Prescription Drug Monitoring Program Reyne Kenton, BA June 19, 2018

Objectives Identify Explain Provide Discuss Describe Identify the mission and purpose of K-TRACS Identify Explain who can/should access K-TRACS data and the appropriate opportunities for utilization Explain Provide information on how K-TRACS can be used to identify potential “doctor shoppers,” individuals who may need referral for substance use disorders, and individuals at high-risk for overdose Provide Discuss current data and trends related to the opioid crisis in Kansas, including new increased availability of naloxone Discuss Describe efforts to increase participation, collaboration, and engagement across healthcare professions with K-TRACS Describe Objectives

The Prescription Drug Monitoring Program (PDMP) in Kansas. Monitors Schedule II-IV controlled substance prescriptions, as well as drugs of concern dispensed within the state as reported by pharmacies and other dispensers A web-accessible database, available 24/7, that provides tools to help address one of the largest threats to patient safety in the state of Kansas: the misuse, abuse, and diversion of controlled substance medications Dispensers electronically report (daily) all controlled substance prescriptions dispensed in an outpatient setting PDMPs are designed to be a clinical resource and tool, with some access for regulatory and law enforcement What is K-TRACS KSA 65-1689(a): There is hereby created the Prescription Monitoring Program Advisory Committee which, subject to the oversight of the Board, shall be responsible for the operation of the Prescription Monitoring Program.

What is K-TRACS KSA 65-1689(a): There is hereby created the Prescription Monitoring Program Advisory Committee which, subject to the oversight of the Board, shall be responsible for the operation of the Prescription Monitoring Program.

Reporting Who Reports? When and how do they Report? Dispensers (pharmacies) Exempt – hospitals for inpatient care, LTC, veterinarians, hospice When and how do they Report? Daily, including zero reporting Electronically to data clearinghouse What do they Report? All CS II-IV and drugs of concern for any Kansan Exempt – 48 supply from ED; direct patient administration Reporting

Drugs of Concern Proposed changes to KAR 68-21-7 Adding gabapentin http://pharmacy.ks.gov/statutes-regs/proposed-changes Public Hearing March 8, 2018 1:30pm Adding gabapentin 90 days to comply Current list: Any product containing all three of these drugs: butalbital, acetaminophen, and caffeine Any compound, mixture, or preparation that contains any detectable quantity of ephedrine, its salts or optical isomers, or salts of optical isomers and is exempt from being reported to the statewide electronic logging system for the sale of methamphetamine precursors Any compound, mixture, or preparation that contains any detectable quantity of pseudoephedrine, its salts or optical isomers, or salts of optical isomers and is exempt from being reported to the statewide electronic logging system for the sale of methamphetamine precursors Promethazine with codeine Drugs of Concern

Advisory Committee Authorized to: review and analyze data for purposes of identifying patterns and activity of concern notify the prescribers and dispensers who prescribed or dispensed the prescriptions notify law enforcement or appropriate regulatory board(s) for additional investigation may utilize volunteer peer review committees of professionals with expertise in the particular practice to create standards and review individual cases Shall work with the following groups to develop continuing education programs: Agencies with oversight of prescribers and dispensers Kansas Bar Association for attorneys KBI for law enforcement Advisory Committee

Data Confidentiality Exceptions: No Exception: Prescribers or Dispensers for purpose of patient care Patient’s own record request Regulatory Agencies with oversight of prescribers and dispensers Law Enforcement KDHE for Medicaid recipient information Subpoena or court order in criminal action K-TRACS personnel for operational purposes Board personnel for administration and enforcement of PMP Act Medical examiners, coroners, etc. No Exception: Civil proceedings Requests under the Kansas Open Records Act (KSA 45-215 et seq) Data Confidentiality

Education and Information Education and Information. PDMPs provide useful feedback to prescribers on their own prescribing trends as well as their patients’ controlled substance histories. PDMPs also provide useful information to prescribers when they suspect that a patient may be non-compliant in their controlled substance use. Public Health Initiative. The public health community can use information from the PDMP to monitor trends and address controlled substance prescribing or utilization problems. Prevent Misuse, Abuse, Diversion. Prescribers, dispensers, and consumers will be prevented or deterred from participating in illegal drug diversion schemes when a PDMP is in place. Intervention. Identify patients for assessment and treatment of potential substance use disorder. Why do we need it?

Prescribers Pharmacists Delegates Who should use it?

Total Users by Role Physicians 5,388 Pharmacist 4,338 Nurse Practitioner 2,237 Prescriber Delegates 2,058 Physician Assistant 1,046 Dentists 700 Pharmacist Delegate 595 Other 1,776 Total 18,138 In 2017, 71.18% of all controlled substance prescriptions reported to K-TRACS were attributed to Active and Registered Kansas Prescribers. Nearly half of those not registered were MDs.

Threshold Patients The 5/5/90 Rule Patient has prescriptions from a minimum of 5 prescribers and filled prescriptions at a minimum of 5 pharmacies in less than 90 days Potential “doctor shoppers” Multiple provider episodes Threshold Patients

Patient Alert Enhancement

Statewide Integration- CDC Grant HOW TO INTEGRATE Statewide Integration- CDC Grant http://pharmacy.ks.gov/k-tracs/k-tracs-statewide-integration Complete an “Integration Interest Form” Review and sign the Terms and Conditions Agreement Work with your EHR vendor and Appriss to integrate Reduce barriers to registration and use of K-TRACS Increase number of prescribers and dispensers using K-TRACS State will cover all PDMP Gateway® connection costs for each Kansas EHR and PMS approved for integration Already requested integration: 26 Hospitals 33 Pharmacies 20 Prescriber Practices

K-TRACS Integration

Harold Rogers Grant-BJA How many patients you have prescribed opioids to as well as a comparison to those within your specialty. Morphine Milligram Equivalent (MME) information is broken out so you can readily see where your opioid prescribing falls within multiple MME ranges. Opioid treatment duration, which shows the percentage of patients who have been prescribed opioids for fewer than 7 days, 7 to 28 days, 29 to 90 days, or more than 90 days. K-TRACS usage, which shows exactly how much you and your delegate(s) are using the PDMP. Multiple Provider Episodes (MPE) provide a look at the number of your patients who have met or exceeded the K-TRACS threshold of 5/5/90 – five prescribers and five pharmacies within 90 days. Dangerous Combination Therapy provides you with details of your patient’s combination therapies that may increase a patient’s risk for overdose.

Harold Rogers Grant http://pharmacy.ks.gov/k-tracs/perx

K-TRACS Office Reyne.Kenton@ks.gov 785-296-6547 Questions? K-TRACS Office Reyne.Kenton@ks.gov 785-296-6547