Drug Diversion and Substance Use Disorder Management: Optimizing Collaboration Across the Continuum Michael O’Neil, Pharm.D. Professor and Chair, Department of Pharmacy Practice Drug Diversion, Substance Abuse, and Pain Management Consultant South College School of Pharmacy Knoxville, TN (304) 546-7746

Disclosure I do not have (nor does any immediate family member have) a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this continuing education activity, or any affiliation with an organization whose philosophy could potentially bias my presentation.

Personal Appreciation NABP Boards of Pharmacy Educators Family

Drug Diversion and Substance Use Disorder Management: Optimizing Collaboration Across the Continuum Objectives Participants will be able to: Define and identify key components of the Collaborative Continuum: -Who’s in the mix? -Where/when is the collaboration? -What information is being shared/What’s not? Recommend strategies to improve outcomes-what does work

Premises of SUD and Drug Diversion: Socioeconomics / environment play a major role SUD does note require a “low” socioeconomic status More than 80% of patients with a SUD have an underlying psychiatric condition (diagnosed or diagnosed) There has and will always be an element of society that wants to “disconnect” There has always been some “element” of addiction in society… e.g. alcohol, drugs, gambling There has always been and will always be “Greed” at the corporate and individual level. There are always 2 elements involving prescription drugs: abusers and diverters ~50% of drug diversion of prescription drugs is for money or trade ~50% of prescription drug abuse and diversion is not controlled substances

O’Neil’s Rules of SUD and Drug Diversion “Don’t confuse issues with facts” “If we create a better mousetrap…we will create a smarter mouse”

Who’s in the Collaborative Mix? Ground Zero / Level 1 Prescribers (MDs, DOs, PAs, NPs) Pharmacists Law Enforcement Officers Level 2 Health Professional Boards (Includes NABP) Level 3 Educators (+/-) Pharmaceutical Companies /Retailers CDC, Health Depts., etc. Legislators Level 4 Substance Abuse Coalitions (+/-) Patients

Where Does Collaboration Occur Now Where Does Collaboration Occur Now? (Traditional Silo Approach of Collaboration-Reactive) Prescribers (collaboration is primarily with Pharmacists) PDMP is primary tool Often lack understanding of pharmacist corresponding responsibilities X Pharmacists (collaboration is primarily with prescribers) PDMP (+) Time limited by volume Pharmacy activities restricted by Retail Management Often lack of understanding of responsibilities Law Enforcement (Confidentiality e.g. HIPAA / Blue wall limits collaboration) PDMP (+/-) Most collaboration requires a warrant Not medically trained Legislators-Pharmaceutical companies/Lobbiest-Health Professions Boards -Patients-Retailers When do the various entities finally interface? …. usually at the legislative sessions due to some proposed bill……on opposing sides….intentions are usually good but misunderstood. Where is NABP

What Information is being shared? Most efforts have been in response to the “Opioid Epidemic”-reactional approach Deaths Overdoses Unusual Headlines (e.g. fentanyl) Arrest of Pill Mill-Prescribers PDMP data? Statistics on Addiction/Lack of beds -Naloxone prescribing / dispensing regulations -Neonatal Abstinence Syndrome -Rescheduling combination hydrocodone products What do these examples all have in common?

How Do We Make This Work? Prescribers (collaboration is primarily with Pharmacists) PDMP is primary tool Often lack understanding of pharmacist responsibilities Pharmacists (collaboration is primarily with prescribers) PDMP (+) Time limited by volume Pharmacy activities restricted by Retail Management Often lack of understanding of responsibilities Law Enforcement (Confidentiality e.g. HIPAA / Blue wall limits collaboration) PDMP (+/-) Most collaboration requires a warrant Not medically trained We are not likely to change to current legislative and regulatory processes…BUT we can change the information provided at EVERY level and become more proactive and preventive in current and future medication related disasters AT A MINIMUM Prescribers-Pharmacist-Law Enforcement-Legislators- Health Professions Boards -Patients-Retailers-Educators-Medical Examiners-Nurses-Addiction Specialist-Patients = Substance Abuse Prevention Coalitions

Who’s in the Collaborative Mix? Ground Zero / Level 1 Prescribers (MDs, DOs, PAs, NPs) Pharmacists Law Enforcement Officers Level 2 Health Professional Boards (Includes NABP) Level 3 Educators (+/-) Pharmaceutical Companies /Retailers CDC, Health Depts., etc. Legislators Level 4 Substance Abuse Coalitions (+/-) Patients Nurses

Substance Abuse Prevention Coalition Pharmacists -Pharmacy Students -Pharmacy School Reps -Board of Pharmacy Members -Profession organization Reps Prescribers MD,DOs,FNPs,PAs -ER Docs -Internal Med -Nursing -Medical Organization Reps -Pain Specs. Law Enforcement -Police -Sherriff -Task force -Sate Police -BCI/DEA Substance Abuse Prevention Coalition Members Legislators -Congressman -Senator -Attorney -Advsors PDMP Representatives Medical Examiners Addiction Specialist Health Dept

Who’s in the Collaborative Mix? Ground Zero / Level 1 + Level 2 Substance Abuse Prevention Coalitions

What Needs to Be Discussed Trends -Medication/Substance Abuse Patterns -Prevention: What’s working what’s not -Statistics e.g. Prescription stimulants, noncontrolled prescription medications, NAS Policies -What’s working-what’s not -******New legislation****** -Emphasis on prevention e.g. marijuana, mandating technology, record keeping requirements

Charge to NABP, State Boards of Pharmacy, AACP members, Pharmacists and Student Pharmacists NABP-get pharmacists on coalitions State Boards of Pharmacy - get Board members on coalitions AACP-Get faculty/student pharmacists on coalition Be an active member of local community (usually county) Substance Abuse Coalitions If you do not do this you are not in the game!