Prescription Drug Monitoring Program Kansas Association of Medical Staff Services November 16, 2018

In 2016, there were more drug poisoning deaths since 1999 (632,331) than the number of American military and civilian deaths during World War II (418,500) .

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.

A Prescription Opioid Epidemic At least 2 out of 100 Kansas adults have used a prescription pain medication without a prescription in the past year. Data Source: 2015 Kansas Behavioral Risk Factor Surveillance Survey (BRFSS). Available at http://www.kdheks.gov/brfss/Survey2015/dr2015_notrxdrguse.html

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?

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, methadone clinics 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

Administers VS. Dispenses This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BY-ND

Drugs of Concern 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

Prescribers Pharmacists Delegates Who should use it?

How to Register for K-TRACS

Register for an Account

Select your User Role

Registration Process

Submit Registration

Validation Documents

K-TRACS Report

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.

July Percent Change in Total KTRACS Users by Year Compared to July 2013 Data Source: Kansas Board of Pharmacy. July 2013, July 2014, July 2015, July 2016, July 2017, and July 2018 running total count of distinct licensure numbers with an active and approved KTRACS account. Note: KTRACS users were computed as the running total number of distinct state licensure number approved for a KTRACS account for prescribers and pharmacists among currently active KTRACS account.

PMPi As of Oct. 2018 Kansas shares with 30 states

Health Inc. Article dated July 12, 2018

St. Louis County PDMP

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

Clinical Alerts: Threshold Patients

Potential Impact of Threshold Patient Clinical Alert Data Source: Appriss Health. CDC Grant Measures. KTRACS. Kansas Board of Pharmacy.

From 2014 to October 2018 2018 Tableau What I see…

Decrease in Opioid prescriptions since 2014

Kansas At Risk Age Groups 2018 Opioids Only

Kansas Opioid Hot spot map 2018

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

Statewide Integration

Statewide Integration Data Source: 1. 2015 – 2018 User Activity Search Dashboard. Kansas Board of Pharmacy. 2. 2017 – 2018 PMPi Gateway PDMP Integration Request. Appriss Health. Kansas Board of Pharmacy.

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

Questions? Reyne Kenton, BA K-TRACS Program Manager 800 SW Jackson, Suite 1414 Topeka, Kansas 66612 785-296-6547 Reyne.Kenton@ks.gov This Photo by Unknown Author is licensed under CC BY-SA-NC