1. Maryland Prescription Drug Monitoring Program (PDMP)

2. United States: Injury Deaths by Cause, 1999-2010 Age adjusted rate per 100,000
Poisoning
MV Traffic
Drug Poisoning
Firearm
Fall
Data Source: National Vital Statistics System-Mortality (NVSS-M), CDC/NCHS
Slide Source: Maryland Poison Center

4. United States: Drug Overdose Deaths Among Women, 1999-2010
SOURCE: National Vital Statistics System, (deaths include suicides)

6. Source: CDC, “Policy Impact: Prescription Painkiller Overdoses”

7. Prescription Drug Abuse & Overdose in Maryland
Between 2008 and 2012:
42% (1437) of all drug- and alcohol-related overdose deaths involved a Rx opioid analgesic
Rx opioid-related admissions to publicly-funded substance use disorder (SUD) treatment programs increased 116%
Publicly-funded SUD treatment admissions related to oxycodone increased 163%

8. DHMH Vital Statistics Administration, “Drug and Alcohol Intoxication Deaths in Maryland, 2007-2012”

9. Maryland Alcohol and Drug Abuse Administration
Admissions to State-Supported Substance Use Disorder Treatment Programs
Maryland Alcohol and Drug Abuse Administration
Patient Race/Ethnicity & Gender
2012
Prescription Drug-Related Admissions
N = 10,937
Other Admissions
N = 34,320

10. Maryland Alcohol and Drug Abuse Administration Patient Age 2012
Admissions to State-Supported Substance Use Disorder Treatment Programs
Maryland Alcohol and Drug Abuse Administration
Patient Age
2012
Prescription Drug-Related Admissions
N = 10,937
Other Admissions
N = 34,320

11. 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 legitimate patient access to optimal pharmaceutical care

12. PDMP as a Clinical Tool
Give healthcare providers real-time, electronic access at the point-of-care to their patients’ complete Maryland controlled dangerous substances (CDS) prescription history to:
Identify aberrant drug using behavior (e.g. receiving multiple CDS Rx from other providers)
Improve providers’ ability to identify possible substance use disorders and refer to appropriate assessment, treatment and recovery services
Improve providers’ ability to safely and effectively manage patients’ pain and other conditions with CDS pharmacotherapy
Increase confidence in prescribing decisions and patient compliance and decrease potential for harmful drug interactions

13. What Does the PDMP Do?
Electronic collection of data on Schedule II-V CDS dispensed to patients in Maryland
Secure storage of prescription information
By law, make prescription data available to:
Healthcare providers
Public health regulatory agencies
Law enforcement agencies
Researchers
Patients

14. PDMP Authority
Legislation in 2011: Md. Ann. Code Health- General Article § 21-2A
Regulations in 2012: COMAR
Administered by the Maryland Department of Health and Mental Hygiene (DHMH), Alcohol and Drug Abuse Administration (ADAA)

15. The Role of CRISP
DHMH has partnered with Chesapeake Regional Information System for our Patients (CRISP) to make CDS prescription data collected by the PDMP available to healthcare providers.
The CRISP health information exchange (HIE) query portal is the only authorized source for provider access to PDMP data.
CRISP provides user registration and technical support services for providers accessing medication history and other clinical information available through the HIE.

16. How Does the PDMP Work?
Within 3 business days of dispensing a CDS Rx drug in Maryland, dispenser must electronically report identifying information for:
Patient for whom drug is prescribed
Prescriber
Dispenser
Drug
NOTE: Both pharmacies and dispensing practitioners are required to report

17. Data Reported by Dispensers
Drug & Rx data
Patient data
Rx #
Name (first, last)
Rx date issued
Date of Birth
Rx date filled
Gender
Rx new or refill?
Address
# refills ordered
ID #
Payment sources
Prescriber data
NDC code
DEA #
Quantity dispensed
Last name
Days’ supply
Dispenser data

18. Reporting Exemptions Direct administration of CDS to a patient
Giving a patient drug samples
Pharmacies the serve only hospital inpatients
Specialty pharmacies that have received a waiver from the Board of Pharmacy to exclusively serve assisted living, comprehensive care and developmental disabilities facilities
Opioid maintenance programs (methadone clinics)
Veterinarian dispensing
Pharmacy dispensing to hospice inpatients (if approved for a waiver by DHMH)

19. Who Can Access PDMP Data?
Prescribers
Healthcare practitioners authorized to prescribe CDS
For Maryland-licensed practitioners, must have current federal DEA AND Maryland CDS registration (with DHMH Division of Drug Control)
Dispensers
Pharmacists and practitioners that dispense CDS
Note: Pharmacists registering for a “dispenser” account will only be able to access PDMP data through the CRISP HIE
Practitioner Delegates
Prescriber or dispenser may delegate access to a licensed healthcare practitioner who works in their practice
Practitioner is not themselves authorized to prescribe or dispense but receives their own user account

