ambien), Zaleplon (Sonata), Eszopiclone (Lunesta), suvorexant (Belsomra)

AWARx. E § Texas PMP is a patient care tool that can be used to: § Inform prescribing practices. § Evaluate safety of patient individual pharmacotherapeutic plan by allowing evaluation of all controlled substance history from all prescribers caring for patient. § Allow prescribers to detect behaviors that may indicate risk for substance use disorder. § Texas PMP share RX data with 30 other states and entities, allowing prescribers/dispensers to track prescriptions filled outside of Texas. § Texas PMP features Narx. Care (new as 7/19/19) § Advanced analytics, clinical decision making, & patient support § Generates interactive report OPIOID TASK FORCE

Establish Texas PMP Account What you need § Registration Manual: https: //www. pharmacy. texas. gov/files_pdf/Registration_Manual. pdf § Registration link: https: //www. pharmacy. texas. gov/pmp/aware. asp § Registration Process § Create account: Email/Password § Select Role: Healthcare/Type of Professional § Demographics: DEA Number(s), Name, DOB, NPI § Employer: DEA, NCPDP/NABP, Name, Address § If Additional Documentation is required, will be requested, as well as account status, will receive email with further instructions and upload information § A prescriber can designate a delegate. § Delegate process is identical to other healthcare professional § Role: one of the prescriber delegate roles § Final section would be delegate supervisor § I am a delegate for…selects email of registered supervisor § Email Verification § Email will send a link, good for 20 minutes OPIOID TASK FORCE

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Patient Report OPIOID TASK FORCE

My Rx Report OPIOID TASK FORCE

Patient Alerts OPIOID TASK FORCE

Narx. Care Enhancement to the PMP § Automatically analyzes data from the TX PMP: § Aggregates and analyzes prescription information from providers and pharmacies and presents visual, interactive information, as well as advanced analytic insights & machine learning risk scores. § Calculates a series of patient risk scores § Enhances capability to identify patient risk for substance use disorder. § Provides interactive visualization of patient controlled substance use patterns. § Can be integrated into EHRs via the PMP Gateway (not automatic, check with your EHR provider). https: //www. pharmacy. texas. gov/files_pdf/pmp_pdfs/Texas. Integration. Welcome. Packet. pdf § Provides tools for patient support and specialty care § Medication Assisted Treatment provider locator § Patient information handouts § Care team coordination including transmission of documents § Three Main Modules § Narx. Scores § Resources § Care Team Communications OPIOID TASK FORCE

Narx. Care § Access by logging in to TX PMP AWARx. E § Link to User Manual: https: //d 1 b 1 sdx 6 nwlphm. cloudfront. net/aware/tx_aws_prod/narxcare_user_guide. pdf OPIOID TASK FORCE

Narx. Care Report OPIOID TASK FORCE

Explanation of Narx Scores § Narx Scores exist for narcotics, sedatives, and stimulants § Narx Scores range from 000 -999 § The last digit of a Narx Score equals the number of active prescriptions of that drug type § Narx Scores are type specific use indicators based on the following measurements: § § Number of Prescribers Number of Pharmacies Milligram equivalents Overlapping prescriptions § Narx Scores have a time element such that more recent activity is weighted more heavily than distant activity. § Increasing numbers of providers, pharmacies, milligram equivalencies, and overlapping prescriptions result in higher Narx Scores. § In a typical state-wide population of patients, the distribution of Narx Scores on any given day is such that: § 75% score less than 200 § 5% score above 500 § 1% score above 650 OPIOID TASK FORCE

Narx Scores How to use § Important Considerations: § Narx Scores that raise concern should trigger a discussion, not a decision. § Narx Scores are not abuse scores. It is true that at very high scores patients are likely to exhibit some form of misuse in their PMP record, but a score alone cannot be used to determine appropriateness or misuse. § The Narcotic and Sedative score overlap in that narcotics contribute to the sedative score and vice versa. As a result, a patient may have a low narcotic score even though they haven’t been prescribed a narcotic. § Overlapping prescriptions are heavily weighted in the scoring algorithm. The key requirement is that two different prescribers prescribe the same type of medication for use on the same day § Red Flags: § More than 5 providers in any year (365 days) § More than 4 pharmacies in any 90 -day period § More than 40 morphine milligram equivalents per day (40 MME) average and more than 100 MME total at any time in the previous 2 years § Overdose Risk Score: based on an Ohio study of 1687 OD deaths § Range from 000 -999, risk of unintentional OD death doubles for every 100 pt increase § Predictive score 450 and up consider co-prescribing naloxone, 650 and up consider review, taper, lock-in, SUD screening if appropriate OPIOID TASK FORCE

Narx. Care Report (continued) OPIOID TASK FORCE

Narx. Care Report (Continued) OPIOID TASK FORCE

Narx. Care Resources OPIOID TASK FORCE

Using a PMP to Improve Patient Safety § PMPs can alert clinicians to provide potentially lifesaving information and interventions. Prescribers and Dispensers can take action to improve patient safety: § Do not dismiss patients from care § If patient total opioid or controlled substance total dosage is high: § Consider collaborating with patient to taper to safer dosage § Offer naloxone § If patient taking benzodiazepine with opioid § Communicate with others managing the patient § Carefully consider patient goals, needs, and risks § If considering evaluating patient for substance use disorder, discuss safety and treatment concerns and options. OPIOID TASK FORCE

Emerging Issues § Effective June 1 st, 2019, ALL official C-II prescription forms ordered prior to 9/1/2018 no longer valid. § All CII forms must be ordered via TX Pharmacy Board application § https: //www. pharmacy. texas. gov/pmp/CIIforms. asp § Consult integration resources and integration welcome packet § As of 01/01/2021 all controlled substance prescriptions must be escripted. § Overdose Risk Score Clinical Guidance: https: //texas. pmpaware. net/narxcontent/narxcare 2/explain-overdose-risk-score. pdf § Narx Score Clinical Guidance: https: //d 1 b 1 sdx 6 nwlphm. cloudfront. net/aware/tx_aws_prod/narxcare_user_guide. pdf § Corresponding Responsibility § You as a prescriber may decide to prescribe a controlled substance, but the dispensing pharmacist has an equal responsibility to evaluate the patient data, and decide whether or not to dispense it. § Dispensers are equally culpable regarding patient safety. OPIOID TASK FORCE

Questions or Comments jalonzo@tamu. edu