Prescription Drug Monitoring Program PDMP Maryland Alcohol and
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Prescription Drug Monitoring Program (PDMP) Maryland Alcohol and Drug Abuse Administration
PDMP Goals • Assist medical, pharmacy and public health professionals in the identification and prevention of prescription drug abuse • Assist law enforcement and regulatory agencies in the identification and investigation of illegal prescription drug diversion • Promote a balanced use of prescription data that preserves the professional practice of healthcare providers and patient access to optimal pharmaceutical-assisted care.
PDMP Objectives Give healthcare providers “real time” access to patient controlled substance Rx history to: • identify “doctor shopping, ” indicating Rx abuse or diversion • Intervene with Rx abusing patients => treatment referral or develop comprehensive clinical care • Increase provider awareness of and ability to deal with substance abuse • Improve provider ability to manage pain effectively • Increase confidence in prescribing decisions • Increase ability to determine patient compliance
Rx Drug Abuse: National Trends • Massive increase in prescribing of drugs with abuse potential for treatment of pain, anxiety and other disorders: 402% increase in mg/person use of opioids 1997 - 2007 • Fueled by increases in Rx-related overdoses, drug overdoses became the #1 cause of unintentional death in 2009 • Fatal opioid-related overdoses triple 1999 -2006, now more than heroin and cocaine combined • ED visits for non-medical opioid use increased 111% 2004 -2008; 84% for benzodiazepines
Rx Drug Abuse in Maryland • Rx-related admissions to ADAA-funded treatment providers nearly doubled between 2007 and 2010, accounting for 1 in 5 admissions in 2010 • Oxycodone exposure calls to MD Poison Center rose by over 250% between FY 2007 -FY 2010 • Office of the Chief Medical Examiner reports that 55% of “intoxication” deaths in 2010 involved a prescription opioid
What is the Prescription Drug Monitoring Program (PDMP)? • Electronic monitoring of the prescribing and dispensing of Schedules II-V Controlled Dangerous Substances (CDS) • Create CDS prescription database • Make prescription data available to: q Prescribers q Dispensers q Health Professional Licensing Boards q Law Enforcement q Units of DHMH (OCME, Medicaid, OIG, OHCQ) q Researchers (de-identified data) q Patients
Schedules II-V CDS include: Opioids/Opiates § Oxycodone (Oxy. Contin, Percocet, Percodan, Roxicet) § Hydrocodone (Vicodin, Lortab) § Hydromorphone (Diluadid) § Methadone § Morphine Benzodiazepines § Alprazolam (Xanax) § Diazepam (Valium) § Clonazepam (Klonopin) Psychostimulants § Methylphenidate (Ritalin, § Amphetamine salts Concerta) (including Adderall)
PDMP Facts • 48 states w/ legislation; 35 operational • State PDMPs vary widely • Housed in health depts, pharmacy boards, substance abuse authorities, attorney general offices, state narcotics enforcement agencies • Monitor one, a few or all CDS drug schedules • Different reporting periods • Allow various groups different levels of access • Some only react to data requests, some actively analyze data and issue reports to prescribers, dispensers, law enforcement, licensing boards, etc.
PDMP in Maryland • Prior legislative attempts: 2006 (passed unanimously, vetoed), PDMP Advisory Council created in 2008 & issued report recommending creation of PDMP in 2009, 2010 (failed) • 2011: authorizing legislation (SB 883) passed with bipartisan support • Law officially effective October 1, 2011 • Actual data collection estimated to begin in Summer 2012 • Housed in ADAA • Currently funded by federal grants
How Does the PDMP Work? For each CDS Rx dispensed, dispenser must electronically report to ADAA identifying information for: • Patient for whom drug is prescribed (name, gender, address, DOB, etc. ) • Prescriber (DEA #) • Dispenser (DEA #) • Drug (NDC, quantity, dose amount, days supply, etc. )
Reporting Exemptions • Dispensing or direct administration to inpatients in a licensed healthcare facility • Dispensers exclusively serving residents of assisted living, comprehensive care and developmental disabilities facilities • Opioid maintenance program dispensing • Veterinarian dispensing • Dispensing to hospice inpatients if dispenser is granted waiver by DHMH
Who Can Request Rx data? • • Prescribers (in connection with care of patient) Dispensers (in connection with dispensing request) Law Enforcement (judicial subpoena required) Licensing Board (administrative subpoena required) Patient (may include parent/guardian for minors) Units of DHMH (existing investigation required) Other states’ PDMPs (if authorized and employing confidentiality, security and access standards at least as stringent as MD’s PDMP) • Researchers (de-identified data only)
Other Legislative Provisions • 5 year sunset • PDMP may not “unduly” increase dispeners’ workload or expense and must provide the IT for reporting • Data are confidential, privileged, not subject to discovery or subpoena in civil litigation, not public records • Prescribers & dispeners not required to check database; no liability for failing to check • Civil penalty for dispenser failure to report • Criminal penalty for unauthorized disclosure • Process for patients to correct errors in record
PDMP Advisory Board • Make recommendations on PDMP design & implementation and report to legislature • Design evaluation component: what impact is PDMP making on Rx abuse/diversion and legitimate patient access to CDS? • Multidisciplinary group composed of: q DHMH Secretary q 1 pediatrician q. Licensing board & MHCC q 3 pharmacists (chain & chairs independent) q 4 physicians & 1 nurse q 1 local law enforcement rep practitioner (pain mgmt, drug q 2 patient reps abuse & behavioral health)
Current PDMP Tasks • Advisory Board first meeting (October 2011) • Draft regulations (enacted by early 2012) • Determine proper IT to support program - RFP for vendor services - integration with Statewide Health Information Exchange (HIE) • Secure funding • Create PDMP website • Develop program educational materials
Michael Baier PDMP Coordinator Alcohol and Drug Abuse Administration 410 -402 -8643 mbaier@dhmh. state. md. us
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