20. Terms of Legitimate Access & Use
Prescribers (and licensed healthcare practitioners delegated by a prescriber) may access PDMP data “in connection with the medical care of a patient.”
Dispensers (and licensed healthcare practitioners delegated by a dispenser) may access PDMP data “in connection with the dispensing of a monitored prescription drug.”
NOTE: PDMP data are confidential, privileged, not subject to discovery or subpoena in civil litigation and are not public records

21. Unlawful Access & Use PDMP Law
Criminal Penalties: “A person who knowingly discloses, uses, obtains, or attempts to obtain by fraud or deceit prescription monitoring data in violation of (Health-General Article, §21-2A, Annotated Code of Maryland) shall be guilty of a misdemeanor and on conviction is subject to imprisonment not exceeding 1 year or a fine not exceeding $10,000 or both.”
Administrative Sanctions: “A prescriber or dispenser who knowingly discloses or uses prescription monitoring data in violation of (Health-General Article, §21-2A, Annotated Code of Maryland) shall be subject to disciplinary action by the appropriate licensing entity.

22. Re-disclosure of PDMP Data
PDMP Law
“The release of prescription monitoring data by a prescriber or dispenser to a licensed health care professional solely for treatment purposes in a manner otherwise consistent with State and federal law is not a violation of Health-General Article, §21-2A, Annotated Code of Maryland.”
PDMP Regulations
“Redisclosure of prescription monitoring data… is prohibited unless intended to facilitate the treatment of a patient and is consistent with all other State and federal laws and regulations governing the security and confidentiality of protected health information and personal medical records.”

23. Caution in Interpreting PDMP Data
Prescription information is reported to the PDMP by the pharmacy or practitioner that dispensed the drug.
Although all efforts are made to ensure data accuracy, reports may contain errors.
If you or your patient has concerns about possible data inaccuracies, first contact the dispenser to verify whether prescription information was reported accurately. The original prescription serves as the official record.
If an error is confirmed by the dispenser, please contact PDMP administration at DHMH ADAA by at or call

24. Controlled Medication Prescribing: A Balancing Act
Appropriate management of specific conditions for which controlled medications may be indicated
Balanced by
Risks of unintended consequences including addiction and overdose

25. Key Points on Prescription Medication Abuse
Look for evidence of aberrant drug-taking behaviors, or “red flags”
Early refills
Lost prescriptions
Multiple similar prescriptions from different doctors
Aberrant drug-taking behaviors exist on a spectrum from less serious to more serious
The presence of aberrant drug-taking behaviors does not necessarily equal addiction
Talk to your patients and screen for substance use disorders!

26. Screening and Brief Intervention and Referral to Treatment (SBIRT)
ASK
ASSESS
ADVISE & ASSIST
ARRANGE FOLLOW-UP
For more information on SBIRT, including screening tools, visit

27. Referrals To specialized substance use disorder treatment facility
To independent addiction specialist
Addiction medicine specialist
Addiction psychiatrist
Licensed non-physician clinician
Refer for:
Addiction assessment
Addiction treatment as indicated by assessment

28. Referral Resources Local Health Department
Behavioral Health or Addiction Services
Maryland Alcohol and Drug Abuse Administration Resource Directory
CSAT Buprenorphine Prescriber Locator

29. Key Points on Safe Opioid Prescribing
Distinguish between acute versus chronic pain
Conduct a comprehensive pain assessment
Identify patient risk factors for addiction
Family history of any substance use disorder
Personal history of any substance use disorder
Untreated psychiatric disorders
For acute moderate to severe pain:
Prescribe short-acting preparations
Prescribe for short periods of time without refills
For chronic moderate to severe pain:
Add opioids on a trial basis only if non-opioid therapies are ineffective in improving function
Start opioids when potential benefits likely will outweigh the risks
Have patient provide fully informed consent
Set clear and measurable goals to determine effectiveness
Explain to patient upfront when and how opioids might be stopped

30. Safe Opioid Prescribing Resources
Prescribers’ Clinical Support System for Opioid Therapies:
Collaborative for REMS Education:
VA/DoD Clinical Practice Guideline:

31. Pain and Addiction Resources
American Society for Addiction Medicine:
National Institute on Drug Abuse (NIDA): Prescription Drugs: Abuse and Addiction

32. Overdose Prevention
New law in Maryland to decrease opioid overdoses (Md. Code Ann. Health Gen § )
Trained lay people can obtain prescriptions for naloxone to counteract opioid overdose
Buys time during overdose until emergency medical services arrive
Consider prescribing naloxone to all patients taking prescription opioids
Naloxone can save lives!