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 Fueled by increases in Rx-related overdoses, drug overdoses became the #1 cause of unintentional death in 2009 Fatal opioid-related overdoses triple , now more than heroin and cocaine combined ED visits for non-medical opioid use increased 111% ; 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 FY2007-FY2010 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:  Prescribers  Dispensers  Health Professional Licensing Boards  Law Enforcement  Units of DHMH (OCME, Medicaid, OIG, OHCQ)  Researchers (de-identified data)  Patients

Schedules II-V CDS include: Opioids/Opiates  Oxycodone (OxyContin, Percocet, Percodan, Roxicet)  Hydrocodone (Vicodin, Lortab)  Hydromorphone (Diluadid)  Methadone  Morphine Benzodiazepines  Alprazolam (Xanax)  Diazepam (Valium)  Clonazepam (Klonopin) Psychostimulants  Methylphenidate (Ritalin, Concerta)  Amphetamine salts (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 (SB883) 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:  DHMH Secretary  Licensing board & MHCC chairs  4 physicians & 1 nurse practitioner (pain mgmt, drug abuse & behavioral health)  1 pediatrician  3 pharmacists (chain & independent)  1 local law enforcement rep  2 patient reps

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